gms | German Medical Science

Introduction: Electronic prescribing has the potential to reduce the number of adverse drug events (ADEs) in hospitals [1]. However, emotional aspects, like the physicians' adoption of computerized physician order entry systems (CPOE), have to be considered, otherwise, increased error rates and other 'unintended adverse consequences' (UACs) might occur [2]. Several CPOE design aspects, like the issue of alerting, have an influence on the physicians' attitudes [3]. The burden of high numbers of alerts for the prescribers is a fact that is commonly described in literature [4], [5], [6], [7]. Alert overload must not be underestimated, otherwise it may cause clinicians to override and ignore even important alerts, endangering patient safety [8], [9]. Several studies have provided insight into the attitudes of prescribers towards drug safety alerts in CPOE systems [10], [11], [12]. So far, however, it is not known whether and to which degree these attitudes depend on the level of computerized decision support (CDS) in the CPOE systems. Study questions: What is the attitude of physicians towards CDS in CPOE systems? How does it correlate with the level of CDS?

Methods: We performed a physician survey in six European hospitals. The hospitals comprised different levels of CDS within their CPOE systems, which we classified adopting Kuperman’s classification [13]. Paper questionnaires were distributed in four hospitals and electronic questionnaires were distributed in two hospitals. The questionnaire comprised 15 statements which were adopted from existing studies [10], [11], [12]. All items were scaled with a 4-point Likert scale. The data was analyzed with descriptive statistics and Kruskal-Wallis tests.

Results: The data acquisition has been completed in four hospitals. The response rate was between 9% and 53%. Prescribers who were using CPOE with CDS reported over-alerting in their facilities (54-62% agreement), but nonetheless seem to believe in the error-reducing capacities of CDS (73-91% agreement). All physicians do not want to be patronized by technology and prefer a focus on the most important alerts (83-96% agreement). The results did not generally diverge according to the level of CDS, but differences could be spotted between single hospitals.

Discussion and conclusion: All results have to be looked at carefully and generalizations cannot be made. However, this first approach to measuring the influence of various CDS levels on the physicians’ attitudes allows a deeper insight into the matter. The results from the study are exploited in the PSIP-project of the European Union (Patient Safety through Intelligent Procedures in medication, grant agreement n° 216130) [14].