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J Am Med Inform Assoc 15:585-600 doi:10.1197/jamia.M2667
  • The Practice of Informatics

The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review

Table 2

Characteristics of 27 Studies on Electronic Prescribing

Paper Time of study Name of hospital Clinical setting Level of care Patients included in study Drugs included in study Name of system Type of system Electronic prescribing introduced since when Description of functionality Type of functionality Control situation
Bates (1998) 1993–1995 Brigham and Women's Hospital, Boston, USA Six intensive, medical and surgical units in a 700-bed academic tertiary-care hospital Normal care No restrictions No restrictions BICS Home grown Electronic prescribing introduced as part of BICS since 1993 with increasing functionality CPOE system with default doses, display of lab results, consequent orders, limited drug-allerg, dru-drug interaction checking and drug-laboratory checking Advanced DSS Orders were handwritten in order books
Bates (1999) 1992–1997 Brigham and Women's' Hospital, Boston, USA One intensive and two general medical care units in a 700-bed academic tertiary-care hospital Normal care No restrictions No restrictions BICS Home grown Electronic prescribing introduced as part of BICS since 1993 with increasing functionality (Period 3): CPOE system with display of lab values, drug-allergy checking, redundant medication checking, drug-drug interaction checking, drug-lab checking, order sets Advanced DSS Orders were handwritten in order books
Bizovi (2002) 1999–2000 Oregon Health & Science University, USA Emergency department of a tertiary care teaching hospital Normal care Emergency care patients No restrictions EmSTAT, CyberPlus Corporation (in use since 1997) Commercial Electronic prescribing was introduced in the emergency department in 2000 Prescription writing module with display of patient name, age, sex, patient's weight No DSS Handwritten prescriptions
Chertow (2001) 1997 - 1998 Brigham and Women's Hospital, Boston, USA Medical, surgical, neurology, and obstetrics and gynaecology services of 720-bed urban tertiary care teaching hospital Normal care Patients with renal insufficiency Renally cleared or nephrotoxic medications BICS Home grown Electronic prescribing introduced as part of BICS since 1993 with increasing functionality Decision-support system that calculates estimated creatinine clearance and proposes a recommended dose and frequency for the ordered drug Limited DSS CPOE without special advice for patients with renal insufficiency with regard to dose and frequency
Colpaert (2006) 2004 Ghent University Hospital, Belgium 22-bed intensive care unit at tertiary care hospital Intensive care Intensive care patients No restrictions Centricity Critical Care Clinisoft, GE Healthcare Europe Commercial Electronic prescribing was implemented in the intensive care unit 10 months before beginning of study ICU with incorporated CPOE: Protocol-based recommendation on drug, dose and frequency, alerts to important drug-drug interactions and drug-related complications, highlighting of patient allergy status Advanced DSS Paper-based ordering
Cordero (2004) 2001–2002 Ohio State University Medical Center, USA Neonatal intensive care units Intensive care Very-low-birth-weight infants Caffeine and Gentamicin Invision 24, Siemens Medical Solutions Commercial Electronic prescribing was introduced to selective services in February 2000 and introduced to the study units in March 2002 CPOE with best-practice based order sets, drug-allergy checks, drug-drug interactions, order duplication, corollary orders, weight-based dosage, maximum dosage, drug-route restriction Advanced DSS All order were entered manually in the chart kept at the patient bedside
Evans (1998) 1992–1995 LDS Hospital, Salt Lake City, Utah, USA 12 bed shock trauma respiratory intensive care unit Intensive care Intensive care patients Antiinfectives HELP Home grown The antiinfectives management program was implemented in the study unit in 1994 Computerized antiinfectives-management program with advice on antiinfective regiment (drug, dosing, dosing interval) based on clinical data and available evidence, drug-allergy checks, drug-drug interactions, information on toxicity and costs Advanced DSS No antiinfectives-management program was used
