Project Management

The following unintended adverse consequences may result from failure to fully consider the project management.

Workflow Issues New Kinds of Errors

Communication Issues More Work/ New Work

Power Issues Emotions Never-ending System Demands Overde- pendence on Technology Paper Persistence

Workflow Issues: 16%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

New Kinds of Errors: 15%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Communication Issues: 13%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

More Work/New Work: 12%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Power Issues: 11%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Emotions: 9%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

Never-ending System Demands: 9%

• A dynamic information system
• Hardware
• Training

Overdependence on Technology: 8%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Paper Persistence: 7%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Vision/Leadership/People

The following unintended adverse consequences may result from failure to fully consider the important roles that leadership and other people will play in the implementation of CPOE.

More Work/New Work Workflow Issues

Power Issues New Kinds of Errors

Communication Issues Emotions Never-ending System Demands Overdependence on Technology Paper Persistence

More Work/New Work: 18%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Workflow Issues: 16%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

Power Issues: 13%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

New Kinds of Errors: 13%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Communication Issues: 10%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

Emotions: 10%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

Never-ending System Demands: 9%

• A dynamic information system
• Hardware
• Training

Overdependence on Technology: 6%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Paper Persistence: 5%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Foundations

The following unintended adverse consequences may result from failure to fully consider the need for proper foundations before beginning implementation.

New Kinds of Errors Workflow Issues

More Work/ New Work Communication Issues

Overdependence on Technology Never-ending System Demands Power Issues Emotions Paper Persistence

New Kinds of Errors: 16%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Workflow Issues: 15%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

More Work/New Work: 15%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Communication Issues: 13%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

Overdependence on Technology: 11%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Never-ending System Demands: 9%

• A dynamic information system
• Hardware
• Training

Emotions: 8%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

Paper Persistence: 8%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Power Issues: 8%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Integration/Workflow/Healthcare Processes

The following unintended adverse consequences may result from failure to fully consider the integration of the CPOE system into the current workflow and healthcare processes of your organization (including other computer systems).

Workflow Issues

More Work/New Work Emotions

New Kinds of Errors Communi- cation Issues Paper Persistence Never-ending System Demands Power Issues Overdepend- ence on Technology

Workflow Issues: 34%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

More Work/New Work: 19%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Emotions: 11%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

New Kinds of Errors: 11%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Communication Issues: 7%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

Paper Persistence: 6%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Never-ending System Demands: 4%

• A dynamic information system
• Hardware
• Training

Overdependence on Technology: 4%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Power Issues: 4%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Technical Considerations

The following unintended adverse consequences may result from failure to fully consider the technical aspects of CPOE implementation.

Workflow Issues

New Kinds of Errors More Work/New Work

Never-ending System Demands Communication Issues Power Issues Overdependence on Technology Paper Emotions

Workflow Issues: 24%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

New Kinds of Errors: 14%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

More Work/New Work: 13%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Never-ending System Demands: 12%

• A dynamic information system
• Hardware
• Training

Communication Issues: 10%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

Power Issues: 9%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Overdependence on Technology: 7%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Emotions: 6%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

Paper Persistence: 5%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Learning/Evaluation/Improvement

The following unintended adverse consequences may result from failure to fully consider the continuous need for learning, evaluation and improvement during and after implementation.

New Kinds of Errors

Workflow Issues Communication Issues

More Work/ New Work Never-ending System Demands

Power Issues Overde- pendence on Technology Emotions Paper Persistence

New Kinds of Errors: 25%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Workflow Issues: 15%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

Communication Issues: 10%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

More Work/New Work: 10%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Never-ending System Demands: 9%

• A dynamic information system
• Hardware
• Training

Power Issues: 9%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Emotions: 7%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

Overdependence on Technology: 7%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Paper Persistence: 6%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Value to Users/Including Decision Support Systems

The following unintended adverse consequences may result from failure to fully consider the value to users.

Workflow Issues More Work/New Work

New Kinds of Errors

Power Issues Emotions Communi- cation Issues Overde- pendence on Tech Paper Persistence

More Work/New Work: 24%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Workflow Issues: 23%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

New Kinds of Errors: 23%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Power Issues: 9%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Emotions: 7%

• Negative

Communication Issues: 6%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

Overdependence on Technology: 3%

• False expectations

Paper Persistence: 3%

• Human Factors make paper familiar and comfortable
• Technology gaps may be filled by paper records, though versioning problems endure

Motivation

The following unintended adverse consequences may result from failure to fully consider your organizations motives for implementing CPOE.

More Work/New Work Workflow Issues

New Kinds of Errors Communication Issues

Never-ending System Demands Power Issues Emotions Overdependence on Technology Paper Persistence

More Work/New Work: 18%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

New Kinds of Errors: 14%

• Asynchronous recording of events
• CIS changes the organizational safety net
• Clinical Information System is not functioning
• Cognitive overload
• Inaccurate or missing data/information/knowledge
• User interface issues

Workflow Issues: 14%

• Alterations in pacing, sequencing and work dynamics
• Ergonomic/human computer interface issues
• Failure to include non-physician personnel in the design process
• Incomplete or flawed implementation of policy and procedure
• Loss of situation awareness

Communication Issues: 12%

• Communication affects user awareness
• CPOE allows communication anywhere, anytime: ubiquitous communication
• CPOE changes communication channels
• Paper is changing its function from that of recording to communicating
• The computer changes the patient-clinician conversation

Never-ending System Demands: 11%

• A dynamic information system
• Hardware
• Training

Emotions: 8%

• Negative Emotions
• Neutral Emotions
• Positive Emotions

Power Issues: 8%

• Coalitions gain power
• Perceived loss of control and autonomy
• Shifts in the power structure

Overdependence on Technology: 7%

• Downtime creates chaos
• False expectations
• Physicians and others cannot live without it

Paper Persistence: 7%

• Human Factors make paper familiar and comfortable
• Regulatory factors
• Technology gaps may be filled by paper records, though versioning problems endure

Training/Support/Help at the Elbow

Costs

The following unintended adverse consequences may result from failure to fully consider the costs of implementation.

Never-ending System Demands

More Work/New Work Workflow Issues Emotions

Never-ending System Demands: 63%

• A dynamic information system
• Hardware
• Training

More Work/New Work: 26%

• Incomplete implementation of systems/poorly integrated systems
• Information restructuring (redundant info, proliferation of unimportant info, can't find where to put info, can't locate where others put info, can't figure out who entered what or when, etc.)
• Loss of shorthand for documentation/ordering
• Rigid computer implementation of rules that require flexibility
• Shift to computers

Workflow Issues: 5%

• Alterations in pacing, sequencing and work dynamics

Emotions: 5%

• Negative Emotions