Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
BMC Med Inform Decis Mak. 2009 Dec 31;9:52. doi: 10.1186/1472-6947-9-52.
Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care.
The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods.
More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001).
Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.
计算机化医嘱录入（CPOE）系统已被引入，以减少用药错误，提高安全性，提高工作流程效率，并提高处方时的医疗服务质量。使 CPOE 系统的影响更加明显可能有助于用户采用。我们着手研究与跨组织和组织内护理相关的 CPOE 系统采用的因素。
采用创新扩散理论来了解医生和护士对 CPOE 系统实施和使用的态度和想法。向全县医疗机构中使用 CPOE 系统的所有医生和护士分发了两份在线调查问卷。对来自 200 名护士（67.0%）的 134 份完整问卷和来自 741 名医生（23.8%）的 176 份完整问卷进行了分析。使用描述性分析统计方法进行数据分析。
与医生（31.3%）相比，更多的护士（56.7%）表示 CPOE 系统在他们的临床环境中运行良好（P<0.001）。同样，与护士（50.7%）相比，更多的医生（73.9%）表示他们发现该系统不适合他们的特定专业实践（P<0.001）。此外，与护士（13.4%）相比，更多的医生（25.0%）表示他们希望回到以前的系统（P=0.041）。我们发现，特别是 CPOE 系统的相对优势被认为显著更高（P<0.001），护士为 39.6%，而医生为 16.5%。然而，医生对 CPOE 的兼容性和复杂性的认同度显著高于护士（P<0.001）。
研究环境中未满足创新扩散理论三个属性的 CPOE 采用资格。CPOE 系统的引入是为了应对基于纸张的系统目前的局限性。因此，用户期望通常很高，因为它们具有相对优势，并且复杂性较低。因此，构建 CPOE 系统需要设计能够提供相当大的额外优势的系统，例如通过防止处方错误并最终提高患者安全性和临床工作安全性。因此，在医疗保健中实施和使用 CPOE 系统的决策过程必须得到改进。由于医疗服务环境中的任何变化通常都会面临阻力，因此我们强调，CPOE 系统设计人员和医疗保健决策者应不断收集用户对系统的反馈，同时不要忘记必须向用户告知所涉及的潜在利益。
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