Effects of computerized physician order entry on prescribing practices.
BACKGROUND
Computerized order entry systems have the potential to prevent errors, to improve quality of care, and to reduce costs by providing feedback and suggestions to the physician as each order is entered. This study assesses the impact of an inpatient computerized physician order entry system on prescribing practices.


METHODS
A time series analysis was performed at an urban academic medical center at which all adult inpatient orders are entered through a computerized system. When physicians enter drug orders, the computer displays drug use guidelines, offers relevant alternatives, and suggests appropriate doses and frequencies.


RESULTS
For medication selection, use of a computerized guideline resulted in a change in use of the recommended drug (nizatidine) from 15.6% of all histamine(2)-blocker orders to 81.3% (P<.001). Implementation of dose selection menus resulted in a decrease in the SD of drug doses by 11% (P<.001). The proportion of doses that exceeded the recommended maximum decreased from 2.1% before order entry to 0.6% afterward (P<.001). Display of a recommended frequency for ondansetron hydrochloride administration resulted in an increase in the use of the approved frequency from 6% of all ondansetron orders to 75% (P<.001). The use of subcutaneous heparin sodium to prevent thrombosis in patients at bed rest increased from 24% to 47% when the computer suggested this option (P<.001). All these changes persisted at 1- and 2-year follow-up analyses.


CONCLUSIONS
Computerized physician order entry is a powerful and effective tool for improving physician prescribing practices.
Teich
J M
JM
Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. jteich@harvard.edu
Merchia
P R
PR
Schmiz
J L
JL
Kuperman
G J
GJ
Spurr
C D
CD
Bates
D W
DW
D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D004363:Drug Utilization; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control*; D016567:Nizatidine / Q000008:administration & dosage / Q000009:adverse effects; D017294:Ondansetron / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012984:Software
D017294:Ondansetron; D006493:Heparin; D016567:Nizatidine