Overriding of Drug Safety Alerts in Computerized Physician Order Entry

Sijs, Heleen van der; Aarts, Jos; Vulto, Arnold G.; Berg, Marc

doi:10.1197/jamia.m1809

Cited by 906 publications

(702 citation statements)

References 51 publications

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“…A recent review found that providers overrode alerts 49-96 % of the time. 25 In one study, VHA clinicians rated only 11 % of reminders as clinically relevant, and in another study, a VA researcher found that 80 % of drug interaction warnings were ignored. 26,27 Studies of CCDS tools that allow for more complex data input have shown better performance of alerts.…”

Section: Discussionmentioning

confidence: 99%

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

et al. 2015

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INTRODUCTION:In 2012, the Veterans Health Administration (VHA) implemented guidelines seeking to reduce PSA-based screening for prostate cancer in men aged 75 years and older. OBJECTIVES: To reduce the use of inappropriate PSAbased prostate cancer screening among men aged 75 and over. SETTING: The Veterans Affairs Greater Los Angeles Healthcare System (VA GLA) PROGRAM DESCRIPTION: We developed a highly specific computerized clinical decision support (CCDS) alert to remind providers, at the moment of PSA screening order entry, of the current guidelines and institutional policy. We implemented the tool in a prospective interrupted time series study design over 15 months, and compared the trends in monthly PSA screening rate at baseline to the CCDS on and off periods of the intervention. RESULTS: A total of 30,150 men were at risk, or eligible, for screening, and 2,001 men were screened. The mean monthly screening rate during the 15-month baseline period was 8.3 %, and during the 15-month intervention period, was 4.6 %. The screening rate declined by 38 % during the baseline period and by 40 % and 30 %, respectively, during the two periods when the CCDS tool was turned on. The screening rate ratios for the baseline and two periods when the CCDS tool was on were 0.97, 0.78, and 0.90, respectively, with a significant difference between baseline and the first CCDS-on period (p<0.0001), and a trend toward a difference between baseline and the second CCDS-on period (p=0.056). CONCLUSION: Implementation of a highly specific CCDS tool alone significantly reduced inappropriate PSA screening in men aged 75 years and older in a reproducible fashion. With this simple intervention, evidence-based guidelines were brought to bear at the point of care, precisely for the patients and providers for whom they were most helpful, resulting in more appropriate use of medical resources.

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Section: Discussionmentioning

confidence: 99%

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

et al. 2015

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“…However, the value of CDS is often limited by providers' lack of alert acceptance. Multiple studies have shown that providers frequently override alerts because they are perceived as irrelevant [39][40][41][42] . The inability of EHR systems to effectively present information for CDS purposes may contribute to the mixed safety benefits observed in studies 1,[7][8][9][10]12,13 .…”

Section: Discussionmentioning

confidence: 99%

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

et al. 2011

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BACKGROUND: Healthcare providers previously using older electronic health records (EHRs) with electronic prescribing (e-prescribing) are transitioning to newer systems to be eligible for federal meaningful use incentives. Little is known about the safety effects of transitioning between systems. OBJECTIVE: To assess the effect of transitioning between EHR systems on rates and types of prescribing errors, as well as provider perceptions about the effect on prescribing safety. DESIGN, PARTICIPANTS: Prospective, case study of 17 physicians at an academic-affiliated ambulatory clinic from February 2008 through August 2009. All physicians transitioned from an older EHR with minimal clinical decision support (CDS) for e-prescribing to a newer EHR with more robust CDS. MAIN MEASUREMENTS: Prescribing errors were identified by standardized prescription and chart review. A novel survey instrument was administered to evaluate provider perceptions about prescribing safety. KEY RESULTS: We analyzed 1298 prescriptions at baseline, 1331 prescriptions 12 weeks post-implementation, and 1303 prescriptions one year post-implementation. Overall prescribing error rates were highest at baseline (35.7 per 100 prescriptions, 95% confidence interval (CI) 23.2-54.8) and lowest one year postimplementation (12.2 per 100 prescriptions, 95% CI 8.6-17.4) (p<0.001). Improvement in prescribing safety was mainly a result of reducing inappropriate abbreviation errors. However, rates for non-abbreviation prescribing errors were significantly higher at 12 weeks post-implementation than at baseline (17.7 per 100 prescriptions, 95% CI 9.5-33.0 versus 8.5 per 100 prescriptions, 95% CI 4.6-15.9) (p <0.001) and no different at baseline than one year (10.2 per 100 prescriptions, 95% CI 6.2-18.6) (p =0.337). Survey results complemented quantitative findings. CONCLUSIONS: Results from this case study suggest that transitioning between systems, even to those with more robust CDS, may pose important safety threats. Recognizing the challenges associated with transitions and refining CDS within systems may help maximize safety benefits. INTRODUCTIONImproving healthcare safety is a national priority, and eprescribing is viewed as an important tool in these efforts 1-2 . Research on the ability of e-prescribing to improve safety has predominantly come from the inpatient setting and on locally developed systems created by organizations for their own use 3-5 . Fewer studies have been conducted on commercial systems or in the outpatient setting and results have been mixed [6][7][8][9][10][11][12][13] . To ensure that federal spending is directed toward effective interventions, it is important to evaluate the effect of e-prescribing on safety in the ambulatory setting, where most prescribing occurs and errors are common 7,[12][13][14][15] .Use of e-prescribing in the ambulatory setting has been low, although increased use is expected given federal incentives for meaningful EHR use 2,[16][17][18][19][20] . To demonstrate meaningful use, providers will have to meet c...

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“…What accounts for this seemingly paradoxical result? With a positive predictive value of only 2.3% and 41,922 alerts, physicians may have become desensitized to alerted patients due to alert fatigue [22]. Modifications of the CDSS are planned to decrease the number of alerts and improve the specificity of the program.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia

Riggio

Cooper

Leiby

et al. 2008

J Thromb Thrombolysis

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Overriding of Drug Safety Alerts in Computerized Physician Order Entry

Cited by 906 publications

References 51 publications

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

Reducing PSA-Based Prostate Cancer Screening in Men Aged 75 Years and Older with the Use of Highly Specific Computerized Clinical Decision Support

Transitioning Between Electronic Health Records: Effects on Ambulatory Prescribing Safety

Effectiveness of a clinical decision support system to identify heparin induced thrombocytopenia

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