Evaluation of Outpatient Computerized Physician Medication Order Entry Systems: A Systematic Review
Open accessAbstract
This paper provides a systematic literature review of CPOE evaluation studies in the outpatient setting on: safety; cost and efficiency; adherence to guideline; alerts; time; and satisfaction, usage, and usability. Thirty articles with original data (randomized clinical trial, non-randomized clinical trial, or observational study designs) met the inclusion criteria. Only four studies assessed the effect of CPOE on safety. The effect was not significant on the number of adverse drug events. Only one study showed a significant reduction of the number of medication errors. Three studies showed significant reductions in medication costs; five other studies could not support this. Most studies on adherence to guidelines showed a significant positive effect. The relatively small number of evaluation studies published to date do not provide adequate evidence that CPOE systems enhance safety and reduce cost in the outpatient settings. There is however evidence for (a) increasing adherence to guidelines, (b) increasing total prescribing time, and (c) high frequency of ignored alerts.
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Using CDSSs for prescribing can reduce medication errors.
“Systematic reviews have demonstrated that use of CDSSs for prescribing can reduce toxic drug levels and time to therapeutic control, 5 6 reduce medication errors 7 8 and change prescribing in accordance with guideline recommendations.9”
From Computerized clinical decision support for prescribing: provision does not guarantee uptake (2010) · cites this paper as [7]
Reviews covering electronic and paper-based CDSS in multiple clinical areas found they can alter clinician behavior, including screening, test ordering, and adherence to guidelines.
“Systematic reviews of electronic and paper-based clinical decision support across a range of clinical domains have demonstrated its effectiveness in changing clinicians' practices such as screening, test ordering and guideline adherence, 5 7-9 11-13 but there is no consistent translation into patient outcomes.11”
From Computerized clinical decision support for prescribing: provision does not guarantee uptake (2010) · cites this paper as [7]
Most available studies were conducted by EHR developers and examined only a few error types related to order entry (CPOE).
“The few available studies have largely been conducted by the developers of the EHRs and have focused on the effect of order entry (CPOE) systems on a limited number of error types.[17][18][19][20]”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [19]
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References 59 · Cited by 200
- Authors
- Eslami, S., Abu-Hanna, A., & de Keizer, N. F.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Eslami, S.
- ORCID
- Eslami, S.
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-07-01
- Volume
- 14
- Issue
- 4
- Pages
- 400-406
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC2244893
- OpenAlex
- W2132673565
- Cited by
- 200
- References
- 59
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 6 · 2023: 2 · 2022: 3 · 2021: 8 · 2020: 5 · 2019: 11 · 2018: 10 · 2017: 9 · 2016: 11 · 2015: 11 · 2014: 11 · 2013: 18 · 2012: 17
- FWCI
- 2.86
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- 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, outpatient care, drug safety, medication errors, adverse drug reactions, drug costs, guideline adherence, clinical decision support alerts, alarm fatigue, usability, patient satisfaction
- MeSH terms
- Drug Therapy, Computer-Assisted, Evaluation Studies as Topic, Humans, Medication Errors, Medication Systems, Guideline Adherence, Decision Support Systems, Clinical, Medical Order Entry Systems
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