Costs associated with developing and implementing a computerized clinical decision support system for medication dosing for patients with renal insufficiency in the long-term care setting
Open accessAbstract
A team of physicians, pharmacists, and informatics professionals developed a CDSS added to a commercial electronic medical record system to provide prescribers with patient-specific maximum dosing recommendations based on renal function. We tracked the time spent by team members and used US national averages of relevant hourly wages to estimate costs. The team required 924.5 hours and $48,668.57 in estimated costs to develop 94 alerts for 62 drugs. The most time intensive phase of the project was preparing the contents of the CDSS (482.25 hours, $27,455.61). Physicians were the team members with the highest time commitment (414.25 hours, $25,902.04). Estimates under alternative scenarios found lower total cost estimates with the existence of a valid renal dosing database ($34,200.71) or an existing decision support add-on for renal dosing ($23,694.51). Development of a CDSS for a commercial computerized prescriber order entry system requires extensive commitment of personnel, particularly among clinical staff.
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Alert creation and maintenance can be quite costly; one study found the cost of creating 94 new drug alerts to be $23,694 to 48,668, or approximately $252 to 518 per alert, with an additional annual maintenance cost of 10-20% of the creation cost.
“Finally, alert creation and maintenance can be quite costly. One study found the cost of creating 94 new drug alerts to be $23,694 to 48,668 (United States dollars), or approximately $252 to 518 per alert, with an additional annual maintenance cost of 10–20% of the creation cost.”
From Qualitative Study of Inpatient Hospital Medicine Interruptive Alerts and Clinical Decision Support (2026) · cites this paper as [22]
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Qualitative Study of Inpatient Hospital Medicine Interruptive Alerts and Clinical Decision Support
Khan, A., & Schnipper, J. (2026) · Applied Clinical Informatics · doi:10.1055/a-2955-9555
- Authors
- Field, T. S., Rochon, P., Lee, M., Gavendo, L., Subramanian, S., Hoover, S., Baril, J., & Gurwitz, J.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Baycrest Centre for Geriatric Care (CA)
- RTI International (US)
- Corresponding author
- Field, T. S.
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-07-01
- Volume
- 15
- Issue
- 4
- Pages
- 466-472
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC2442257
- OpenAlex
- W1533598587
- Cited by
- 60
- References
- 1
- Citations by year
- 2026: 1 · 2025: 2 · 2022: 4 · 2021: 1 · 2020: 1 · 2019: 5 · 2018: 3 · 2017: 1 · 2016: 6 · 2015: 5 · 2014: 3 · 2013: 2 · 2012: 7
- FWCI
- 14.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship@UMassChan (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS015430, HS15430, R01 HS010481, HS010481)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- computerized clinical decision support, renal dosing, renal failure, drug dosing, long-term care, electronic health records, development costs, computerized physician order entry
- MeSH terms
- Costs and Cost Analysis, Drug Therapy, Computer-Assisted, Health Personnel, Humans, Long-Term Care, Medication Systems, Organizational Innovation, Task Performance and Analysis, User-Computer Interface, Medical Records Systems, Computerized, Decision Support Systems, Clinical, Medical Order Entry Systems, Renal Insufficiency
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