UNINTENDED CONSEQUENCES OF THE USE OF COMPUTERIZED PROVIDER ORDER ENTRY IN THE UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM

Health Information Technology (HIT) is believed to have the potential to tackle the ever rising costs of healthcare. The use of HIT should lower error rates and increase efficiency. However, research indicates HIT does not succeed in this task. Unintended consequences of HIT use may cause HIT to lead to opposite effects: higher error rates and a decreasing efficiency. In this thesis I discuss the use of a Computerized Provider Order Entry (CPOE) system in the University of Pennsylvania Healthcare System (UPHS) in Philadelphia. Our research focused on unintended consequences of the use of Sunrise Clinical Manager as a CPOE system. The main research question was ‘What unintended consequences of the use of Sunrise CPOE system pose a threat to the quality of care in the University of Pennsylvania Health System in the Summer of 2012?’ Data are compared with three earlier studies performed at UPHS over the last decade. The ISTA model, developed by Harrison, Koppel and Bar-Lev in 2007, was utilized as a framework to study the development of issues over time and compare our findings. To gather data, we interviewed house staff, with a focus on residents, and HIT authorities within UPHS. 86 residents responded to an online survey. Results were used to develop a questionnaire, which was utilized in face-to-face interviews with 45 residents and 21 other house staff. 4 meetings were held with HIT authorities for a different perspective on issues, and to discuss findings. We studied 38 unintended consequences of CPOE use, 8 of which were newly identified. Several other issues were identified which require further studying to determine their origin, significance, and possible link to other issues. No evidence was found of previously identified issues that were fixed since the preceding study in 2011. Following the ISTA model, I found the main contributor to the emergence of unintended consequences to be the complex interactions between new HIT and the social system, and to a lesser degree the interactions between new HIT and the technical infrastructure. These interactions cause a mismatch between the way HIT is designed to be used, and the way it is used in practice. I expect that more focus on these interactions and their effect on the way HIT is used in practice will help achieve a better match between the design and the actual use. With this thesis, I aim to contribute to achieving this goal of the use of HIT: lower costs for healthcare by a decrease in error rates and more efficient use of our limited resources.