The evolution of the market for commercial computerized physician order entry and computerized decision support systems for prescribing.
OBJECTIVE
To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals.


METHODS
Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England. The authors collected data from semi-structured interviews with 11 individuals from 4 vendors, including the 2 most entrenched suppliers, and 6 adopter hospitals, and 21 h of ethnographic observation of 2 user groups, and 1 vendor event. The research and analysis was informed by insights from studies of the evolution of technology fields and the emergence of generic COTS enterprise solutions.


RESULTS
Four key themes emerged: (1) adoption of systems that had been developed outside of England, (2) vendors' configuration and customization strategies, (3) localized adopter practices vs generic systems, and (4) unrealistic adopter demands. Evidence for our over-arching finding concerning the current immaturity of the market was derived from vendors' strategies, adopters' reactions to the technology, and policy makers' incomplete insights.


CONCLUSIONS
The CPOE/CDS market in England is still in an emergent phase. The rapid entrance of diverse products, triggered by federal policy initiatives, has resulted in premature adoption of systems that do not yet adequately meet the needs of hospitals. Vendors and adopters lacked understanding of how to design and implement generic solutions to meet diverse user needs.
Centre for Medical informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK h.mozaffar@ed.ac.uk.
Hajar
H
Mozaffar
Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, UK.
Robin
R
Williams
Centre for Medical informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
Kathrin
K
Cresswell
Business School, University of Aberdeen, Aberdeen, UK.
Zoe
Z
Morrison
Center for Patient Safety Research and Practice, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
David W
DW
Bates
Centre for Medical informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK Center for Patient Safety Research and Practice, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
Aziz
A
Sheikh
D003132:Commerce; D020000:Decision Support Systems, Clinical; D055695:Electronic Prescribing; D004739:England; D006801:Humans; D007407:Interviews as Topic; D050316:Medical Order Entry Systems
CPOE/CDS market challenges; computerized decision support; computerized physician order entry; health information infrastructures