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- Title
Impact of Vendor Computerized Physician Order Entry in Community Hospitals.
- Authors
Leung, Alexander; Keohane, Carol; Amato, Mary; Simon, Steven; Coffey, Michael; Kaufman, Nathan; Cadet, Bismarck; Schiff, Gordon; Zimlichman, Eyal; Seger, Diane; Yoon, Catherine; Song, Peter; Bates, David
- Abstract
BACKGROUND: It is uncertain if computerized physician order entry (CPOE) systems are effective at reducing adverse drug event (ADE) rates in community hospitals, where mainly vendor-developed applications are used. OBJECTIVE: To evaluate the impact of vendor CPOE systems on the frequency of ADEs. DESIGN AND PATIENTS: Prospective before-and-after study conducted from January 2005 to September 2010 at five Massachusetts community hospitals. Participants were adults admitted during the study period. A total of 2,000 charts were reviewed for orders, medication lists, laboratory reports, admission histories, notes, discharge summaries, and flow sheets. MAIN MEASURES: The primary outcome measure was the rate of preventable ADEs. Rates of potential ADEs and overall ADEs were secondary outcomes. KEY RESULTS: The rate of preventable ADEs decreased following implementation (10.6/100 vs. 7.0/100 admissions; p = 0.007) with a similar effect observed at each site. However, the associated decrease in preventable ADEs was balanced against an increase in potential ADEs (44.4/100 vs. 57.5/100 admissions; p < 0.001). We observed a reduction of 34.0% for preventable ADEs, but an increase of 29.5% in potential ADEs following implementation. The overall rate of ADEs increased (14.6/100 vs. 18.7/100 admissions; p = 0.03), which was driven by non-preventable events (4.0/100 vs. 11.7/100 admissions; p < 0.001). CONCLUSIONS: Adoption of vendor CPOE systems was associated with a decrease in the preventable ADE rate by a third, although the rates of potential ADEs and overall ADEs increased. Our findings support the use of vendor CPOE systems as a means to reduce drug-related injury and harm. The potential ADE rate could be reduced by making refinements to the vendor applications and their associated decision support.
- Subjects
MASSACHUSETTS; ORDER entry; ELECTRONIC health records; PREVENTION of drug side effects; LABORATORY reports; HOSPITALS
- Publication
JGIM: Journal of General Internal Medicine, 2012, Vol 27, Issue 7, p801
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-012-1987-7