Using health information technology to improve drug monitoring: a systematic review.
OBJECTIVE
To conduct a systematic review of current evidence regarding the use of health information technology (HIT) interventions to improve drug monitoring in ambulatory care.


METHODS
We searched PubMed, CINAHL, the Cochrane Library, and other computerized databases from 1 January 1998 to 30 June 2008 using the key words "drug monitoring," "medical records systems, computerized," "ambulatory care," and "outpatients." We manually reviewed reference lists of articles identified through computer searches and asked experts in the field to review our search strategy and results for completeness.


RESULTS
Seven relevant studies were identified. Four of these studies assessed real-time interventions that used alerts to physicians at the time of medication ordering to ensure adequate monitoring, only one of which showed an improvement in monitoring. Of three studies using HIT outside the physician encounter, two suggested some improvement in monitoring rates. Methodological limitations were apparent in all studies identified.


CONCLUSIONS
Few studies have assessed the effectiveness of HIT interventions to improve drug monitoring, and among them, there is no clear consensus regarding the most consistently effective approaches to reducing drug monitoring errors. There is a clear need for well designed randomized trials to evaluate possible interventions to reduce drug monitoring errors. Such studies should incorporate health outcomes and detailed cost analyses to further characterize the feasibility of successful interventions.
Hayward
Geoffrey L
GL
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Parnes
Aaron J
AJ
Simon
Steven R
SR
D000553:Ambulatory Care; D020811:Biomedical Technology / Q000458:organization & administration*; D016903:Drug Monitoring / Q000379:methods*; D006801:Humans; D007256:Information Systems / Q000592:standards*; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D050316:Medical Order Entry Systems / Q000592:standards / Q000706:statistics & numerical data; D010045:Outpatients; D011787:Quality of Health Care / Q000592:standards; D016032:Randomized Controlled Trials as Topic