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

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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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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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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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