Background: Computerized Provider Order Entry (CPOE) allows providers to enter medication and service orders electronically. Workflow analysis is a critical component of CPOE implementation. Objectives 1. To develop a nosology for provider ordering workflow. 2. To describe actual provider ordering workflow focusing on chart and computer usage 3. To model the impact of computerized ordering on provider workflow in three future state scenarios Method: 20 hours of participant observation was performed for nosology development, time motion studies totaling 47 and predictive modeling projected effects of possible implementation scenarios Results/Conclusions: Unique nosology was developed. Clinicians spent 27% of their time with the patient, 2.2% writing orders and 1.1% locating patient charts. Our study predicted that the E-All scenario (computerization of all orders) would be the best implementation choice. Limitations: Small sample size (25 clinicians), participant frame of reference and other assumptions may have affected the results of this study.

Background: Computerized Provider Order Entry (CPOE) allows providers to enter medication and service orders electronically. Workflow analysis is a critical component of CPOE implementation. Objectives 1. To develop a nosology for provider ordering workflow. 2. To describe actual provider ordering workflow focusing on chart and computer usage 3. To model the impact of computerized ordering on provider workflow in three future state scenarios Method: 20 hours of participant observation was performed for nosology development, time motion studies totaling 47 and predictive modeling projected effects of possible implementation scenarios Results/Conclusions: Unique nosology was developed. Clinicians spent 27% of their time with the patient, 2.2% writing orders and 1.1% locating patient charts. Our study predicted that the E-All scenario (computerization of all orders) would be the best implementation choice. Limitations: Small sample size (25 clinicians), participant frame of reference and other assumptions may have affected the results of this study.

The Institute of Medicine reported seven thousand deaths annually due to medication errors. It is estimated that two out of one hundred admissions experience a preventable adverse medication event resulting in an average cost of $4,700 per admission, which is $2.8 million dollars annually for a 700 bed hospital (Institute of Medicine, 1999). In Canada, medication related errors were identified as the most common adverse event (Canadian Institute for Health Information, 2007). A medication error is “any error that occurs during the process of history taking, ordering, dispensing, administering and surveillance of a medication regardless of whether harm occurred to the patient or if there was potential harm (Eslami, Abu Hanna, & de Keizer, 2007; Ong, 2007). Computerized provider order entry (CPOE) can play a vital role in the prevention of medication errors in the drug ordering stage. It was reported that the occurrence of Adverse Drug Events (ADE) was decreased by fifty-five percent with the addition of CPOE system (Berger & Kichak, 2004). However, the literature review on CPOE impact is heavily focused on the physicians’ perspective (Eslami et al., 2007; Reckmann, Westbrook, Koh, Lo, & Day, 2009; ). Nurses play a significant role in the medication process, as traditionally, nurses are involved in all the medication process stages. Research on the impact of CPOE in the entire medication process is still lacking (Househ, Ahmad, Alshaikh, & Alsuweed, 2013). Understanding the perspective of nurses on the impact of CPOE in their work will increase awareness and understanding of CPOE use among health care professionals and health informaticians. This research adopts a grounded theory approach to explore the question of “how do nurses perceive the impact of CPOE on the medication process and on collaborative practice?” Ten participants were interviewed and out of the ten, eight participants were observed during a portion of their work. The information collected was analyzed using a constant comparative method. Participants described that the CPOE supported legible order communication between care providers and departments. CPOE use removed the requirement to transcribe orders to the medication administration record, as well as, the necessity to fax the order sheet to the pharmacy. However, in the ordering stage the nurse is also involved in providing information for order decision-making. Nurses discuss probable medication orders in cases of urgent situations, or nursing assessments of the patient. In this decision-making, the information requirements of nurses involve not only the medication information, but also information about other orders such as diagnostics, laboratory, and patient care orders. Future CPOE design and CPOE implementations should consider including mobile devices, alerts, and workflow modeling with the nursing information needs. / Graduate / 0710 / 0569 / vitor@uvic.ca

Medical errors occur at the prescription step due to lack adequate knowledge of medications by the physician, failure to adhere to policies and procedures, memory lapses, confusion in nomenclature, and illegible handwriting. Unfortunately, these errors can lead to patient readmission within 30 days of dismissal. Hospital leaders lose 0.25% to 1% of Medicare’s annual reimbursement for a patient readmitted within 30 days for the same illness. United States, lawmakers posited the use of health information technology, such as computerized physician order entry scores systems (CPOES), reduced hospital readmission, improved the quality of service, and reduced the cost of healthcare. Grounded in systems theory, the purpose of this correlational study was to examine the relationship between computerized physician order entry scores, medication reconciliation scores, and 30-day readmission rates. Archival data were collected from 117 hospitals in the southeastern region of the United States. Using multiple linear regression to analyze the data, the model as a whole did not significantly predict 30-day hospital readmission rate, F (2, 114) = 1.928, p = .150, R2 = .033. However, medical reconciliation scores provided a slightly higher contribution to the model (β = .173) than CPOES (β = .059. The implications for positive social change included the potential to provide hospital administrators with a better understanding of factors that may relate to 30-day readmission rates. Patients stand to benefit from improved service, decreased cost, and quality of healthcare.

