Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients

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This is a review of an article by K.M. Vermeulena, J.E. van Doormaalb et al., titled 'Creating Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients.[1]


Computerized Physician Order Entry (CPOE), combined with basic Clinical Decision Support (CDS) Systems - (CPOE/CDSS) is considered to decrease medication errors and subsequently preventable adverse drug events (ADEs). However these systems are expensive.This study aims to study the cost effectiveness of CPOE/CDSS compared to the traditional paper-based medication ordering.


This study was conducted in two hospitals, a University Medical Center and a general teaching hospital. The economic evaluation was performed alongside an interrupted time series study on the effectiveness of CPOE/CDSS.

For the effectiveness study. an interrupted time series method was done,having two periods of measurement: a pre implementation measurement, in which the paper-based medication ordering system was evaluated, and a post implementation measurement, in which the CPOE/CDS system was evaluated.Outcomes measured were medication errors and preventable adverse drug events.

In the economic evaluation,only costs related to medication ordering made in the hospital were calculated and taken into account in the cost-effectiveness analysis for all prescriptions of all included patients. Results were presented in ratios of incremental costs to incremental effects (Incremental Cost Effectiveness Ratio,ICER[1]).


The percentage of medication orders containing at least one medication error reduced from 55% to 17% with the introduction of CPOE/CDSS.

Total costs of the paper-based system and CPOE/CDSS amounted to 12.37 euros and to 14.91 euros per patient/day respectively. The Incremental Cost-Effectiveness Ratio(ICER) for medication errors was 3.54 and for preventable adverse drug events 322.70. this means that an additional 3.54 euros would be the incremental cost to decrease 1 medication error and 322.70 euros to minimize 1 preventable ADE, by installing the CPOE/ CDSS systems.


The study supports the premise that CPOE/CDSS systems greatly reduce the chances of Medication errors and preventable ADEs. They are also cost effective, even with a higher incremental cost to reduce pADEs. Another added value with implementing a CPOE system is the time investment of the physician decreased. Doctors were spending less time answering questions concerning illegible handwriting, continuation of certain medication, etc.[1]

Discussion/ Comments

This was a study of a basic CDSS. More robust and sophisticated systems would have an additional effect on medication errors especially therapeutic medication errors.


  1. 1.0 1.1 Vermeulena,K.M., van Doormaalb, J.E., Zaal,R.J., Mol,P.G.M., Lenderink,A.W., Haaijer-Ruskamp,F.M., Kosterink, J.G.W., van den Bemt,P.L.M.A. Creating Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. International Journal of Medical Informatics. 2014;83(8):572-580. Retrieved from