Abstract
Objective To assess changes in computerized provider order entry error rates among providers
who with less than 24-hour notice were switched from four-chart access to one-chart-only
access.
Methods An interrupted time series analysis of emergency medicine providers, hospitalists,
and maternal child health providers was performed with pairwise comparison of computerized
provider order entry error rates within and between specialties. This retrospective
snapshot consisted of four phases. Phase 1 was the baseline 2 weeks where providers
were privileged to work with up to four charts open. Phase 2 was the 2-week period
where providers were limited to one-chart access. Phase 3 was the 2-week period where
providers were returned to four-chart access. And phase 4 was a 2-week period 3 months
following the end of phase 3.
Results Analysis of the overall and specialty-stratified cohorts revealed no statistically
significant differences in median computerized provider order entry error rates across
the four phases (Wilcoxon signed-rank test, α = 0.05). However, statistically significant
differences in median computerized provider order entry error rates were detected
between the three specialties within each phase of the study (Kruskal–Wallis, p < 0.001).
Conclusion Allowing providers in select specialties to have access to four charts simultaneously
does not increase their computerized provider order entry error rates. Significant
differences in error rates between specialties suggest the need for further study
of the use of standardized order sets, charting, and workflow variations.
Keywords
open charts - electronic health records - health information technology - patient
safety
