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First published June 25, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2453
Journal of the American Medical Informatics Association 2008;15(5):620-626
© 2008 American Medical Informatics Association

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Submitted on March 28, 2007
Accepted on June 13, 2008

Evaluating Clinical Decision Support Systems: Monitoring CPOE order check override rates in the Department of Veterans Affairs' Computerized Patient Record System

Ching-Ping Lin1*, Thomas H. Payne MD2, W. Paul Nichol MD3, Patty J. Hoey RPh3, Curtis L. Anderson4, and John H. Gennari PhD5

Affiliation of the authors: 1 Biomedical and Health Informatics, University of Washington, Seattle, WA; 2 Biomedical and Health Informatics, University of Washington, Seattle, WA; UW Medicine Information Technology Services, University of Washington, Seattle, WA ; 3 VA Puget Sound Health Care System, Seattle, WA; 4 Salt Lake City CIO Field Office, Dept. of Veterans Affairs, Salt Lake City, UT ; 5 Biomedical and Health Informatics, University of Washington, Seattle, WA

* To whom correspondence should be addressed.

Objective To measure critical order check override rates in VA Puget Sound Health Care System's computerized practitioner order entry (CPOE) system and to compare 2006 results to a similar 2001 study.

Design Analysis of ordering and order check data gathered by a post-hoc logging program. Use of Pearson's chi-square contingency table test comparing results from this study and the earlier study.

Measurements Factors measured were total number of orders, frequency of order check types, frequency of order check overrides by order check type and comparisons of these results with previous results.

Results A total of 37,040 orders generated 908 (2.5%) critical order checks. Drug-drug critical alert override rate was 74/85 (87%) in 2006 compared to 95/108 (88%) in 2001 (X2=0.04, df=1, p=0.85). The drug-allergy override rate was 341/420 (81%) compared to 72/105 (69%) in 2001 (X2=7.97, df=1, p=0.005). In 2001, 0.25% (105/42,621) orders generated a drug-allergy order check compared to 1.13% (420/37,040) in 2006 (X2=238.45, df=1, p<0.0001).

Conclusion Override rates of critical drug-drug and drug-allergy order checks remain high at VA Puget Sound Health Care System including significant increases in drug-allergy order checks. We recommend that monitoring override rates be regular practice in clinical computing systems and conclude that qualitative research should be carried out to better understand how physicians interact with decision support at the point of ordering.






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