Skip to main content
Log in

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

  • Clinical Review
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff. 2004;23:184–90.

    Article  Google Scholar 

  2. Kaushal R, Bates DW. Information technology and medication safety: what is the benefit? Qual Saf Health Care. 2002;11:261–5.

    Article  PubMed  CAS  Google Scholar 

  3. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163:1409–16.

    Article  PubMed  Google Scholar 

  4. Rochon PA, Field TS, Bates DW, et al. Computerized physician order entry with clinical decision support in the long-term care setting: insights from the Baycrest Centre for Geriatric Care. J Am Geriatr Soc. 2005;53:1780–9.

    Article  PubMed  Google Scholar 

  5. Kohn LT. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  6. Fortescue EB, Kaushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111:722–9.

    Article  PubMed  Google Scholar 

  7. Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005;118:251–8.

    Article  PubMed  Google Scholar 

  8. Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2007;14:29–40.

    Article  PubMed  Google Scholar 

  9. Gesteland PH, Nebeker JR, Gardner RM. These are the technologies that try men’s souls: common-sense health information technology. Pediatrics. 2006;117:216–7.

    Article  PubMed  Google Scholar 

  10. Sittig DF, Ash JS, Zhang J, Osheroff JA, Shabot MM. Lessons from “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system”. Pediatrics. 2006;118:797–801.

    Article  PubMed  Google Scholar 

  11. Jacobs BR, Brilli RJ, Hart KW. Perceived increase in mortality after process and policy changes implemented with computerized physician order entry. Pediatrics. 2006;117:1451–2.

    Article  PubMed  Google Scholar 

  12. Longhurst C, Sharek P, Hahn J, Sullivan J, Classen D. Perceived increase in mortality after process and policy changes implemented with computerized physician order entry. Pediatrics. 2006;117:1450–1.

    Article  PubMed  Google Scholar 

  13. Rosenbloom ST, Harrell FE Jr., Lehmann CU, Schneider JH, Spooner SA, Johnson KB. Perceived increase in mortality after process and policy changes implemented with computerized physician order entry. Pediatrics. 2006;117:1452–5.

    Article  PubMed  Google Scholar 

  14. Bates DW, Boyle DL, Vliet MVV, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10:199–205.

    Article  PubMed  CAS  Google Scholar 

  15. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. JAMA. 1995;274:29–34.

    Article  PubMed  CAS  Google Scholar 

  16. Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.

    Article  PubMed  Google Scholar 

  17. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.

    Article  PubMed  Google Scholar 

  18. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277:307–11.

    Article  PubMed  CAS  Google Scholar 

  19. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277:301–6.

    Article  PubMed  CAS  Google Scholar 

  20. Field TS, Gilman BH, Subramanian S, Fuller JC, Bates DW, Gurwitz JH. The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care. 2005;43:1171–6.

    Article  PubMed  Google Scholar 

  21. Institute of Medicine. Preventing Medication Errors: Quality Chasm SeriesWashington, DC: National Academy Press; 2007.

  22. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    Article  PubMed  CAS  Google Scholar 

  23. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–6.

    Article  PubMed  CAS  Google Scholar 

  24. Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6:313–21.

    PubMed  CAS  Google Scholar 

  25. Colpaert K, Claus B, Somers A, Vandewoude K, Robays H, Decruyenaere J. Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial. Crit Care. 2006;10:R21.

    Article  PubMed  Google Scholar 

  26. Evans RS, Classen DC, Pestotnik SL, Clemmer TP, Weaver LK, Burke JP. A decision support tool for antibiotic therapy. Proceedings from the 19th Annual Symposium on Computer Applications in Medical Care. 1995:651–5.

  27. Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med. 1998;338:232–8.

    Article  PubMed  CAS  Google Scholar 

  28. Evans RS, Pestotnik SL, Classen DC, Horn SD, Bass SB, Burke JP. Preventing adverse drug events in hospitalized patients. Ann Pharmacother. 1994;28:523–7.

    PubMed  CAS  Google Scholar 

  29. Mullett CJ, Evans RS, Christenson JC, Dean JM. Development and impact of a computerized pediatric antiinfective decision support program. Pediatrics. 2001;108:E75.

    Article  PubMed  CAS  Google Scholar 

  30. Peterson JF, Kuperman GJ, Shek C, Patel M, Avorn J, Bates DW. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med. 2005;165:802–7.

    Article  PubMed  Google Scholar 

  31. Steele AW, Eisert S, Witter J, et al. The effect of automated alerts on provider ordering behavior in an outpatient setting. PLoS Med. 2005;2:e255.

    Article  PubMed  Google Scholar 

  32. Upperman JS, Staley P, Friend K, et al. The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital. J Pediatr Surg. 2005;40:57–9.

    Article  PubMed  Google Scholar 

  33. Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–38.

    Article  PubMed  CAS  Google Scholar 

  34. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–46.

    Article  PubMed  CAS  Google Scholar 

  35. Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. New York: Oxford University Press; 2000.

    Google Scholar 

  36. Rochon PA, Field TS, Bates DW, et al. Clinical application of a computerized system for physician order entry with clinical decision support to prevent adverse drug events in long-term care. CMAJ. 2006;174:52–4.

    PubMed  Google Scholar 

  37. Judge J, Field TS, Deflorio M, et al. Prescribers’ responses to alerts during medication ordering in the long term care setting. J Am Med Inform Assoc. 2006;13:385–90.

    Article  PubMed  Google Scholar 

  38. Ganjavi H, Herrmann N, Rochon PA, et al. Adverse drug events in cognitively impaired elderly patients. Dement Geriatr Cogn Disord. 2007;23:395–400.

    Article  Google Scholar 

  39. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2)239–45.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Mary Thomson Ph.D. for her assistance with the identification of original investigations for inclusion in our sample and Peter Anderson for his assistance with the manuscript preparation. The study was supported by grants (HS010481 and HS15430) from the Agency for Healthcare Research and Quality, Bethesda, MD, USA.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paula A. Rochon MD, MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wolfstadt, J.I., Gurwitz, J.H., Field, T.S. et al. The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review. J GEN INTERN MED 23, 451–458 (2008). https://doi.org/10.1007/s11606-008-0504-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0504-5

KEY WORDS

Navigation