• Diana Isaksen
  • Gunilla Svensmark
3 year, Master of Health Informatics (Continuing education) (Continuing Education Programme (Master))
The project took its starting point in our own and others’ observations of clinicians’ unauthor-ized use of computerized physician order entry systems (CPOE’s). The aim was to investigate to what extent clinicians adapt to CPOE, and to what extent they adjust their use of CPOE according to their accustomed workflow. Furthermore it was our aim to seek an explanation of these ‘workarounds’ or deviations from the formal rules for the use of CPOE. As empirical field we chose a gynaecological-obstetrical department that has used CPOE for a little more than a year. We used triangulation in our research design involving observation, interviews and an analysis of adverse events associated with CPOE reported by the ward. Data were analysed within a theoretical frame of reference consisting of actor-network theory and SCOT (Social Construction Of Technology), as well as sociological research on the working relations between doctors and nurses. As our theoretical frame of analysis we chose to test a new socio-technical model that has been developed for studies on health informatics system in clinical practise. We found that we could identify almost the same types of workarounds and unintended consequences of CPOE described in the literature. In addition we found some observations that have not been well described: The physical environment and the interior design of especially the ward’s medication room are essential factors, and there must be a sufficient amount of small and handy scanners, as well as a well functioning wireless network. Finally we found that the division of work between doctors and nurses are fluent, and that it often are nurses who take the initiative to medical orders and adjustment of medical doses. Clinicians use CPOE as far as possible. In those situations where it is not feasible, they use CPOE as they used the former medication chart, and they document on paper. It is reflected in the same types of workarounds that have been observed internationally. An explanation can be found in the paradigms inherent in CPOE. The system reflects the legislation on medication and a linear conception of the medication process. Moreover, the au-thorization structure freezes professional demarcations, and splits the patient’s trajectory into ward- and departmental units, leading to loss of coherence across departmental boundaries. Some of the inappropriate elements in CPOE may be solved by rebuilding, purchasing of appropriate and sufficient hardware, as well as a more lenient interpretation of the legislation. In the long term, however, a new type of system development and design must be established that see it as an aim to develop socio-technical systems in cooperation with the clinical users.
Publication date2008
Number of pages133
Publishing institutionAalborg Universitet
ID: 14518998