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OBJECTIVE To describe the kinds of unintended consequences related to the implementation of computerized provider order entry (CPOE) in the outpatient setting. DESIGN Ethnographic and interview data were collected by an interdisciplinary team over a 7 month period at four clinics. MEASUREMENTS Instances of unintended consequences were categorized using(More)
Having found that an unintended consequence of computerized provider order entry (CPOE) implementation is "changes in the power structure" of the organization, we sought a deeper understanding of what was happening and why. If such consequences can be anticipated, they can be better managed. Using qualitative methods to study five successful CPOE sites, a(More)
OBJECTIVE To identify types of clinical unintended adverse consequences resulting from computerized provider order entry (CPOE) implementation. DESIGN An expert panel provided initial examples of adverse unintended consequences of CPOE. The authors, using qualitative methods, gathered and analyzed additional examples from five successful CPOE sites. (More)
In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information(More)
BACKGROUND Computerized decision support reduces medication errors in inpatients, but limited evidence supports its effectiveness in reducing the coprescribing of interacting medications, especially in the outpatient setting. The usefulness of academic detailing to enhance the effectiveness of medication interaction alerts also is uncertain. METHODS This(More)
BACKGROUND Given the fragmentation of outpatient care, timely follow-up of abnormal diagnostic imaging results remains a challenge. We hypothesized that an electronic medical record (EMR) that facilitates the transmission and availability of critical imaging results through either automated notification (alerting) or direct access to the primary report(More)
BACKGROUND We have carried out an extensive qualitative research program focused on the barriers and facilitators to successful adoption and use of various features of advanced, state-of-the-art electronic health records (EHRs) within large, academic, teaching facilities with long-standing EHR research and development programs. We have recently begun(More)
BACKGROUND More people than ever are turning to the Internet for health-related information, and recent studies indicate that the information patients find online directly affects the decisions they make about their health care. Little is known about the information needs or actual search behavior of people who use the Internet for health information. (More)
BACKGROUND American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help(More)
Background: Decision support (i.e., alerts and reminders) at the time of medication prescribing has been shown to be an effective method for reducing potential medication errors for inpatients, but much less is known about the effects in the outpatient setting. Using qualitative methods to inform our work, medication safety decision support and provider(More)