Int J Med Inform - Functionality test for drug safety alerting in computerized physician order entry systems.

Tópicos

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Resumo

RPOSE: To evaluate the functionality of drug safety alerting in hospital computerized physician order entry (CPOE) systems by a newly developed comprehensive test.METHODS: Comparative evaluation of drug safety alerting quality in 6 different CPOEs used in Dutch hospitals, by means of 29 test items for sensitivity and 19 for specificity in offices of CPOE system vendors. Sensitivity and specificity were calculated for the complete test, and for the categories "within-order checks", "patient-specific checks", and "checks related to laboratory data and new patient conditions". Qualitative interviews with 16 hospital pharmacists evaluating missing functionality and corresponding pharmacy checks.RESULTS: Sensitivity ranged from 0.38 to 0.79 and specificity from 0.11 to 0.84. The systems achieved the same ranking for sensitivity as for specificity. Within-order checks and patient-specific checks were present in all systems; alert generation or suppression due to laboratory data and new patient conditions was largely absent. Hospital pharmacists unanimously rated checks on contra-indications (absent in 2 CPOEs) and dose regimens less than once a day (absent in 4 CPOEs) as important. Pharmacists' opinions were more divergent for other test items. A variety of pharmacy checks were used, and clinical rules developed, to address missing functionality.CONCLUSIONS: Our test revealed widely varying functionality and appeared to be highly discriminative. Basic clinical decision support was partly absent in two CPOEs. Hospital pharmacists did not rate all test items as important and tried to accommodate the lacking functionality by performing additional checks and developing clinical rules.

Resumo Limpo

rpose evalu function drug safeti alert hospit computer physician order entri cpoe system newli develop comprehens testmethod compar evalu drug safeti alert qualiti differ cpoe use dutch hospit mean test item sensit specif offic cpoe system vendor sensit specif calcul complet test categori withinord check patientspecif check check relat laboratori data new patient condit qualit interview hospit pharmacist evalu miss function correspond pharmaci checksresult sensit rang specif system achiev rank sensit specif withinord check patientspecif check present system alert generat suppress due laboratori data new patient condit larg absent hospit pharmacist unanim rate check contraind absent cpoe dose regimen less day absent cpoe import pharmacist opinion diverg test item varieti pharmaci check use clinic rule develop address miss functionalityconclus test reveal wide vari function appear high discrimin basic clinic decis support part absent two cpoe hospit pharmacist rate test item import tri accommod lack function perform addit check develop clinic rule

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