Evaluation of Outpatient Computerized Physician Medication Order Entry Systems: A Systematic Review

This is a review of the article published in Journal of the American Medical Informatics Association in 2007.

Introduction

Computerized Physician Order Entry (CPOE) or Electronic Prescription (EP) have been identified by The Institute of Medicine as key elements in reducing medication errors and improving safety. The authors systematically reviewed literature of outpatient CPOE systems that evaluated safety, cost and efficiency, adherence to guidelines, alerts, time, satisfaction, usage, and usability.

Methods

The authors performed literature search in Ovid MEDLINE, Ovid MEDLINE, and EMBASE for relevant articles from 1950 to 2006. There were two reviewers; the discrepancies were solved by a third reviewer. The reviewed articles represented clinical trials, observational studies and simulation studies. The selected articles included objectives of evaluation of an outpatient CPOE system and DSS.

Results

The main outcome measures were:

• Medication safety

Out of the four studies that addressed medication safety, only one showed a significant reduction in medication errors.

• Cost and (organizational) efficiency

Three studies showed reduced costs while five others did not.

• Adherence to guidelines

Most studies showed a positive effect.

• Alerts and appropriateness of alerts

Out of six studies, one showed weaknesses in generating alerts. Four studies showed that most of the alerts were ignored by the physicians.

• Time

Most studies showed that total time for patient care increased with introduction of CPOE.

• Satisfaction, usage and usability

Five studies showed that the majority of users were satisfied with the system, while three studies showed decreased satisfaction. As for usage, studies had variable results.

Discussion

The authors suggest that difficulty of obtaining quantitative data and the high cost of chart reviewing could explain the low number of ADE-related evaluation studies. The studies should instead focus on specific patient groups, high risk drugs, simple errors and typical ADEs. The studies on alerts were mostly observational. More qualitative and quantitative studies are needed to explore the reasons for ignoring alerts and whether the system must be redesigned. The authors believe that the system can be beneficial in the reduction of medication costs, if it has patients specific suggestions and targets expensive drug groups.