CPOE in Non-Surgical Versus Surgical Specialties: A Qualitative Comparison of Clinical Contexts in the Medication Process

Zahra Niazkhani*, 1, 2, Habibollah Pirnejad1, 2, Antoinette de Bont1, Jos Aarts1
1 Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
2 Health Information Technology (HIT) Group, Urmia University of Medical Sciences, Urmia, Iran

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© Niazkhani et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Health Information Technology (HIT) Group, Urmia University of Medical Sciences, P.O. Box: 1138, Urmia, Iran; Tel: +98-441-2752305; Fax:+98-441-2770047; E-mails: or



Computerized provider order entry (CPOE) systems are implemented in various clinical contexts of a hospital. To identify the role of the clinical context in CPOE use, we compared the impact of a CPOE system on the medication process in both non-surgical and surgical specialties.


We conducted a qualitative study of surgical and non-surgical specialties in a 1237-bed, academic hospital in the Netherlands. We interviewed the clinical end users of a computerized medication order entry system in both specialty types and analyzed the interview transcripts to elicit qualitative differences between the clinical contexts, clinicians’ attitudes, and specialty-specific requirements.


Our study showed that the differences in clinical contexts between non-surgical and surgical specialties resulted in a disparity between clinicians’ requirements when using CPOE. Non-surgical specialties had a greater medication workload, greater and more diverse information needs to be supported in a timely manner by the system, and thus more intensive interaction with the CPOE system. In turn these factors collectively influenced the perceived impact of the CPOE system on the clinicians’ practice. The non-surgical clinicians expressed less positive attitudes compared to the surgical clinicians, who perceived their interaction with the system to be less intensive and less problematic.


Our study shows that clinicians’ different attitudes towards the system and the perceived impact of the system were largely grounded in the clinical context of the units. The study suggests that not merely the CPOE system, the technology itself, influences the perceptions of its users and workflow-related outcomes. The interplay between technology and clinical context of the implementation environment also matters. System design and redesigning efforts should take account of different units’ specific requirements in their particular clinical contexts.

Keywords: Clinical context, CPOE, medication, medical order entry systems, surgical, non-surgical.