Computer-Based Provider Order Entry (CPOE) Implementation in Intensive Care Units (ICUs)

Health care technologies can be used to improve quality of care, but technology implementation can also have negative repercussions. This project built on an existing interdisciplinary research network and examined the effects of implementing computerized provider order entry (CPOE) and electronic health record (EHR) technologies in intensive care units (ICUs). The research examined the effects of technology implementation on patient safety, quality of care, financial costs, and end users. The project also used prospective human factors analysis methods for improving the design and implementation of CPOE/EHR in the ICUs at Geisinger Medical Center (GMC). Applying a human factors engineering approach to CPOE/EHR implementation in ICUs is unique and, because of its theoretical basis, can provide important information on methods for improving the design and usage of CPOE/EHR in health care institutions.

A pre-post design was used to examine the impact of CPOE/EHR implementation in four ICUs at GMC, including a 24-bed Adult ICU, an 18-bed Cardiac ICU, a 38-bed Neonatal ICU, and a 12-bed Pediatric ICU. The project had four specific aims:

1. Determine the effect of CPOE/EHR on safety and quality of care in ICUs, including medication errors, adverse drug events, infection rates, protocol compliance, length of stay, mortality rates, and antibiotic turnaround time.
2. Determine the impact of CPOE/EHR on physicians, nurses, physician assistants, and nurse practitioners in ICUs, including end users' job tasks, communication, coordination, quality of working life, and perceptions of patient safety and quality of care.
3. Determine the financial value of CPOE/EHR implementation by examining the cost of patient care in the ICUs before and after the CPOE/EHR implementation.
4. Examine the role of human factors analysis in CPOE/EHR implementation through a usability analysis and a proactive risk analysis.

The investigators observed some short-term negative effects, such as decreased perception of communication timeliness; however, these negative effects disappeared 1 year post-implementation. In addition, the investigators observed changes in job tasks conducted by nurses, physicians, and physician assistants, such as increased time spent on documentation and review tasks. Finally, the results also show some benefit of CPOE/EHR on timeliness of IV medication delivery. The CPOE/EHR implementation was accompanied by major attention to organizational issues and change management by the organization. The investigators demonstrated the feasibility and benefits of using human factors methods, such as usability and proactive risk assessment, before the technology is fully designed and implemented.

Future research should focus on the longitudinal use of CPOE/EHR technology. This research can help in identifying ways that the technology can be used for improving work systems, care processes, and quality of care and patient safety. Issues related to end user adaptation of and to the technology are also important to examine in future longitudinal research.

More information on the project is available at http://cqpi.wisc.edu/computerized-provider-order-entry-in-icus/.