Attitudes and Perceptions of Pediatric Residents on Transitioning to CPOE
23 April 2014
accepted: 30 June 2014
19 December 2017 (online)
Background: Many resident physicians have experienced transitioning from traditional paper documentation and ordering to an electronic process during their training.
Objective: We sought to investigate the attitudes and perceptions of residents related to implementation of computer provider order entry (CPOE) and clinical decision support (CDS).
Methods: Pediatric residents completed web-based surveys prior to CPOE implementation and at 6 months and 12 months after implementation. The survey assessed resident attitudes and perceptions related to CPOE and the use of CDS tools. Additionally, at 6 and 12 months, residents were asked how electronic medical record (EMR) resources might impact future career decisions.
Results: Prior to CPOE implementation, 70% of residents were looking forward to CPOE, but 28% did not want to transition from paper ordering. At 12 months post-implementation, 80% of residents favored CPOE over paper ordering and only 3.33% wished to revert to paper ordering. Residents reported an increase in time needed to enter admission orders 6-months after CPOE implementation. By 12 months post-implementation, there was no significant difference in perceived time to complete admission orders when compared to pre-CPOE responses. Most residents (91.67%) identified that overall EMR resources were an important factor when considering future employment opportunities. The most important factors included the degree of EMR implementation, technology resources and the amount of support staff. The least important factors included patient portal access and which EMR product is used.
Conclusions: Overall, residents demonstrated a preference for CPOE compared to traditional paper order entry. Many residents remained unaware of CDS tools embedded within CPOE at the 12 month follow-up, but a majority of residents did find them helpful and felt more knowledgeable about current guidelines. EMR resources, including degree of EMR implementation, technology resources and support staff are likely to be important factors as residents take future employment opportunities into consideration.
Citation: Shriner AR, Webber EC. Attitudes and perceptions of pediatric residents on transitioning to CPOE. Appl Clin Inf 2014; 5: 721–730
- 1 ONC Data Brief. No. 9; March 2013. http://www.healthit.gov/sites/default/files/oncdatabrief9final.pdf. Accessed July 31 2013.
- 2 Institute of Medicine.. Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001
- 3 McGreevey M. Joint Commission Resources, Inc. Using Technology to Improve Medication Safety. 2005
- 4 Kaushal R, Shojania KG, Bates DW. Effects of computerised physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163 (12) 1409-1416.
- 5 Ozdas A, Speroff T, Waitman LR, Ozbolt J, Butler J, Miller RA. Integrating „best of care“ protocols into clinicians’ workflow via care provider order entry: impact on quality-of-care indicators for acute myocardial infarction. J Am Med Inform Assoc 2006; 13 (02) 188-196.
- 6 Asaro PV, Sheldahl AL, Char DM. Embedded guideline information without patient specificity in a commercial emergency department computerized order-entry system. Acad Emerg Med 2006; 13 (04) 452-458.
- 7 Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-1512.
- 8 Weant KA, Cook AM, Armitstead JA. Medication-error reporting and pharmacy resident experience during implementation of computerized prescriber order entry. American journal of health-system pharmacy 2007; 64 (05) 526-530.
- 9 Knight AM, Kravet SJ, Harper GM, Leff B. The effect of computerized provider order entry on medical student clerkship experiences. J Am Med Inform Assoc 2005; 12 (05) 554-560.
- 10 Keenan CR, Nguyen HH, Srinivasan M. Electronic medical records and their impact on resident and medical student education. Acad Psychiatry 2006; 30 (06) 522-527.
- 11 Grinspan ZM, Banerjee S, Kaushal R, Kern LM. Physician specialty and variations in adoption of electronic health records. Appl Clin Inform 2013; 4 (02) 225-240.
- 12 Ferenchick GS, Solomon D, Mohmand A, Towfig B, Kavanaugh K, Warbasse L, Addision J, Chames F. Are students ready for meaningful use?. Med Educ Online 2013; 18: 22495. ((Please check))
- 13 Hing E, Hsaio CJ. Electronic medical record use by office-based physicians and their practices: United States, 2007. Natl Health Stat Report 2010; 23: 1-11.
- 14 Ash JS, Fournier L, Stavri PZ, Dykstra R. Principles for a successful computerized physician order entry implementation. AMIA Annu Symp Proc 2003: 36-40.
- 15 Ghahramani N, Lendel I, Haque R, Sawruk K. User satisfaction with computerized order entry system and its effect on workplace level of stress. J Med Syst 2009; 33 (03) 199-205.
- 16 Syed S, Wang D, Goulard D, Rich T, Innes G, Lang E. Computer order entry systems in the emergency department significantly reduce the time to medication delivery for high acuity patients. Int J Emerg Med 2013; 6 (01) 20.
- 17 Davis L, Brunetti L, Lee EK, Yoon N, Cho SH, Suh DC. Effects of computerized physician order entry on medication turnaround time and orders requiring pharmacist intervention. Res Social Adm Pharm. 2013
- 18 Bates DW, Boyle DL, Teich JM. Impact of computerized physician order entry on physician time. Proc Annu Symp Comput Appl Med Care. 1994: 996.
- 19 Overhage JM, Perkins S, Tierney WM, McDonald CJ. Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care. internal medicine practices 2001; 8 (Suppl. 04) 361-371.
- 20 Shu K, Boyle D, Spurr C, Horsky J, Heiman H, O’Connor P, Lepore J, Bates DW. Comparison of time spent writing orders on paper with computerized physician order entry. Stud Health Technol Inform 2001; 84 Pt2 1207-1211.
- 21 Ash JS, Stavri PZ, Kuperman GJ. A consensus statement on considerations for a successful CPOE implementation. J Am Med Inform Assoc 2003; 10 (03) 229-234.
- 22 McAlearney AS, Chisolm D, Veneris S, Rich D, Kelleher K. Utilization of evidence-based computerized order sets in pediatrics. Int J Med Inform 2006; 75 (Suppl. 07) 501-512.
- 23 Hoonakker PLT, Carayon P, Brown RL, Cartmill RS, Wetterneck TB, Walker JM. Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units. J Am Med Inform Assoc 2013; 20: 252-259.
- 24 Friedberg M, Crosson FJ, Tutty M. Physicians’ Concerns About Electronic Health Records: Implications And Steps Towards Solutions. http://healthaffairs.org/blog/2014/03/11/physicians-concerns-about-electronic-health-records-implications-and-steps-towards-solutions March 11 2014.