An unintended consequence of CPOE implementation: shifts in power, control, and autonomy.

Having found that an unintended consequence of computerized provider order entry (CPOE) implementation is "changes in the power structure" of the organization, we sought a deeper understanding of what was happening and why. If such consequences can be anticipated, they can be better managed. Using qualitative methods to study five successful CPOE sites, a multidisciplinary team found that CPOE enables shifts in power related to work redistribution and safety initiatives and causes a perceived loss of control and autonomy by clinicians. With recognition of the extent of these shifts, clinicians can anticipate them and will no longer be surprised by them. Greater provider involvement in planning, quality initiatives, and the work of clinical information coalitions/committees can benefit the organization and provide a different kind of power and satisfaction to clinicians.