title: Acceptability and feasibility of the Leapfrog computerized physician order entry evaluation tool for hospitals outside the United States.
abstract: BACKGROUND
  Computerized physician order entry (CPOE) with clinical decision support is expected to deliver many benefits in terms of patient safety. The Leapfrog tool was developed to allow hospitals to assess their medication-safety related decision support. To explore the approach's generalizability, we examined its acceptability and feasibility through an evaluation using this tool in four Korean hospital systems.
  
  
  METHODS
  Four hospitals with locally developed CPOE systems participated, and a cross-sectional study design was used with the approval of the Leapfrog Group and the institutional review board at each hospital site. The hospitals were tertiary and academic institutions with long experience of advanced CPOE. From January 21 to 28, 2014, web-based tests were conducted at each site following the given instructions, and the results were self-reported. We measured each system's response rate, category completion rate, and time to complete the evaluation. Additionally, we compared the evaluation results of the four systems with scores from five US systems, as was reported in another study.
  
  
  RESULTS
  The four systems underwent the tests, and the overall category completion rates ranged from 67.9% to 75.5%. The times to finish the tests were tolerable and within the allowed test timeframe. One system did not pass the deception analysis, which checks for false positives, due to a conflict with another type of alert checking for the presence of a medical diagnosis for documentation purposes. The other three systems scored at the completed the evaluation stage, with scores ranging from 21.6% to 36.5%. Of the nine error categories, Drug-Allergy was an area of strength for all systems, whereas the categories of Therapeutic duplication, Drug-Labs, and Drug-Age were areas of weakness for all. In comparison with the US systems, gaps were identified, and further improvement is needed.
  
  
  CONCLUSIONS
  The acceptability of the CPOE evaluation tool was moderate, but the feasibility was sufficient to operate the test outside the US, and the results revealed many opportunities for improvement in the Korean systems, as was the case when this application was introduced in the US.
authors.affiliation: Nursing Department, Inha University, Incheon, South Korea; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Insook
authors.initials: I
authors.lastname: Cho
authors.affiliation: The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: jaeholee@amc.seoul.kr.
authors.forename: Jae-Ho
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Inha University School of Medicine, Incheon, South Korea.
authors.forename: Sun-Keun
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, South Korea.
authors.forename: Jin-Wook
authors.initials: JW
authors.lastname: Choi
authors.affiliation: Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Hee
authors.initials: H
authors.lastname: Hwang
authors.affiliation: The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Partners Healthcare Systems, Inc., Wellesley, MA, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical; D004059:Diffusion of Innovation; D005240:Feasibility Studies; D006761:Hospitals; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000517:prevention & control*; D015397:Program Evaluation; D017751:Safety Management; D014481:United States
keywords: Computerized physician order entry; Decision support; Medication safety; Prescribing; Quality