Physician satisfaction with two order entry systems.

OBJECTIVES In the wake of the Institute of Medicine report, To Err Is Human: Building a Safer Health System (LT Kohn, JM Corrigan, MS Donaldson, eds; Washington, DC: National Academy Press, 1999), numerous advisory panels are advocating widespread implementation of physician order entry as a means to reduce errors and improve patient safety. Successful implementation of an order entry system requires that attention be given to the user interface. The authors assessed physician satisfaction with the user interface of two different order entry systems-a commercially available product, and the Department of Veterans Affairs Computerized Patient Record System (CPRS). DESIGN AND MEASUREMENT A standardized instrument for measuring user satisfaction with physician order entry systems was mailed to internal medicine and medicine-pediatrics house staff physicians. The subjects answered questions on each system using a 0 to 9 scale. RESULTS The survey response rates were 63 and 64 percent for the two order entry systems. Overall, house staff were dissatisfied with the commercial system, giving it an overall mean score of 3.67 (95 percent confidence interval [95%CI], 3.37-3.97). In contrast, the CPRS had a mean score of 7.21 (95% CI, 7.00-7.43), indicating that house staff were satisfied with the system. Overall satisfaction was most strongly correlated with the ability to perform tasks in a "straightforward" manner. CONCLUSIONS User satisfaction differed significantly between the two order entry systems, suggesting that all order entry systems are not equally usable. Given the national usage of the two order entry systems studied, further studies are needed to assess physician satisfaction with use of these same systems at other institutions.

[1]  T. Massaro.  Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior , 1993, Academic medicine : journal of the Association of American Medical Colleges.

[2]  Jonathan M. Teich,et al.  Research Paper: Implementation of Physician Order Entry: User Satisfaction and Self-Reported usage Patterns , 1996, J. Am. Medical Informatics Assoc..

[3]  G Franchi,et al.  Assessing users' satisfaction through perception of usefulness and ease of use in the daily interaction with a hospital information system. , 1996, Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium.

[4]  O. L. Davies,et al.  Statistical Methods. 6th Edition. , 1968 .

[5]  R A Miller,et al.  Recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, Computer-based Patient Record Institute, Medical Library Association, Association of Academic Health Science Libraries, American Health Information Management Association , 1997, Journal of the American Medical Informatics Association : JAMIA.

[6]  D. Bates,et al.  Effects of computerized physician order entry on prescribing practices. , 2000, Archives of internal medicine.

[7]  Jonathan M. Teich,et al.  An institution-based process to ensure clinical software quality , 1999, AMIA.

[8]  J. E. Bailey,et al.  Development of an Instrument for the Management of Computer User Attitudes in Hospitals , 1990, Methods of Information in Medicine.

[9]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[10]  Top-priority actions for preventing adverse drug events in hospitals. Recommendations of an expert panel. , 1996, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[11]  R S Evans,et al.  Computerized surveillance of adverse drug events in hospital patients* , 2005, Quality and Safety in Health Care.

[12]  Michael Weiner,et al.  Research Paper: Contrasting Views of Physicians and Nurses about an Inpatient Computer-based Provider Order-entry System , 1999, J. Am. Medical Informatics Assoc..

[13]  T. Massaro,et al.  Introducing Physician Order Entry at a Major Academic Medical Center: II. Impact on Medical Education , 1993, Academic medicine : journal of the Association of American Medical Colleges.

[14]  C G Schroeder,et al.  Direct order entry by physicians in a computerized hospital information system. , 1986, American journal of hospital pharmacy.

[15]  M. Chassin,et al.  The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. , 1998, JAMA.

[16]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[17]  Colin Potts,et al.  Design of Everyday Things , 1988 .

[18]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[19]  William W. Stead,et al.  Review: Computer-based Physician Order Entry: The State of the Art , 1994, J. Am. Medical Informatics Assoc..

[20]  R A Miller,et al.  Summary Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems , 1997, Annals of Internal Medicine.

[21]  R F Beckley,et al.  Response to a trial of physician-based inpatient order entry. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[22]  Kent L. Norman,et al.  Development of an instrument measuring user satisfaction of the human-computer interface , 1988, CHI '88.

[23]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[24]  C. McDonald,et al.  Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. , 1993, JAMA.

[25]  Reed M. Gardner,et al.  Research Paper: Evaluation of User Acceptance of a Clinical Expert system , 1994, J. Am. Medical Informatics Assoc..

[26]  M Zviran.  Evaluating user satisfaction in a hospital environment: An exploratory study , 1992, Health care management review.

[27]  Julie M. Fiskio,et al.  Evaluating physician satisfaction regarding user interactions with an electronic medical record system , 1999, AMIA.

[28]  R S Evans,et al.  Preventing Adverse Drug Events in Hospitalized Patients , 1994, The Annals of pharmacotherapy.

[29]  J M Teich,et al.  Impact of computerized physician order entry on physician time. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[30]  David Classen,et al.  Implementing Antibiotic Practice Guidelines through Computer-Assisted Decision Support: Clinical and Financial Outcomes , 1996, Annals of Internal Medicine.

[31]  R F Beckley,et al.  Design of an easy-to-use physician order entry system with support for nursing and ancillary departments. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[32]  C J McDonald,et al.  The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. , 1990, The New England journal of medicine.

[33]  Jonathan M. Teich,et al.  The impact of computerized physician order entry on medication error prevention. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[34]  Scott E. Maxwell,et al.  Designing Experiments and Analyzing Data , 1992 .

[35]  Molla S. Donaldson,et al.  The Urgent Need to Improve Health Care Quality: Consensus Statement , 1998 .

[36]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[37]  Paul Wallace,et al.  Embedding guidelines into direct physician order entry: simple methods, powerful results , 1999, AMIA.

[38]  C. McDonald,et al.  Computerized display of past test results. Effect on outpatient testing. , 1987, Annals of internal medicine.

[39]  R. Raschke,et al.  A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital. , 1998, JAMA.

[40]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[41]  M. Musen,et al.  Handbook of Medical Informatics , 2002 .

[42]  Paul N. Gorman,et al.  Physician order entry in U.S. hospitals , 1998, AMIA.