Background Computerised provider order entry (CPOE) with clinical decision support (CDS) can improve medicines safety and reduce medicines-related expenditure. The guidance and prompts of CDS can constitute one of the primary mechanisms by which electronic health records can transform the quality and efficiency of healthcare delivery. Hospital pharmacists have a crucial place in the development and implementation of these technologies.
Purpose To describe and review medicines-related decision support systems introduced into healthcare organisations, identifying basic and advanced stages. Also, to point out CDS opportunities that might solve the current obstacles to CPOE dissemination and implementation.
Materials and methods We reviewed the PubMed literature, selecting papers that reflect current practice and have relevance to system designers. We also identified papers that illustrate the limitations of current technologies and can help point the way forward for future developments in the field.
Results Medicines-related decision support has achieved many benefits. Yet, many issues remain for future work. For basic medicines-related decision support, we identified five categories: drug-allergy checking, basic dosing guidance for CPOE medicines, formulary decision support, duplicate medicines checking and drug–drug interactions. For more advanced medicines-related decision support, four categories were distinguished: advanced dosing guidance in CPOE, advanced guidance for medicines-associated lab testing, advanced checking of drug–disease interactions and contraindications or drug-physiological conditions (i.e. pregnancy) alerting. Some challenges in the implementations were identified, that come to be critical for CDS, such as the customisation of CDS for inpatient or outpatient settings, strategies to reduce alert fatigue, local customisation databases and lack of therapeutic duplication checking across institutions.
Conclusions Prescription-related CDS within CPOE systems can improve the quality and safety of medicines prescribing and reduce medicines costs. However, the implementation of CDS must be done consciously, taking into account improvements in the pharmacotherapeutic care workflow and the vulnerabilities of the new model.
No conflict of interest.
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