Comparison of a basic and an advanced pharmacotherapy-related clinical decision support system in a hospital care setting in the Netherlands
Open Access
- 1 January 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of the American Medical Informatics Association
- Vol. 19 (1), 66-71
- https://doi.org/10.1136/amiajnl-2011-000360
Abstract
Objective To compare the clinical relevance of medication alerts in a basic and in an advanced clinical decision support system (CDSS). Design A prospective observational study. Materials and methods We collected 4023 medication orders in a hospital for independent evaluation in two pharmacotherapy-related decision support systems. Only the more advanced system considered patient characteristics and laboratory test results in its algorithms. Two pharmacists assessed the clinical relevance of the medication alerts produced. The alert was considered relevant if the pharmacist would undertake action (eg, contact the physician or the nurse). The primary analysis concerned the positive predictive value (PPV) for clinically relevant medication alerts in both systems. Results The PPV was significantly higher in the advanced system (5.8% vs 17.0%; pConclusion The advanced CDSS produced a higher proportion of clinically relevant medication alerts, but the number of irrelevant alerts remained high. To improve the PPV of the advanced CDSS, the algorithms should be optimized by identifying additional risk modifiers and more data should be made electronically available to improve the performance of the algorithms. Our study illustrates and corroborates the need for cyclic testing of technical improvements in information technology in circumstances representative of daily clinical practice.Keywords
This publication has 31 references indexed in Scilit:
- Ability of pharmacy clinical decision-support software to alert users about clinically important drug—drug interactionsJournal of the American Medical Informatics Association, 2011
- Laboratory Tests in the Clinical Risk Management of Potential Drug-Drug InteractionsDrug Safety, 2009
- Clinical Decision Support Capabilities of Commercially-available Clinical Information SystemsJournal of the American Medical Informatics Association, 2009
- Turning Off Frequently Overridden Drug Alerts: Limited Opportunities for Doing It SafelyJournal of the American Medical Informatics Association, 2008
- A Systematic Review of the Performance Characteristics of Clinical Event Monitor Signals Used to Detect Adverse Drug Events in the Hospital SettingJournal of the American Medical Informatics Association, 2007
- Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A ReviewJournal of the American Medical Informatics Association, 2007
- A Composite Screening Tool for Medication Reviews of OutpatientsDrugs & Aging, 2007
- Adverse Drug Event Detection in a Community Hospital Utilising Computerised Medication and Laboratory DataDrug Safety, 2007
- Prescribers' Responses to Alerts During Medication Ordering in the Long Term Care SettingJournal of the American Medical Informatics Association, 2006
- Clinical Relevance of Drug-Drug InteractionsDrug Safety, 2005