Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial
Abstract
Background The effectiveness of computerized physician order entry (CPOE) systems has been modest, largely because clinicians frequently override electronic alerts. Methods To evaluate the effectiveness of a nearly "hard stop" CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole, a randomized clinical trial was conducted at 2 academic medical centers in Philadelphia, Pennsylvania. A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the standard practice. The study duration was August 9, 2006, through February 13, 2007. Results The proportion of desired responses (ie, not reordering the alert-triggering drug within 10 minutes of firing) was 57.2% (111 of 194 hard stop alerts) in the intervention group and 13.5% (20 of 148) in the control group (adjusted odds ratio, 0.12; 95% confidence interval, 0.045-0.33). However, the study was terminated early because of 4 unintended consequences identified among patients in the intervention group: a delay of treatment with trimethoprim-sulfamethoxazole in 2 patients and a delay of treatment with warfarin in another 2 patients. Conclusions An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing. However, this intervention precipitated clinically important treatment delays in 4 patients who needed immediate drug therapy. These results il…
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Evaluations of CDS have not consistently demonstrated improved patient outcomes.
“Despite initial promise of success and widespread CDS implementations, evaluations of CDS have not consistently demonstrated improved patient outcomes.9–12”
From Clinician collaboration to improve clinical decision support: the Clickbusters initiative (2022) · cites this paper as [12]
Cites
Types of Unintended Consequences Related to Computerized Provider Order Entry
Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2042 · Cited by 823 · see citing works
Improving Acceptance of Computerized Prescribing Alerts in Ambulatory Care
Shah, N. R., Seger, A. C., Seger, D. L., Fiskio, J. M., Kuperman, G. J., Blumenfeld, B., Recklet, E. G., Bates, D. W., & Gandhi, T. K. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1868 · Cited by 353 · see citing works
Miller, R. A., Waitman, L. R., Chen, S., & Rosenbloom, S. T. (2005) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2005.08.009 · Cited by 144 · see citing works
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Effect of Clinical Decision-Support Systems: A Systematic Review
Bright, T. J., Wong, A., Dhurjati, R., Bristow, E., Bastian, L., Coeytaux, R. R., Samsa, G., Hasselblad, V., Williams, J. W., Musty, M. D., et al. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-157-1-201207030-00450 · Cited by 1,200 · see citing works
Kesselheim, A. S., Cresswell, K., Phansalkar, S., Bates, D. W., & Sheikh, A. (2011) · Health Affairs · doi:10.1377/hlthaff.2010.1111 · Cited by 277 · see citing works
Medication-related clinical decision support alert overrides in inpatients
Nanji, K. C., Seger, D. L., Slight, S. P., Amato, M. G., Beeler, P. E., Her, Q. L., Dalleur, O., Eguale, T., Wong, A., Silvers, E. R., et al. (2018) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocx115 · Cited by 179 · see citing works
Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., Rashidee, A. H., Elson, R. B., Whitney, D. L., Thach, T.-T., et al. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003555 · Cited by 138 · see citing works
A framework for evaluating the appropriateness of clinical decision support alerts and responses
McCoy, A. B., Waitman, L. R., Lewis, J. B., Wright, J. A., Choma, D. P., Miller, R. A., & Peterson, J. F. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000185 · Cited by 138 · see citing works
The unintended consequences of health information technology revisited
Ash, J., Berg, M., & Coiera, E. (2016) · Yearbook of Medical Informatics · doi:10.15265/iy-2016-014 · Cited by 101 · see citing works
Clinician collaboration to improve clinical decision support: the Clickbusters initiative
McCoy, A. B., Russo, E. M., Johnson, K. B., Addison, B., Patel, N., Wanderer, J. P., Mize, D. E., Jackson, J. G., Reese, T. J., Littlejohn, S., et al. (2022) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocac027 · Cited by 41 · see citing works
Stultz, J. S., & Nahata, M. C. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-001725 · Cited by 28 · see citing works
A model curriculum for an emergency medicine residency rotation in clinical informatics
Baker, C., Maniam, N., Schnapp, B., Genes, N., Nielson, J., Mohan, V., Hersh, W., & Slovis, B. (2022) · Journal of Education and Teaching in Emergency Medicine · doi:10.5070/m57459214 · Cited by 6 · see citing works
- Authors
- Strom, B. L., Schinnar, R., Aberra, F., Bilker, W., Hennessy, S., Leonard, C. E., & Pifer, E.
- Affiliations
- University of Pennsylvania (US)
- El Camino Hospital (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2010-09-27
- Volume
- 170
- Issue
- 17
- Pages
- 1578-83
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2023248069
- Cited by
- 217
- References
- 3
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 8 · 2023: 7 · 2022: 20 · 2021: 12 · 2020: 6 · 2019: 19 · 2018: 11 · 2017: 14 · 2016: 15 · 2015: 28 · 2014: 10 · 2013: 24 · 2012: 20
- FWCI
- 33.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pennsylvania
- Agency for Healthcare Research and Quality (U18HS016946)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- computerized physician order entry, electronic prescribing alerts, drug interaction prevention, warfarin, trimethoprim-sulfamethoxazole, unintended consequences, treatment delay, alert override, inpatient prescribing, drug safety
- MeSH terms
- Anti-Infective Agents, Anticoagulants, Decision Making, Computer-Assisted, Drug Interactions, Drug Therapy, Computer-Assisted, Hemorrhage, Humans, Medication Errors, Medication Systems, Hospital, Drug Prescriptions, Time Factors, Warfarin, Philadelphia, Trimethoprim, Sulfamethoxazole Drug Combination, Odds Ratio, Reminder Systems, Decision Support Systems, Clinical, Medical Order Entry Systems, Electronic Prescribing
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