Eslami S et al. 2007 "Evaluation of outpatient computerized physician medication order entry systems: a systematic review."

Reference
Eslami S, Abu-Hanna A, de Keizer NF. Evaluation of outpatient computerized physician medication order entry systems: a systematic review. J Am Med Inform Assoc 2007;14(4):400-406.
Abstract
"This paper provides a systematic literature review of [computerized provider order entry] CPOE evaluation studies in the outpatient setting on: safety; cost and efficiency; adherence to guideline; alerts; time; and satisfaction, usage, and usability. Thirty articles with original data (randomized clinical trial, non-randomized clinical trial, or observational study designs) met the inclusion criteria. Only four studies assessed the effect of CPOE on safety. The effect was not significant on the number of adverse drug events. Only one study showed a significant reduction of the number of medication errors. Three studies showed significant reductions in medication costs; five other studies could not support this. Most studies on adherence to guidelines showed a significant positive effect. The relatively small number of evaluation studies published to date do not provide adequate evidence that CPOE systems enhance safety and reduce cost in the outpatient settings. There is however evidence for (a) increasing adherence to guidelines, (b) increasing total prescribing time, and (c) high frequency of ignored alerts."
Objective
To provide a "systematic literature review of CPOE evaluation studies in the outpatient setting on: safety; cost and efficiency; adherence to guideline; alerts; time; and satisfaction, usage, and usability."
Size
not applicable
Type of Health IT
Computerized provider order entry (CPOE)
Type of Health IT Functions
As defined for this review, a CPOE system "allows clinicians to enter medication orders directly for outpatients or primary care patients."
Workflow-Related Findings
"Three studies, one observational, one non-[randomized control trial] RCT, and one RCT, evaluated the effect of electronic prescription on physician office resources and showed a reduction in pharmacist interventions for prescriptions. One RCT showed there was no statistically significant effect on consultation rate."
"Five studies addressed user response to alerts. Four studies showed that most of the alerts (from 55% to 91.2%) were ignored by the physicians. Two studies showed that "clinical irrelevance" was the main reported reason for overriding alerts."
"Five observational studies showed that after the introduction of the CPOE system, the majority of users were satisfied with the system and they believed that the system is usable. Although the environment, questionnaire, and target groups were different in these studies, the majority of users believed that CPOE improved drug management and quality of care. Three others, one RCT and two non-RCT, showed that user satisfaction and usability decreased."
"Eleven studies evaluated the impact of CPOE with a [decision support system] DSS on the adherence to a guideline or another standard. Among these, four studies showed that there was a significant positive effect on adherence; two studies showed a positive effect without reporting on statistical significance; and five studies did not find a significant difference between the control and the intervention group."
"Three studies, one RCT and two non-RCTs, showed that the total time for direct and indirect patient care increased due to the introduction of the CPOE system. Another observational study showed that physicians did not believe that electronic prescription was more time consuming than hand-written prescription."
Study Design
Systematic literature review
Study Participants
The literature review consisted of 30 original articles.