Evaluation of computerized provider order entry systems’ adoption for reducing medication errors in outpatient settings: A systematic review

Abstract

Background This study evaluates electronic health information systems for the patient safety, in particular, computerized physician order entry systems (CPOE) for the reduction of medication error, which eventually causes avoidable patient harm. The topic of patient safety has been widely spoken all over the world in recent years as patient harm often leaves people with disabilities or even causes death. Thus, this paper will conduct a systematic review on one part of electronic health information systems, which includes e-prescribing systems and clinical decision support systems and their impact on medication error rates in adults. Methods The systematic review was performed by two individual reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PRISMA 2020 guidelines. The PubMed (2002-2022), Scopus (2001-2022), Cochrane Library (2000-2022), Web of Science (2000-2022) and The Lancet (1981-2022) were searched by the reviewers for the literature review. Systematic search yielded 214 articles. The initial screening of titles and abstracts performed by two reviewers individually has resulted in 35 articles to be included in full-text review. Results A total of eight studies met inclusion criteria and measured the effect of CPOE and electronic prescribing systems on medication errors in outpatient clinics. The studies included are pre-post studies (n=5), randomized control trials (n=1), other observational interventional studies (n=2). One study was conducted in Middle East, one in Taiwan, one in Canada and five other studies included were conducted in the United States of America. Two of the 3 studies on effectiveness of electronic prescribing compared to traditional prescribing in reducing medication errors demonstrated a significant decrease in medication error rates 20% and 55% reduction rates after implementation of CPOE in the chosen settings. One study conducted in two different settings at different time periods showed 25% and 2% reduction rate. On the effectiveness of electronic prescribing with CDSS compared to electronic prescribing without CDSS, 28.5% reduction rate in overall inappropriate prescription rate in short-term and insignificant reduction rate in long-term was shown. The research identified significant rate of acceptance of alerts and recommendations by physicians in two studies (51.1% and 67%) and lower in other two studies (9.2% for DDI alerts, 23.0% for drug-allergy alerts; 3.06% for short term, 2.31% for long-term). There was no significant difference between acceptance rates of on-demand and computer-triggered CDSS. Conclusion First, the review provides clear information on the importance of CPOE implementation when paper-based system is in use, which can significantly reduce the medication error rate in the outpatient settings. Secondly, the review identified that integration of CDSS to electronic prescribing can positively impact number of medication errors in patients with renal insufficiency. Lastly, the review suggests high acceptance rate of various types of alerts by physicians for improving completeness of prescriptions, not only for medication but for laboratory test prescriptions as well.