Impact of health information technology on detection of potential adverse drug events at the ordering stage

Abstract

The impact of implementing commercially available health care information technologies at hospitals in a large health system on the identification of potential adverse drug events (ADEs) at the medication ordering stage was studied. All hospitals in the health system had implemented a clinical decision-support system (CDSS) consisting of a centralized clinical data repository, interfaces for reports, a results reviewer, and a package of ADE alert rules. Additional technology including computerized provider order entry (CPOE), an advanced CDSS, and evidence-based order sets was implemented in nine hospitals. ADE alerts at these hospitals were compared with alerts at nine hospitals without the advanced technology. A linear mixed-effects model was used in determining the mean response profile of six dependent variables over 28 total months for each experimental group. Overall, hospitals with CPOE and an advanced CDSS captured significantly more ADE alerts for pharmacist review; an average of 336 additional potential ADEs per month per hospital were reviewed. Pharmacists identified some 94% of the alerts as false positives. Alerts identified as potentially true positives were reviewed with physicians, and order changes were recommended. The number of true-positive alerts per 1000 admissions increased. The implementation of CPOE and advanced CDSS tools significantly increased the number of potential ADE alerts for pharmacist review and the number of true-positive ADE alerts identified per 1000 admissions.