Sittig D F, Stead W W
Center for Biomedical Informatics, Vanderbilt University, Nashville, TN 37232-8340, USA.
J Am Med Inform Assoc. 1994 Mar-Apr;1(2):108-23. doi: 10.1136/jamia.1994.95236142.
Direct computer-based physician order entry has been the subject of debate for over 20 years. Many sites have implemented systems successfully. Others have failed outright or flirted with disaster, incurring substantial delays, cost overruns, and threatened work actions. The rationale for physician order entry includes process improvement, support of cost-conscious decision making, clinical decision support, and optimization of physicians' time. Barriers to physician order entry result from the changes required in practice patterns, roles within the care team, teaching patterns, and institutional policies. Key ingredients for successful implementation include: the system must be fast and easy to use, the user interface must behave consistently in all situations, the institution must have broad and committed involvement and direction by clinicians prior to implementation, the top leadership of the organization must be committed to the project, and a group of problem solvers and users must meet regularly to work out procedural issues. This article reviews the peer-reviewed scientific literature to present the current state of the art of computer-based physician order entry.
基于计算机的直接医嘱录入已经成为20多年来的争论焦点。许多机构已经成功实施了相关系统。其他机构则彻底失败或险些酿成大祸，导致严重延误、成本超支，并引发了工作行动的威胁。医嘱录入的理由包括流程改进、支持注重成本的决策制定、临床决策支持以及优化医生的时间。医嘱录入的障碍源于实践模式、护理团队中的角色、教学模式和机构政策所需的变革。成功实施的关键要素包括：系统必须快速且易于使用，用户界面在所有情况下都必须表现一致，机构在实施前必须有临床医生广泛且坚定的参与和指导，组织的高层领导必须致力于该项目，并且一群问题解决者和用户必须定期开会以解决程序问题。本文回顾了经过同行评审的科学文献，以呈现基于计算机的医嘱录入的当前技术水平。
