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J Am Med Inform Assoc. 2009 Jul-Aug;16(4):539-49. doi: 10.1197/jamia.M2419. Epub 2009 Apr 23.

The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review.

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Institute of Health Policy and Management, Erasmus University Medical Center, Rotterdam, The Netherlands.


Previous studies have shown the importance of workflow issues in the implementation of CPOE systems and patient safety practices. To understand the impact of CPOE on clinical workflow, we developed a conceptual framework and conducted a literature search for CPOE evaluations between 1990 and June 2007. Fifty-one publications were identified that disclosed mixed effects of CPOE systems. Among the frequently reported workflow advantages were the legible orders, remote accessibility of the systems, and the shorter order turnaround times. Among the frequently reported disadvantages were the time-consuming and problematic user-system interactions, and the enforcement of a predefined relationship between clinical tasks and between providers. Regarding the diversity of findings in the literature, we conclude that more multi-method research is needed to explore CPOE's multidimensional and collective impact on especially collaborative workflow.

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