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

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.