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Evaluation of Outpatient Computerized Physician Medication Order Entry Systems: A Systematic Review

Department of Medical Informatics, Academic Medical Center, Universiteit van Amsterdam, Amsterdam, The Netherlands.

^_* Correspondence and reprints: Saeid Eslami, Academic Medical Center, Universiteit van Amsterdam, Department of Medical Informatics, J1b-124, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands (Email: s.eslami{at}amc.uva.nl).

Received for publication: 08/02/06; accepted for publication: 04/02/07.

This paper provides 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. 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.

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