Clinician reports of the impact of electronic ordering on an emergency department

The importance of health informatics evaluations adopting a pluralist approach which considers the technical as well as the organizational and social aspects of system implementation has been espoused by many researchers. Kaplan's 4Cs evaluation framework presents a lens through which evaluations of clinical systems can be assessed, with a focus on communication, care, control and context. Our aim was to investigate the effects of Computerized Provider Order Entry (CPOE) on Emergency Department (ED) work, communication practices and patient care using this framework as a means to orient the study. A qualitative study using interviews and focus groups was undertaken in an Australian 640-bed ED after the introduction of CPOE. Systematic concurrent analysis revealed five themes: i) Expectations; ii) Changes in responsibility; iii) Monitoring of the test order process; iv) System usability; and v) System requirements. CPOE systems in EDs present specific challenges which differ from other hospital departments. Due to the critical nature of clinical work in this setting a poor fit between CPOE and ED work may result in serious incidents.