title: The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature.
abstract: OBJECTIVE
  We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED).
  
  
  METHODS
  We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011.
  
  
  RESULTS
  We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications).
  
  
  CONCLUSIONS
  There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, Australia. a.georgiou@unsw.edu.au
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.forename: Mirela
authors.initials: M
authors.lastname: Prgomet
authors.forename: Richard
authors.initials: R
authors.lastname: Paoloni
authors.forename: Nerida
authors.initials: N
authors.lastname: Creswick
authors.forename: Antonia
authors.initials: A
authors.lastname: Hordern
authors.forename: Scott
authors.initials: S
authors.lastname: Walter
authors.forename: Johanna
authors.initials: J
authors.lastname: Westbrook
mesh_terms: D020000:Decision Support Systems, Clinical; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control; D011787:Quality of Health Care