Few studies examine technical barriers, such as usability, to successful Computerized Provider Order Entry (CPOE) system implementation. This thesis explores this literature gap through the evaluation of the Sunnybrook CPOE order set system with a heuristic evaluation of the Sunnybrook CPOE system, the development of a more user friendly CPOE order set interface (Test Design), and a usability study comparing three order set formats (Sunnybrook CPOE, Test Design, and paper order sets). A randomized trial was conducted with 27 Sunnybrook physicians at the hospital. Results showed that the Sunnybrook CPOE order set system was less efficient (task times were on average 364 seconds longer than Test Design and 344 seconds longer than paper), less user-friendly (users were less confident, less satisfied, and more frustrated with Sunnybrook CPOE tasks), and less safe than paper order sets (more harmful errors). Test Design was as efficient and safe as paper order sets.

The overall goal of this research study is to determine if there is a correlation between electronic health (e-Health) adoption, e-Health investment and better health outcomes in a hospital setting. To carry out this research, data with respect to e-Health spending, e-Health adoption and relevant health outcome indicator results for Ontario hospitals were analyzed to determine if there is a correlation between the variables. There were significant positive correlations between e-Health adoption and investment variables; indicating that higher e-Health investment is associated with greater e-Health adoption. There were significant correlations between variables related to e-Health adoption, investment and certain health outcomes. For example, increased e-Health adoption was significantly and negatively correlated with variables related to Length of Stay (LOS), which suggests that increased e-Health adoption is associated with lower LOS. This study attempts to create a foundation upon which Return On Investment (ROI) may be calculated for e-Health technology.

The overall goal of this research study is to determine if there is a correlation between electronic health (e-Health) adoption, e-Health investment and better health outcomes in a hospital setting. To carry out this research, data with respect to e-Health spending, e-Health adoption and relevant health outcome indicator results for Ontario hospitals were analyzed to determine if there is a correlation between the variables. There were significant positive correlations between e-Health adoption and investment variables; indicating that higher e-Health investment is associated with greater e-Health adoption. There were significant correlations between variables related to e-Health adoption, investment and certain health outcomes. For example, increased e-Health adoption was significantly and negatively correlated with variables related to Length of Stay (LOS), which suggests that increased e-Health adoption is associated with lower LOS. This study attempts to create a foundation upon which Return On Investment (ROI) may be calculated for e-Health technology.

Few studies examine technical barriers, such as usability, to successful Computerized Provider Order Entry (CPOE) system implementation. This thesis explores this literature gap through the evaluation of the Sunnybrook CPOE order set system with a heuristic evaluation of the Sunnybrook CPOE system, the development of a more user friendly CPOE order set interface (Test Design), and a usability study comparing three order set formats (Sunnybrook CPOE, Test Design, and paper order sets). A randomized trial was conducted with 27 Sunnybrook physicians at the hospital. Results showed that the Sunnybrook CPOE order set system was less efficient (task times were on average 364 seconds longer than Test Design and 344 seconds longer than paper), less user-friendly (users were less confident, less satisfied, and more frustrated with Sunnybrook CPOE tasks), and less safe than paper order sets (more harmful errors). Test Design was as efficient and safe as paper order sets.

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According to the National Patient Safety Foundation, more than 1.5 million Americans are affected by medication errors because of varied factors including miscommunication, bad handwriting, name confusion, poor packaging, and metric or other dosing unit errors. This project addressed medication errors and adverse drug events by developing policy and practice guidelines to support and aid the utilization of health information technology (HIT) systems in addressing medication errors and adverse drug events at a local nursing home in Cincinnati, Ohio. The National Quality Strategy Framework was used by a team of interdisciplinary stakeholders as a guide for the development of policies and practice guidelines. An interdisciplinary project team of institutional stakeholders was led by the DNP student through a review of literature to assess the effectiveness of current policies and guidelines and explore areas for improvement. New policy, practice guidelines, and educational materials were developed, along with plans for implementing and evaluating the policies in the institution. Policy and practice guidelines were shared with 4 scholars possessing expertise in health information technology to validate content of the products. Feedback was used to inform revision and preparation of final policy, practice guidelines, educational materials, and plans for implementation and evaluation. The implementation plan advocates a process that includes multiple stakeholders and institutional preparatory stages. The evaluation plan addresses multiple outcomes related to efficiency and patient safety, and proposes both intermediate and long-term evaluation based on comparisons of pre-post metrics routinely collected by the institution. Following implementation and evaluation, dissemination of results of the project may stimulate positive social change by reducing medication errors in similar health care institutions that adopt related measures.