Physician perspective on computerized order-sets with embedded guideline information in a commercial emergency department information system.
Computerized provider order entry (CPOE) is a promising conduit for medical knowledge in support of guideline-consistent decision-making at the point of care. While there are many published examples of successful implementations of CPOE with decision support, there remain questions about the effectiveness of commercially available information system products, particularly in the emergency department (ED). We describe an attempt at using the available CPOE functionality in a commercial ED information system to deliver guideline knowledge and report the results of physician surveys regarding paper-based guideline/order-sets and the corresponding CPOE order-sets that replaced them. Physicians reported that they liked the CPOE order-sets better than the paper version and did use the order-sets, but guide-line compliance did not improve. Cultural and organizational issues as well as limitations in the functionality of the commercial system appear to have limited the effectiveness of this implementation.
Asaro
Phillip V
PV
Division of Emergency Medicine, Washington University, St. Louis, Missouri, USA.
Sheldahl
Amy L
AL
Char
Douglas M
DM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D003625:Data Collection; D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D019983:Guideline Adherence; D006751:Hospital Information Systems; D006801:Humans; D007396:Internship and Residency; D008485:Medical Audit; D050316:Medical Order Entry Systems; D008505:Medical Staff, Hospital; D009203:Myocardial Infarction / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists