The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review

Abstract

CONTEXT: Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE). OBJECTIVE:To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure.DATA SOURCES: PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists of included studies were also searched. METHODS:We searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed. RESULTS:Of the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P≤.05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates.CONCLUSIONS: Few studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings.KEY WORDS: computerized physician order entry; clinical decision support; adverse drug event.

Adverse Drug Event Rates in Six Community Hospitals and the Potential Impact of Computerized Physician Order Entry for Prevention

“…Better performance might be expected with additional decision support 15,16 . In a systematic review that evaluated the effect of CPOE with CDS on reducing ADEs, five out of ten studies showed a significant reduction of ADEs 17 .…”

Variation in Electronic Health Record Adoption and Readiness for Meaningful Use: 2008–2011

“…4 Furthermore, certain MU functionalities such as CPOE, electronic prescribing and clinical decision support have been associated with improvements in care. 2,[23][24][25][26][27][28][29][30] However, the full clinical benefits of MU have yet to be empirically evaluated and warrant future research. Although adoption of many functionalities varied by specialty, adoption of several functionalities associated with e-prescribing significantly increased between 2009 and 2011 across both primary care physicians and specialists.…”

Impact of Vendor Computerized Physician Order Entry in Community Hospitals

“…Its administration may be in response to an overdose of potassium, a side effect of a medication, or the result of a drug-drug interaction. Additionally, we added "yeast infection related to antibiotics" and "platelet count <50,000×10 6 /μl" as triggers, and excluded lidocaine, gentamicin, tobramycin, amikacin, vancomycin, and theophylline levels in our adaptation of the tool.…”

“…5,6 These studies have influenced policymakers 7 and consumer advocates 8,9 to promote the nationwide adoption of CPOE as a safety-driven initiative. However, despite this mandate, CPOE has not yet achieved significant market penetration.…”