We broadly define clinical end-users as those health care providers and other clinical staff (e.g., physicians, pharmacists, nurses, ward secretaries, etc.) who work with CPOE systems. Specifically, we gathered perspectives regarding CPOE from three groups: clinical end-users, IT staff, and administrators. The current study focuses not on the impact of CPOE on clinical outcomes for patients, but instead on impacts affecting health care personnel who use, maintain, or manage CPOE systems. Because CPOE implementations affect many different types of personnel in the health care environment, their evaluation must encompass multiple, discrete perspectives. The purpose of this study was to identify and describe the major types of UACs related to CPOE implementation. 4,5 Careful identification, description, and categorization of UACs can provide insight into the unexpected outcomes of placing CPOE systems into complex health care work environments. 1-3 Yet, several studies indicate that unpredictable, emergent problems, or unintended adverse consequences (UACs) can surround CPOE implementation and maintenance.
Health care organizations often implement CPOE as part of their approach to improve medication safety and reduce health care costs. This study refers to CPOE systems as containing, at a minimum, electronic order entry capabilities, whether or not this functionality is part of a larger, more complex information system. CPOE systems commonly exist as one of many integrated clinical applications in larger institutions' information systems the other applications offer complementary functionality such as real-time clinical decision support, on-line clinical documentation, and electronic message transmission. Computerized provider order entry (CPOE), narrowly defined, is the process by which physicians or their surrogates (but not intermediaries) directly enter medical orders into a computer application.
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