Impact of health information technology on detection of potential adverse drug events at the ordering stage

Document Type


Peer Reviewed


Publication Date


NLM Title Abbreviation

Am J Health Syst Pharm

Journal/Book/Conference Title

American Journal of Health-System Pharmacy

PubMed ID


DOI of Published Version


Start Page


End Page



PURPOSE: The impact of implementing commercially available health care information technologies at hospitals in a large health system on the identification of potential adverse drug events (ADEs) at the medication ordering stage was studied. METHODS: All hospitals in the health system had implemented a clinical decision-support system (CDSS) consisting of a centralized clinical data repository, interfaces for reports, a results reviewer, and a package of ADE alert rules. Additional technology including computerized provider order entry (CPOE), an advanced CDSS, and evidence-based order sets was implemented in nine hospitals. ADE alerts at these hospitals were compared with alerts at nine hospitals without the advanced technology. A linear mixed-effects model was used in determining the mean response profile of six dependent variables over 28 total months for each experimental group. RESULTS: Overall, hospitals with CPOE and an advanced CDSS captured significantly more ADE alerts for pharmacist review; an average of 336 additional potential ADEs per month per hospital were reviewed. Pharmacists identified some 94% of the alerts as false positives. Alerts identified as potentially true positives were reviewed with physicians, and order changes were recommended. The number of true-positive alerts per 1000 admissions increased. CONCLUSION: The implementation of CPOE and advanced CDSS tools significantly increased the number of potential ADE alerts for pharmacist review and the number of true-positive ADE alerts identified per 1000 admissions.


Adverse Drug Reaction Reporting Systems, Clinical Pharmacy Information Systems/organization & administration, Decision Support Systems, Clinical/organization & administration, Drug Therapy, Computer-Assisted/methods, Drug Toxicity/prevention & control, Humans, Medical Order Entry Systems/organization & administration, Medication Errors/prevention & control, Medication Systems, Hospital/organization & administration, Pharmaceutical Preparations/adverse effects

Published Article/Book Citation

American Journal of Health-System Pharmacy, 67:21 (2010) pp.1838-1846. DOI:10.2146/ajhp090637.

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