Clinicians satisfaction with CPOE ease of use and effect on clinicians' workflow, efficiency and medication safety

Abstract

Objectives: To study the satisfaction of end-users of a computerized physician order entry (CPOE) system concerning ease of use and the effect on users' workflow, efficiency, and medication safety and to seek users' opinions regarding required improvements of the system. Usability evaluation had shown that this system, which was in use for almost a decade, contained a number of severe usability problems. So another objective of the study was to determine whether there was a direct relation between user satisfaction and the results of a usability evaluation of the system.

Methods: Two survey questionnaires were distributed to CPOE system users (physicians and nurses) working in inpatient departments of a university hospital. Questionnaires included items that were rated using a five point Likert scale. Multiple choice questions with space for free text additions also were used to collect qualitative data concerning the use of the CPOE system and the users' opinion concerning system requirements for improvement. Data were analyzed using descriptive statistics and by the use of Mann-Whitney U and Kruskal Wallis tests.

Results: Two hundred seventeen physicians and 587 nurses were eligible to participate in this study (response rate 49% and 56% respectively). Physicians were satisfied with the CPOE ease of use (median 3.8, interquartile range [IQR] 3.3-4), and the effect on workflow (median 3.7, IQR 3.3-4), medication safety (median 3.75, IQR 3-4), and efficiency (median 4, IQR 3-4). Nurses also had a positive attitude towards CPOE ease of use (median 3.6, IQR 3-4), and its effect on workflow (median 3, IQR 3-3.6), medication safety (median 3, IQR 2.5-3.5), and efficiency (median 3.5, IQR 3-4). Users mainly indicated that the system needs: supplementary functionalities (e.g. alerts for allergies), improvement of current functionalities, integration with other hospital information systems and improvement of information presentation (e.g. a clear medication overview). Users did not use some current functionalities because of lack of awareness of the functionalities or having difficulty in using them.

Conclusions: Users of this CPOE system, which was used for almost a decade, were satisfied with the system's ease of use and its effect on efficiency, workflow and medication safety although the system showed many usability problems and lacked some functionalities. In this case study, therefore, there seems no direct relation between the results of the earlier performed usability evaluation and user satisfaction as determined in the current study.