|Abstract or Summary
- Objectives: To identify the perceptions of community hospital physicians on
computerized physician order entry.
Design: Multi-method approach consisting of a mail survey of 659 community
hospital physicians with active admitting privileges at three PeaceHealth, Inc.,
along with follow-up personal interviews with stratified random selection from
Measurements: Perceptions were assessed by means of a mail survey that asked
physicians to rank themselves on a scale that represented the five adopter
categories contained in the Diffusion of Innovation (DOI) change theory, along
with several questions regarding computer use and attitudes toward potential
effects of computers and CPOE on medicine and healthcare. Physicians
representing four of the five adopter categories were interviewed to assess
general perceptions and perceived attributes of innovations, an another construct
within the DOI theory.
Results: The response rate was 41%. Medical specialty, years in practice, and
gender were found not to influence attitudes toward use of computers or, more
specifically CPOE in medicine and healthcare. However, more medical specialists
favor CPOE implementation at PeaceHealth than expected.
Self-ranking on the DOI five adopter categories appears to influence
attitudes toward use of computers in medicine and healthcare with positive
trends in improving quality, rapport, and patient satisfaction mainly in the
Innovator, Early Adopter, and Early Majority categories. A positive trend was
seen in the relationship between CPOE's potential effects on improving patient
care, not interfering with communication, and improving patient satisfaction with
negative relationships with impact on physician workflow and enjoyment of
medical practice. A relationship is seen between the five adopter categories and
favoring CPOE implementation at PeaceHealth.
The perceived attributes of innovations of Ease of Use, Result
Demonstrability, and Visibility were supported by interview responses. Relative
Advantage seemed to be supported by other questions. The concept of
Compatibility was also supported. No steps of the processes of change construct
within the Transtheoretical Model were identified during the interviews.
Conclusions: This study appears to refute the suggestion that there might be a
difference between medical specialists and surgical specialists, age, or gender in their support of computers and specifically CPOE. These data appear to support
the Diffusion of Innovation theory is appropriate to consider in investigating
CPOE and its diffusion among community hospital physicians.
Implementing CPOE according to adopter categories would provide the
option for interested physicians to use CPOE, to use CPOE on certain hospital
units or patients, and to expand its use before making mandatory.
Communication should be targeted toward the adopter categories rather
than mass media and emphasize the perceived attributes of innovation.