The Impact of Computerized Physician Order Entry Session on Redesigning Work Processes to Improve Patient Safety and Quality AHRQ Conference, Bethesda MD, September 2007 Ross Koppel, Ph.D. Ross Koppel, Ph.D. Center for Clinical Epidemiology & Center for Clinical Epidemiology & Biostatistics Biostatistics School of Medicine, & Sociology School of Medicine, & Sociology Department Department University of Pennsylvania University of Pennsylvania [email protected][email protected]
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The Impact of Computerized Physician Order Entry Session on Redesigning Work Processes to Improve Patient Safety and Quality AHRQ Conference, Bethesda.
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The Impact of Computerized Physician Order Entry
Session on Redesigning Work Processes to Improve Patient Safety and Quality
AHRQ Conference, Bethesda MD, September 2007
Ross Koppel, Ph.D. Ross Koppel, Ph.D.
Center for Clinical Epidemiology & BiostatisticsCenter for Clinical Epidemiology & BiostatisticsSchool of Medicine, & Sociology Department School of Medicine, & Sociology Department
University of PennsylvaniaUniversity of [email protected]@sas.upenn.edu
M. Harrison, R. Koppel & S. Bar-Lev. Unintended consequences of information technologies in health care – An interactive sociotechnical analysis . Journal of the American Medical Informatics Association, Sept. 2007.
Interactive Sociotechnical Systems
Cases (1) New HIT changes existing social system
CPOE procedures changes communication between transport teams and emergency room in Children’s hospital (Han)*
* For references, see Harrison et al., JAMIA paper or email us.
Interactive Sociotechnical Systems
Cases (2) Technical & physical infrastructures mediate HIT use -- Interaction of new HIT with existing technical and physical conditions affect HIT-in-use
paper persistence (Campbell, 2006)
computer carts on wheels
Interactive Sociotechnical Systems
Cases (3) Social system mediates HIT use --Interaction of new HIT with the social system affects HIT-in-use
Instead of real-time entry, nurses document meds at end of shift (Koppel et al.; Bar-Lev and Harrison)
Interactive Sociotechnical Systems
Cases (4) HIT-in-use changes social system – Interaction of new HIT with the social system affects HIT-in-use, which then further changes the social system.
Stealth dosing erodes authority of infectious disease fellows (Larosa et al.)
Interactive Sociotechnical Systems
Cases (5) HIT-social system interactions engender HIT redesign --Interaction of new HIT with the social system affects HIT-in-use, which then leads to changes in HIT properties
Physicians resist fixed choice templates, forcing redesign to allow free-text entry for diagnoses (Bar-Lev and Harrison)