Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems

Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline Studies that reported qualitative data about the types and causes of these errors were included A narrative synthesis of all eligible studies was undertaken

Results A total of 1185 publications were identified, of which 34 were included in the review We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors

Discussion and Conclusions Human factors design is important to reduce error rates Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations

A Systematic Review of The Types And Causes Of Prescribing Errors Generated From Using Computerized Provider Order Entry Systems in Primary and Secondary Care.

Machine Learning in Medicine In this view of the future of medicine, patient–provider interactions are informed and supported by massive amounts of data from interactions with similar patients. The...

Machine Learning for Medicine

[Artificial intelligence will transform internal medicine].

L’intelligence artificielle va révolutionner la médecine interne

Purpose Previous studies indicate that the introduction of information and communication technology (ICT) in health care organizations impairs health care professional's working conditions and diminishes job discretion. Most of these studies, however, were designed to explore the influence of ICT exclusively on a single group of health care professionals and thereby did not consider the influence of the same technology on other groups of health care professionals. The aim of this article is to explore the influence of a fully integrated ICT system on both doctors and registered nurses within the same working environment: a high-tech hospital. Methods This is a cross-sectional study conducted in a high-tech Norwegian hospital. Data were collected in 2016. In total, 264 registered nurses and 172 doctors responded to a questionnaire on their working conditions and experiences with ICT in clinical work. Descriptive statistics, compare means, cross-tables, Chi-square and bivariate correlation analysis were used to analyze the data. Statistical significance was set at p < 0.05. Results The findings revealed differences in doctors' and registered nurses' working conditions. Registered nurses reported a statistically significant higher workload and better job content than doctors. There was no difference in job discretion between doctors and registered nurses. Both occupational groups experienced that the ICT system impairs patient contact and the quality of health services. We found statistically significant correlations between registered nurses' and doctors' experiences with ICT in clinical work and working conditions, whereof the strongest correlation was related to job discretion in clinical work. Conclusion This study concludes that the impact of ICT on doctors' and registered nurses' working conditions in a hospital depends on the experiences of ICT in clinical work. In consequence, it is recommended to involve doctors and registered nurses in the implementation of ICT in hospitals.

The Impact of Information and Communication Technology on Doctors’ and Registered Nurses’ Working Conditions and Clinical Work – A Cross-Sectional Study in a Norwegian Hospital

The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.

D. Morquin

Papers

Résistance légitime sans technophobie : analyse des impacts de l'informatisation du dossier du patient sur le cœur du métier médical