Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

Abstract

BackgroundComputerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care.MethodsThe diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods.ResultsMore nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001).ConclusionsQualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

Nursing Home Organizational Change: The “Culture Change” Movement as Viewed by Long-Term Care Specialists

“…Motivating this research is Roger’s (1995) diffusion of innovation theory, which has previously been used to understand adoption of innovation by health care organizations (Rahimi, Timpka, Vimarlund, Uppugunduri, & Svensson, 2009). Diffusion of innovation theory posits that based on an organization’s characteristics and histories (prior practices, prior innovativeness, other), it will have a differing predisposition to adoption of an innovation.…”

The Effectiveness and Outcomes of Computerized Provider Order Entry in Emergency Care Deparment of Private Hospitals

“…Technological enhancement modifies care process, alters work activities and creates opportunities for quality improvement in EC. Therefore, physicians and nurses evaluated the effectiveness and outcomes of CPOE system in EC services of private hospitals by structured questionnaire developed by Rahimi et al (24).…”

“…Moreover, CPOE was effectively used for oral medication, injection, infusion and inhalation in the present study. CPOE system has critical properties regarding effect of workflow, medication safety, efficiency (24) and changing communication pattern (29). Technological enhancement modifies care process, alters work activities and creates opportunities for quality improvement in EC.…”

“…The structured questionnaire developed by Rahimi et al (24) was translated in to Turkish by authors. In physicians, twelve items related with effectiveness, 12 items for outcomes of CPOE were used in the questionnaire.…”

“…Data were collected by a multi-item questionnaire (24) by face-to-face interview in EC services. The structured questionnaire developed by Rahimi et al (24) was translated in to Turkish by authors.…”