SummaryObjectives: To analyze the attitude of physicians towards alerting in CPOE systems in different hospitals in different countries, addressing various organizational and technical settings and the view of physicians not currently using a CPOE.Methods: A cross-sectional quantitative and qualitative questionnaire survey. We invited 2,600 physicians in eleven hospitals from nine countries to participate. Eight of the hospitals had different CPOE systems in use, and three of the participating hospitals were not using a CPOE system.Results: 1,018 physicians participated. The general attitude of the physicians towards CPOE alerting is positive and is found to be mostly independent of the country, the specific organizational settings in the hospitals and their personal experience with CPOE systems. Both quantitative and qualitative results show that the majority of the physicians, both CPOE-users and non-users, appreciate the benefits of alerting in CPOE systems on medication safety. However, alerting should be better adapted to the clinical context and make use of more sophisticated ways to present alert information. The vast majority of physicians agree that additional information regarding interactions is useful on demand. Around half of the respondents see possible alert overload as a major problem; in this regard, physicians in hospitals with sophisticated alerting strategies show partly better attitude scores.Conclusions: Our results indicate that the way alerting information is presented to the physicians may play a role in their general attitude towards alerting, and that hospitals with a sophisticated alerting strategy with less interruptive alerts tend towards more positive attitudes. This aspect needs to be further investigated in future studies.

Drug-drug interactions were very frequent and were very stable over the years studied, involving on average 27% of all prescriptions and 44% in internal medicine. Only a very limited amount of drugs were responsible for the vast majority of DDI, especially when the most severe categories of DDI were considered. Most of the severe DDI alerts could be automatically handled, if for example laboratory values could be taken into account. The DDI database should ideally be supplemented by information enabling more sophisticated computerised support in order to deliver more reasonable results from DDI checks.

Quantitative data analysis of treatment regimens in patients with CHF is an inaccurate method for measuring guideline adherence. Combining quantitative prescribing data with semistructured interviews shows a 90% match concerning guideline adherence compared to an only 60% match based on quantitative data alone. Thus, neither quality nor economical assessments of the treatment strategy in patients with chronic diseases should be solely based on quantitative analysis. Understanding non-adherence is crucial for defining and improving quality of care.

The incidences of erroneous too frequent low-dose methotrexate prescriptions observed at both hospitals were considered too high due to the high potential for increased morbidity, mortality and costs. Therefore, quality assurance measures were implemented and the preliminary data show a positive impact on patient safety for both approaches.

The actual level of exposure to non-ionizing radiation in Swiss hospitals is not well known. Therefore, the electromagnetic field of wireless LAN (WLAN) and other non-ionizing radiation sources in the publicly funded Hospital Thun (Switzerland), where WLAN supports bedside access to the computerized patient record for more than three years, has been measured. The results are compared to the international and national exposure limits for the general public. Nurse workplaces as well as patient rooms show exposure levels well below the legal (national and international) exposure limits. In the investigated patients' room the electromagnetic field of GSM and broadband cellular phone networks are dominant, whereas at the nurse workplace WLAN exposure is the most important source of exposure. The results of a questionnaire survey emphasize, that the hospital staff does not worry much about electromagnetic fields of new ICT technologies.