title: The effectiveness of computerized drug-lab alerts: a systematic review and meta-analysis.
abstract: BACKGROUND
  Inadequate lab monitoring of drugs is a potential cause of ADEs (adverse drug events) which is remediable.
  
  
  OBJECTIVE
  To determine the effectiveness of computerized drug-lab alerts to improve medication-related outcomes.
  
  
  METHODS
  Citations from the Computerized Clinical Decision Support System Systematic Review (CCDSSR) and MMIT (Medications Management through Health Information Technology) databases, which had searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts from 1974 to March 27, 2013.
  
  
  METHODS
  Randomized controlled trials (RCTs) of clinician-targeted computerized drug lab alerts conducted in any healthcare setting. Two reviewers performed full text review to determine study eligibility.
  
  
  METHODS
  A single reviewer abstracted data and evaluated validity of included studies using Cochrane handbook domains.
  
  
  RESULTS
  Thirty-six studies met the inclusion criteria (25 single drug studies with 22,504 participants, 14 targeting anticoagulation; 11 multi-drug studies with 56,769 participants). ADEs were reported as an outcome in only four trials, all targeting anticoagulants. Computerized drug-lab alerts did not reduce ADEs (OR 0.89, 95% CI 0.79-1.00, p=0.05), length of hospital stay (SMD 0.00, 95%CI -0.93 to 0.93, p=0.055, 1 study), likelihood of hypoglycemia (OR 1.29, 95% CI 0.31-5.37) or likelihood of bleeding, but were associated with increased likelihood of prescribing changes (OR 1.73, 95% CI 1.21-2.47) or lab monitoring (OR 1.47, 95% confidence interval 1.12-1.94) in accordance with the alert.
  
  
  CONCLUSIONS
  There is no evidence that computerized drug-lab alerts are associated with important clinical benefits, but there is evidence of improvement in selected clinical surrogate outcomes (time in therapeutic range for vitamin K antagonists), and changes in process outcomes (lab monitoring and prescribing decisions).
authors.affiliation: Department of Family Medicine, McMaster University, Canada; Kingston Community Health Centres, Canada; Department of Family Medicine, Queen's University, Canada. Electronic address: imaan@kchc.ca.
authors.forename: Imaan
authors.initials: I
authors.lastname: Bayoumi
authors.affiliation: Department of Pharmacy, St. Joseph's Health Care Hamilton, Hamilton, Canada.
authors.forename: Mosab
authors.initials: M
authors.lastname: Al Balas
authors.affiliation: Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA, United States; Center for Health Equity Research and Promotion (CHERP), VAPHS, Pittsburgh, PA, United States.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada; Department of Family Medicine, McMaster University, Canada; Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada; Department of Family Medicine, McMaster University, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Hutchison
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Canada; Division of Clinical Pharmacology & Therapeutics, Department of Medicine, McMaster University, Canada; Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Holbrook
mesh_terms: D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D016903:Drug Monitoring / Q000379:methods*; D004360:Drug Therapy, Computer-Assisted; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D006801:Humans; D050316:Medical Order Entry Systems
keywords: Computer-assisted decision making; Computerized alerts; Drug monitoring; Drug toxicity; Systematic review