title: Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals.
abstract: OBJECTIVE
  To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in 'early adopter' hospitals.
  
  
  METHODS
  In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS. We used a combination of documentary analysis of the implementation plans, audiorecorded semistructured interviews with system users, and observations of strategic meetings and systems usage.
  
  
  RESULTS
  We collected 11 documents, conducted 43 interviews, and conducted a total of 21.5 h of observations. We identified three major themes: (1) impacts on individual users, including greater legibility of prescriptions, but also some accounts of increased workloads; (2) the introduction of perceived new safety risks related to accessibility and usability of hardware and software, with users expressing concerns that some problems such as duplicate prescribing were more likely to occur; and (3) realizing organizational benefits through secondary uses of data.
  
  
  CONCLUSIONS
  We identified little difference in the medium-term consequences of a CPOE and a CDS system. It is important that future studies investigate the medium- and longer-term consequences of CPOE and CDS systems in a wider range of hospitals.
authors.affiliation: School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
authors.forename: Kathrin M
authors.initials: KM
authors.lastname: Cresswell
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.affiliation: Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Williams
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Morrison
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Slee
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Coleman
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Robertson
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D004360:Drug Therapy, Computer-Assisted; D057286:Electronic Health Records; D006801:Humans; D007407:Interviews as Topic; D050316:Medical Order Entry Systems / Q000458:organization & administration*; D008508:Medication Errors; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D058996:Quality Improvement; D006113:United Kingdom; D014584:User-Computer Interface
keywords: Adoption; CDS; Cpoe; Eprescribing; Implementation