Feldstein (2006) 2000–2004 Kaiser Permanente Northwest, a health maintenance organization, USA 8 primary care clinics with 126 primary care clinicians Normal care No restrictions Warfarin EpicCare EMR, Epic Systems* (in use since 1996) Commercial Warfarin alerts were implemented in January 2003 CPOE system with alerts on five warfarin-interacting drugs Advanced DSS CPOE without alerts
Fraenkel (2003) 1995–1998 Royal Brisbane Hospital, Queensland, Australia 12-bed adult general intensive care unit in a 790-bed tertiary referral teaching hospital Intensive care Intensive care patients No restrictions CareVue, Philips Medical Systems Commercial Intensive care system with electronic prescribing was introduced on study unit in November 1996 Medication administration record module with pre-defined dose ranges, drug scheduling and drug preparation notes, prompt for drug administration No DSS Paper-based documentation
Galanter (2005) 2002–2003 University of Illinois Hospital and Medical Center, USA Not further described Normal care Patients with renal insufficiency Renally cleared or nephrotoxic medications Millenium and Discern Expert, Cerner Corporation Commercial Alerts were implemented during study period CPOE system that calculates the creatinine clearance and checks for potentially contraindicated drugs Advanced DSS CPOE without alert on potentially contraindicated drugs for patients with renal insufficiency
Gandhi (2005) 1999–2000 Four Boston adult primary care practices affiliated with an academic medical center, USA 4 primary care practices Normal care Outpatients over Age 18 No restrictions One commercial, one home-grown system Mixed No further information provided Computerized prescribing with printed prescriptions, required fields and non-mandatory default doses, without any automatic checks No DSS Hand-written prescriptions
Igboechi (2003) 1999–2002 Metropolitan Hospital Center, New York, USA Inpatient and outpatient services of 350-bed acute tertiary care hospital Normal care No restrictions No restrictions Ulticare System Database, Per Se Technologies Commercial Electronic prescribing was introduced in June 2001 after recent upgrade to a new clinical system CPOE system with drug-allergy alerts, drug interaction alerts, dosage range checks, lab values, and drug information resource Advanced DSS Handwritten orders
Kim (2006) 2001–2004 John Hopkins Children's Center, Baltimore, USA Paediatric oncology Normal care Children with neoplastic disorders Chemotherapeutica RxTFC Pharmacy Information Systems, GE Medical Systems Information Technologies Commercial Electronic prescribing was introduced as part of the available pharmacy system in 2002 CPOE system with dosing support and drug-allergy checking* Advanced DSS Paper-based order entry
King (2003) 1993–1999 Children's Hospital of Eastern Ontario, Canada Three medical and two surgical wards of a tertiary care paediatric hospital Normal care Children No restrictions Sunrise Clinical Manager, Eclyps Commercial Electronic prescribing was introduced, with periodic upgrades, on the two intervention wards in 1996 CPOE without decision support (no further information provided) No DSS Handwritten order entry
Kirk (2005) 2003 National University Hospital, Singapore Paediatric unit in a university teaching hospital Normal care Paediatric patients (< 16 years of age) Paracetamol and promethazine Not specified Home grown Existing clinical decision support system (in use since 2000) system was modified in March 2003 to also support electronic prescribing for paediatric departments Computer calculated dosing based on weight Limited DSS Traditional computer-based prescription, no dosing advice
Koide (2000) 1994–1996 University of Tokyo Hospital, Japan 1040-bed tertiary care and teaching hospital Normal care Patients with psoriasis Etretinate, a medication indicated for psoriasis Medical information system (in operation since 1973) Unknown Electronic prescribing in operation since 1988, alerts for etretinate added in 1995 Alert system monitors ALT values and AST values Limited DSS CPOE without alerts
Maurer (2003) 1999–2000 Centre Hospitalier Le Raincy-Montfermell, Montfermell, France General Pneumology Unit with 60 beds Normal care Pneumology Patients No restrictions Excel-based application Home grown Electronic prescribing introduced in January 2000 Prescription sheet with drug list and recommended dosing based on weight and renal function Limited DSS Handwritten prescriptions
