Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review

Scott, Ian A.; Pillans, Peter I.; Barras, Michael; Morris, Christopher

doi:10.1177/2042098618784809

Cited by 114Pharmaceutical Practices and Patient OutcomesElectronic Health Records SystemsMedical Coding and Health Information

Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review

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Scott, Ian A., Pillans, Peter I., Barras, Michael, Morris, Christopher·2018·Therapeutic Advances in Drug Safety

DOI 10.1177/2042098618784809PMC PMC6116772

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Abstract

Prescribing of potentially inappropriate medications (PIMs) that pose more risk than benefit in older patients is a common occurrence across all healthcare settings. Reducing such prescribing has been challenging despite multiple interventions, including educational campaigns, audits and feedback, geriatrician assessment and formulary restrictions. With the increasing uptake of electronic medical records (EMRs) across hospitals, clinics and residential aged care facilities (RACFs), integrated with computerized physician order entry (CPOE) and e-prescribing, opportunities exist for incorporating clinical decision support systems (CDSS) into EMR at the point of care. This narrative review assessed the process and outcomes of using EMR-enabled CDSS to reduce the prescribing of PIMs. We searched PubMed for relevant articles published up to January 2018 and focused on those that described EMR-enabled CDSS that assisted prescribers to make changes at the time of ordering PIMs in adults. Computerized systems offering only medication reconciliation, dose checks, monitoring for medication errors, or basic formulary information were not included. In addition to outcome measures of medication-related processes and adverse drug events, qualitative data relating to factors that influence effectiveness of EMR-enabled CDSS were also gathered from selected studies. We analysed 20 studies comprising 10 randomized trials and 10 observational studies performed in hospitals ( n = 8), ambulatory care clinics ( n = 9) and RACFs ( n = 3). Studies varied in patient populations (although most involved older patients), type of CDSS, method of linkage with EMR, study designs and outcome measures. However, assuming little publication bias, the totality of evidence favoured EMR-enabled CDSS as being effective in reducing the prescribing of PIMs in hospitals, although results were more mixed for ambulatory care settings and RACFs. While absolute effects in most positive studies were modest, they suggest EMR-enabled CDSS are feasible and acceptable to clinicians, and if certain design features are adhered to, there is potential for even greater impact.

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Attempts to digitize deprescribing criteria into electronic clinical decision support have raised difficulties, typically requiring a labor-intensive coding process and unstructured information such as free text from patient records to contextualize certain criteria.
“Attempts to digitize these criteria into electronic clinical decision support (CDS) have raised difficulties, typically requiring a labor-intensive coding process and unstructured information such as free text from patient records to contextualize certain criteria [11,12].”
From Identifying Deprescribing Opportunities With Large Language Models in Older Adults: Retrospective Cohort Study (2025) · cites this paper as [11]

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The Future of Service Post-COVID-19 Pandemic, Volume 1
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Using the behavior change wheel to link published deprescribing strategies to identified local primary healthcare needs
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Functional IT Complementarity and Hospital Performance in the United States: A Longitudinal Investigation
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Identifying Deprescribing Opportunities With Large Language Models in Older Adults: Retrospective Cohort Study
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Shared Interoperable Clinical Decision Support Service for Drug-Allergy Interaction Checks: Implementation Study
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Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use
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Strategies to guide the successful implementation of deprescribing in community practice: Lessons learned from the front line
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Impact of Check of Medication Appropriateness (CMA) in optimizing analgesic prescribing: An interrupted time series analysis
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The Use of a Decision Support System in Swedish Pharmacies to Identify Potential Drug-Related Problems—Effects of a National Intervention Focused on Reviewing Elderly Patients’ Prescriptions
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Evaluating the Wasfaty E-Prescribing Platform Against Best Practices for Computerized Provider Order Entry
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Clinical Decision Support System Based on Hybrid Knowledge Modeling: A Case Study of Chronic Kidney Disease-Mineral and Bone Disorder Treatment
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Classification of Musculoskeletal Radiograph Requisition Appropriateness Using Machine Learning
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The impact of including a medication review in an integrated care pathway: A pilot study
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The evolution of polypharmacy: appropriate and problematic polypharmacy, choosing the right strategy and tactics
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Medical Decision Support to Reduce Unwarranted Methylene Tetrahydrofolate Reductase (MTHFR) Genetic Testing
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Chronic-pharma: New Platform for Chronic Patients Pharmacotherapy Optimization
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Eliminating medication overload: A national action plan
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A simulation trial evaluating ABiMed, a clinical decision support system for medication reviews and polypharmacy management
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Evaluation Criteria for the Effects of Decision Support Integrated into Computerized Provider Order Entry System: A Scoping Review
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One Hundred Explicit Definitions of Potentially Inappropriate Prescriptions of Antibiotics in Hospitalized Older Patients: The Results of an Expert Consensus Study
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Potentially inappropriate medicines for older people: consensus-based lists
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Automation or augmentation? The impact of artificial intelligence's technological characteristics on usage intention in medical staff
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Drug Combinations for Mood Disorders and Physical Comorbidities That Need Attention: A Cross-Sectional National Database Survey
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Click, care, connect: incorporating nursing informatics into undergraduate nursing curricula
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Digitalisation of the drug prescribing process in Swiss hospitals – results of a survey
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Electronic Medical Records (EMR) For Nursing Documentation: A Concept Analysis
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Ambulatory Medication Errors and Adverse Events Involved in Medicine-Related Malpractice Cases From 2011 to 2021
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Effectiveness of Patient-Directed Education to Sustain Deprescribing: A Pragmatic Trial
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Causality, severity and avoidability of adverse drug reactions in children: An 11‐year review
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Configuration Systems Applied to the Healthcare Sector for an Enhanced Prescription Process
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Authors: Scott, I. A., Pillans, P. I., Barras, M., & Morris, C.
Affiliations: Princess Alexandra Hospital (AU)
The University of Queensland (AU)
Queensland Health (AU)
Corresponding author: Scott, Ian A.
ORCID: Scott, Ian A.
Barras, Michael
Morris, Christopher
Venue: Therapeutic Advances in Drug Safety
Publisher: SAGE Publications
Published: 2018-07-12
Volume: 9
Issue: 9
Pages: 559-573
ISSN: 2042-0986 (ISSN-L)
2042-0994
DOI: 10.1177/2042098618784809
PMC: PMC6116772
OpenAlex: W2874356702
Cited by: 114
References: 68
Citations by year: 2026: 4 · 2025: 16 · 2024: 15 · 2023: 6 · 2022: 25 · 2021: 18 · 2020: 13 · 2019: 16 · 2018: 1
FWCI: 1.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Therapeutic Advances in Drug Safety (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Keywords: potentially inappropriate medications, computerized decision support systems, electronic health records, drug prescribing, older adults, electronic prescribing, computerized physician order entry, drug safety, adverse drug reactions, residential aged care facilities, outpatient care, hospital prescribing

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Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review

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