title: Same system, different outcomes: comparing the transitions from two paper-based systems to the same computerized physician order entry system.
abstract: OBJECTIVE
  To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities.
  
  
  METHODS
  13 non-surgical, adult inpatient wards in a Dutch academic hospital.
  
  
  METHODS
  Questionnaire survey of 295 nurses before and 304 nurses after the implementation of a CPOE system. These nurses worked with two different paper-based medication systems before the implementation: 'Kardex-system' and 'TIMED-system'. In the Kardex-system, the structure of the nursing medication work was similar to that of after the CPOE implementation, while in the TIMED-system, it was different. 'Adaptive Structuration Theory' (AST) was used to interpret the results.
  
  
  RESULTS
  The response rates were 52.2% (154/295) before and 44.7% (136/304) after the implementation. Kardex-nurses reported more positive effects than TIMED-nurses. TIMED-nurses reported that the computerized system was more inflexible, more difficult to work with, and slower than the TIMED-system. In the TIMED group, the overall mean score of the computerized process was not significantly different from that of the paper-based process. Moreover, nurses in both groups were more satisfied with the post-implementation process than with the pre-implementation process. Nevertheless, none of groups reported a better workflow support in the computerized system when compared to that of the paper-based systems.
  
  
  CONCLUSIONS
  Our findings suggest that not only the technology but also large differences between pre- and post-implementation work structure influence the perceptions of users, and probably make the transition more difficult. This study also suggests that greater satisfaction with a system may not necessarily be a reflection of better workflow support.
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University Medical Center, Rotterdam, The Netherlands. z.niazkhani@erasmusmc.nl
authors.forename: Zahra
authors.initials: Z
authors.lastname: Niazkhani
authors.forename: Heleen
authors.initials: H
authors.lastname: van der Sijs
authors.forename: Habibollah
authors.initials: H
authors.lastname: Pirnejad
authors.forename: William K
authors.initials: WK
authors.lastname: Redekop
authors.forename: Jos
authors.initials: J
authors.lastname: Aarts