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Computerized prescribing alerts can be designed to be widely accepted by primary care clinicians

Clinical decision support systems (CDSS) embedded within computerized prescribing systems reduce medication errors by checking entered prescriptions for potential problems such as drug interactions and allergies. If a potential problem is found, the CDSS provides clinicians with real-time alerts, allowing the clinician to make appropriate changes before the prescription is finalized. When the threshold for alerting is set too low, clinicians are inundated with alerts of low clinical significance, leading to high override rates and the potential threat they will override even important alerts.

However, it is possible to design computerized prescribing alerts that will be widely accepted by clinicians, concludes a study supported by the Agency for Healthcare Research and Quality (HS11169 and T32 HS00020). The researchers designated that only critical to high-severity alerts could interrupt clinician workflow. The alerts were presented to clinicians using computerized prescribing within an electronic medical record in 31 primary care practices. A total of 18,115 drug alerts were generated during the 6-month study period.

Of the drug alerts, 71 percent were in noninterruptive display mode and 29 percent were interruptive. Clinicians accepted the 5,182 interruptive (critical or high-severity) alerts two-thirds (67 percent) of the time, which is much higher than previously published acceptance rates.

Their reasons for overriding alerts were varied. In some cases, they were transitioning the patient from one drug to the other (42 percent) or the patient was on long-term therapy with the drug combination (21 percent). In other cases, the patient was being placed on the drug combination for a short-term or as-needed basis only (7 percent) or "new evidence" existed for the drug's use (2 percent). These reasons suggest that clinicians often deviate from prescribing recommendations for good clinical reasons. This information is worth capturing for subsequent evaluation and revision of alerts, suggest the researchers.

See "Improving acceptance of computerized prescribing alerts in ambulatory care," by Nidhi R. Shah, M.D., M.P.H., Andrew C. Seger, Pharm.D., Diane L. Seger, R.Ph., and others, in the January 2006 Journal of the American Medical Informatics Association 13(1), pp. 5-11.

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