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Clinical Information Systems: Overcoming Adverse Consequences

Author(s): Dean F. Sittig, PhD, University of Texas Health Science Center
Joan S. Ash, PhD, Oregon Health & Science University
  • ISBN-13: 9780763757649
  • Paperback    236 pages      © 2011
Price: $156.95 US List
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As the number of healthcare organizations beginning to implement clinical information systems grows, the number of unanticipated and unintentional consequences inevitably increases as well.  While existing research suggests that much good can come from clinicians entering orders directly, errors or other unintended consequences related to technology may arise.  Ideal for both clinicians and information technology professionals, Clinical Information Systems: Overcoming Adverse Consequences helps fledgling organizations better prepare for the inevitable challenges and obstacles they will face upon the implementation of such systems.  Based on the research and findings from the Provider Order Entry Team from the Oregon Health & Science University, this book discusses the nine categories of unintended adverse consequences that occurred at many of the leading medical centers during their implementation and maintenance of a state-of-the-art clinical information system. It goes on to present the best practices they identified to help organizations overcome these obstacles. 

Features & Benefits

Based on a multi-year academic research project conducted by the Provider Order Entry Team (POET) from the Oregon Health and Science University, this book helps organizations better understand and deal with the inevitable and unintended adverse events that may occur when implementing clinical information systems.

Begins with an overview of the various types of unintended negative consequences that often occur following implementation of these systems, while later chapters discuss them in detail.

Discusses the extensive interviews with key clinical, technical, and administrative informants as they used, and often struggled with, new systems.

Provides a list of considerations that organizations should keep in mind during the implementation and optimization process.

Closes with a description of an innovative qualitative research methodology that can be used to study one’s own organization.

Dean F. Sittig, PhD-University of Texas Health Science Center

Dean F. Sittig is an Associate Professor in the School of Health Information Sciences at the University of Texas, Health Sciences Center at Houston and a member of the UT-Memorial Hermann Center for Healthcare Quality & Safety. Dr. Sittig’s research interests center on the design, development, implementation, and evaluation of all aspects of clinical information systems. In addition to Dr. Sittig’s work on measuring the impact of clinical information systems on a large scale, he is working to improve our understanding of both the factors that lead to success, as well as, the unintended consequences associated with computer-based clinical decision support and provider order entry systems. Towards this end, he is a co-founder of The IMPROVE-IT Institute. The goal of IMPROVE-IT is to develop a world-wide consortium of organizations interested in learning about and improving the processes surrounding the implementation and use of all aspects of clinical information systems.  He is the lead investigator of the clinical knowledge management and CCHIT teams within the AHRQ. Finally, he is the founding editor of both The Informatics Review (, an on-line serial devoted to helping clinicians and information system professionals keep up to date with the field of clinical informatics, and The ClinfoWiki (, an interactive, collaborative on-line clinical informatics reference resource.

Joan S. Ash, PhD-Oregon Health & Science University

Joan S. Ash is Professor and Vice-Chair, Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University (OHSU), Portland, OR. She holds masters degrees in library science, health science, and business administration and a Ph.D in Systems Science. She has served on the Boards of Directors of the American Medical Informatics Association, the Medical Library Association, on NLM’s Biomedical Library and Informatics Review Committee, and is presently chair of the Board of Scientific Counselors for the Lister Hill National Center for Biomedical Communications of NLM. She is an elected fellow of the American College of Medical Informatics. Her research has as its focus behavioral and social issues related to implementing clinical information systems, specifically computerized provider order entry (CPOE) and clinical decision support (CDS), and the use of qualitative methods for conducting such studies. Dr. Ash leads a team of researchers, the Provider Order Entry Team (POET), which has conducted national surveys of CPOE use and its unintended consequences and fieldwork in fifteen organizations to investigate success factors and unintended consequences of CPOE and CDS. More information is available on the POET web site at

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