Table 3 Doctors’ time horizons over chemotherapy treatments and computerised provider order entry (CPOE) support

life-long

A view over cumulative effects of medications over time, to manage life-long risks (e.g. hearth failure)

Compared to paper-based records, CPOE makes patient information available, independent of time and place

(*) Difficulty in tracing specific data across different orders/screens

(*) IT teams can manually build into the system automated alerts on cumulative doses – but this must be done for each drug, and may not be available when needed

...the cardiologist team always need to know how much anthracyclines they’ve received, because it’s cardiotoxic and the dose that they’ve received makes a difference about what was risk stratifying and things. So to try and find a patient’s cumulative anthracycline dose sometimes has been exhausting. More exhausting than night shifts exhausting. (id20)

whole treatment

A view over ‘where we are at’ in the protocol as a whole; how the protocol is being given – possibly adapted – to the patient, and the patient response to treatment. It is a view of how much chemotherapy overall is needed, to minimise toxicity and maximise effect, and how it is given over time

Compared to paper-based records, CPOE makes patient information available, independent of time and place

(*) Lack of a summary overview/graphic display of the whole regimen with any variations of protocols applied to the patient in the past and planned future doses

(*) Information is available but very detailed and fragmented

I can go through a three-day admission, it’s all there in a capsule. But when that becomes 6 months or 12 months or 5 years, ... the system is not geared to allow us to navigate to the critical information [...] The treatment is listed as a series of lines [...] it’s very hard to actually visualise that they haven’t got an extra dose at day 15 or they’ve missed a dose at day seven, ... (id6)

here and now

A view over the requirements and constraints for the administration of the current dose, to prevent medication errors, unwanted deviations from protocols, and delays

Automated pre-coded prescription items, time dependencies and scheduling, all items included in the prescription at planning stage

...the main thing is the system is built on protocol. [...] it follows almost exactly the way the protocol is written, almost all the time. And if in case what I am prescribing is a deviation from what is allowed, then [...] it is going to flag up. For example, if something that I needed to be charted for day 1, I charted again for day 2 and 3 [..], then it will say, it’s already there why are you [ordering] it? [...] and it’s really handy that [...] the cut offs [safety thresholds] are already there, right next to that. (id2)

the timing [...] often it’s pre-suggested as well, depending on what medication you’re charting it will already have a suggested frequency that you should be charting it (d5)