Journal ArticleDOI
Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System
Yong Y. Han,Joseph A. Carcillo,Shekhar T. Venkataraman,Robert S. B. Clark,R. Scott Watson,R. Scott Watson,Trung C. Nguyen,Hülya Bayır,Richard A. Orr +8 more
TLDR
An unexpected increase in mortality coincident with CPOE implementation is observed, which suggests that when implementing C POE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.Abstract:
Objective. In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care. Methods. Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children’s hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed. Results. Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94–5.55) after adjustment for other mortality covariables. Conclusions. We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.read more
Citations
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Journal ArticleDOI
Methodological Review: The Technology Acceptance Model: Its past and its future in health care
TL;DR: Findings show that TAM predicts a substantial portion of the use or acceptance of health IT, but that the theory may benefit from several additions and modifications.
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Research Commentary---The Digital Transformation of Healthcare: Current Status and the Road Ahead
TL;DR: This commentary surveys the landscape of existing studies on HIT to provide an overview of the current status of HIT research and identifies three major areas that warrant further research: HIT design, implementation, and meaningful use; measurement and quantification of HIT payoff and impact; and extending the traditional realm of HIT.
Journal ArticleDOI
Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries
Dave Ludwick,John Doucette +1 more
TL;DR: The review showed that quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation, and revealed the concept of socio-technical factors, or "fit" factors, that complicate health information systems deployment.
Journal ArticleDOI
The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review
TL;DR: It seems that electronic prescribing can reduce the risk for medication errors and ADE, however, studies differ substantially in their setting, design, quality, and results.
Journal ArticleDOI
Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis
TL;DR: The model draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology to capture common types of interaction.
References
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To Err Is Human Building a Safer Health System
TL;DR: Boken presenterer en helhetlig strategi for hvordan myndigheter, helsepersonell, industri og forbrukere kan redusere medisinske feil.
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Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock
Emanuel P. Rivers,Bryant Nguyen,Suzanne Havstad,Julie Ressler,Alexandria Muzzin,Bernhard P. Knoblich,Edward L. Peterson,Michael C. Tomlanovich +7 more
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R. Phillip Dellinger,Jean Carlet,Henry Masur,Herwig Gerlach,Thierry Calandra,Jonathan Cohen,Juan Gea-Banacloche,Didier Keh,John C. Marshall,Margaret M. Parker,Graham Ramsay,Janice L. Zimmerman,Jean Louis Vincent,Mitchell M. Levy +13 more
TL;DR: Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient.
Journal ArticleDOI
To err is human. Building a safer health system
TL;DR: The IOM report “To Err is Human” proposes an approach for reducing medical errors and improving patient safety by designing processes that are able to ensure that patients are safe from accidental injury.