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J Am Med Inform Assoc 2009;16:531-538 doi:10.1197/jamia.M2910
  • The Practice of Informatics
  • Review Paper

What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians' Prescribing Behavior?

  1. Angela Schedlbauer, MDa,
  2. Vibhore Prasad, MBChBa,
  3. Caroline Mulvaney, PhD, MSca,
  4. Shobha Phansalkar, RPh, PhDc,d,e,
  5. Wendy Stanton, BA, Dip Libb,
  6. David W Bates, MD, MScc,d,e,
  7. Anthony J Avery, DMa
  1. aDivision of Primary Care, School of Community Health Sciences, University of Nottingham, Nottingham, UK
  2. bResearch and Learning Resources Division, Information Services, University of Nottingham, Nottingham, UK
  3. cDivision of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
  4. dHarvard Medical School, Boston, MA
  5. eInformation Systems, Partners HealthCare System, Wellesley, MA
  1. Correspondence: Angela Schedlbauer, Division of Primary Care, School of Community Health Sciences, University of Nottingham, 13th Floor, Tower Building, UK - Nottingham NG7 2RD 7; e-mail: angela.schedlbauer{at}nottingham.ac.uk
  • Received 26 June 2008
  • Accepted 31 March 2009

Abstract

Alerts and prompts represent promising types of decision support in electronic prescribing to tackle inadequacies in prescribing. A systematic review was conducted to evaluate the efficacy of computerized drug alerts and prompts searching EMBASE, CINHAL, MEDLINE, and PsychINFO up to May 2007. Studies assessing the impact of electronic alerts and prompts on clinicians' prescribing behavior were selected and categorized by decision support type. Most alerts and prompts (23 out of 27) demonstrated benefit in improving prescribing behavior and/or reducing error rates. The impact appeared to vary based on the type of decision support. Some of these alerts (n = 5) reported a positive impact on clinical and health service management outcomes. For many categories of reminders, the number of studies was very small and few data were available from the outpatient setting. None of the studies evaluated features that might make alerts and prompts more effective. Details of an updated search run in Jan 2009 are included in the supplement section of this review.

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