Mitchell (2004) 2002 Southmead Hospital, Bristol, UK General surgery Normal care No restrictions No restrictions Clinical Manager 3.0A, iSoft UK PLC Commercial Electronic prescribing introduced in general surgery as 3-months-pilot in 2002 Comparing unit with electronic medication administration record and electronic prescribing with areas of hand-written prescriptions No DSS Paper-based ordering
Mullett (2001) 1998–1999 Primary Children's Medical Center, University of Utah, USA 26-bed paedriatric intensive care unit of a 232-bed primary children's medical center Intensive care Children Antiinfective HELP Home grown Pediatric antiinfectives decision support tool was implemented on intensive care units in January 1999 Computerized antiinfectives-management program with dosing recommendations based on evidence and clinical data Limited DSS Handwritten orders
Oliven (2005) 2001* Bnai-Zion Medical Center, Haifa, Israel Two 44-beds general medical wards in an acute care university hospital Normal care No restrictions No restrictions Unknown Home grown Electronic prescribing was introduced three years before the study CPOE system with administration reminders, reminders for blood-drug-level test or further monitoring, extended drug information, treatment guidelines, drug-drug interaction, drug-allergy, drug-disease, drug-lab alerts, access to blood test results Advanced DSS Handwritten drug orders
Pestotnik (1996) 1988–1994 LDS Hospital, Salt Lake City, Utah, USA 520-bed acute-care referral hospital Normal care No restrictions Surgical antibiotics HELP Home grown Surgical antibiotics management modules were developed since 1985 Antibiotic management program with patient-specific guideline-based clinical decision support Advanced DSS No antibiotic management program available, computerized ordering mainly related to nursing orders and supply orders*
Peterson (2005) 2001–2002 Brigham and Women's' Hospital, Boston, USA Medical, surgical, neurology, and gynaecology services of tertiary care academic hospital Normal care Elderly patients (65 years and older) Psychotropic medication BICS Home grown Decision-support for psychotropic medication was developed and implemented for the study CPOE with evidence-based geriatric-specific recommendations for dosing and substitution Limited DSS CPOE with dosing suggestions and recommendations for substitutions
Potts (2004) 2001–2002 Vanderbilt Children's Hospital, Nashville, USA 20-bed paediatric critical care unit in a tertiary-care children's hospital Normal care Children No restrictions WizOrder (developed in 1994) Home grown CPOE was implemented in critical care unit in December 2001 CPOE with decision support such as drug allergy alerts, dose checking, drug interaction alerts, clinical pathways-based order sets, links to drug monographs, drug-lab alerts Advanced DSS No CPOE
Shulman (2005) 2001–2002 University College Hospitals London, Middlesex hospital, London, UK Intensive Care Unit Intensive care Intensive care patients No restrictions QS 5.6 Clinical Information System, GE Healthcare Commercial QS with electronic prescribing was introduced in April 2002 CPOE component without decision support No DSS Hand-written drug charts
Spencer (2005) 2002–2003 University of North Carolina, Chapel Hill, USA Two general medicine floors of a 688-bed academic hospital Normal care No restrictions No restrictions Siemens Medical Solutions, Malvern, PA Commercial Siemens CPOE system was implemented on two study units in October 2002 resp. January 2003 Patient allergy screening was partly in use* Advanced DSS No CPOE
Tamblyn (2003) 1997–1998 General Practicioners in Quebec, Canada 107 primary care physicians Normal care Elderly patients (66 years and older) No restrictions Unknown Commercial Electronic prescribing was introduced to intervention group physicians two months after randomization Health-record software which documented medication prescribed, offering drug-disease contraindications and information on previous drugs Advanced DSS No computerized decision support
Teich (2000) 1991–1995* Brigham and Women's' Hospital, Boston, USA 720-bed urban academic medical center Normal care Adults No restrictions BICS Home grown Electronic prescribing introduced as part of BICS since 1993 with increasing functionality CPOE system with dosing recommendation, drug-allergy, drug-drug interactions, duplicate medications, possible alternative medication, consequent order recommendation Advanced DSS Paper-based ordering

  • ↵* this information was provided by the author upon request.

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