Authors' objectives:

The aim of this report was to systematically review the effectiveness of electronic prescribing to improve practitioner performance and patient-oriented outcomes.

Authors' results and conclusions: Implications for the provision of care Computers should be introduced when it is important that asynchronous pieces of data need to be communicated together and where the results from complex or repetitive evaluations need to be presented to health professionals rapidly. Computers can improve the administration of health care, enhance physician performance in relation to drug dosing and improve practitioners- prescribing behaviour. Computers can improve patient management decisions and enable guidelines to be more effectively deployed but the effects of computers on health outcomes remain unclear. Key characteristics of situations where electronic prescribing systems have worked well include: organisations where there has been significant collaboration and leadership from senior clinicians and management, the use of fast, reliable systems that are uniform throughout the organisation and interface well with their operators, easy and direct access to machines (fixed or mobile) that are available where the clinical work is undertaken, and the provision of adequate resources including staff training and information technology backup. Designers of computer software for use in health care settings should take more account of how other patient data can be used particularly in primary care where a substantial amount of information (e.g., medical history, tests results) is now available electronically. Decision support should be introduced judiciously. POE should be implemented within organisations with sophisticated, computerised patient information systems. Consideration should be given to the introduction of corollary orders in conjunction with POE. Computerised alerts and warnings should be provided as backup where computerised information systems exist because electronic systems can be bypassed or not kept up-to-date. New systems should be developed that can communicate with each other. International standards should be developed for these systems and their data. Given the rapid rate of development of computerised prescribing, the inconsistencies in results and the limited range of clinical settings in which they have been trialled, it is important that the provision of an electronic prescribing system should always be evaluated using a well-designed method that incorporates patient outcomes. This is especially true if the system has not been previously tested, if the clinical setting differs from that of previously tested sites or if specially trained staff were included in the previous evaluation.

Authors' recommendations: There is a pressing need for rigorous evaluations of: The acceptability of electronic prescribing to health professionals that: - determine aspects of decision support that are most helpful and acceptable to prescribers - explore the acceptability of alerts and warnings - investigate how these warnings could be made more useful to prescribers - consider the acceptability of different types of POE to prescribers. Economic evaluations that: - describe costs and health outcomes associated with integrated computer systems that incorporate pharmacy, laboratory and administrative data - define costs and health outcomes related to POE - explore the marginal costs and effectiveness of decision support with and without POE - evaluate the marginal costs and effectiveness of decision support with and without evidencebased guidelines - determine whether decision support enables other professional groups to effectively and safely assume roles (prescribing, diagnosing, patient information provision etc) previously occupied by physicians. Patient outcomes related to electronic prescribing that: - determine the effects of all types of electronic prescribing on health outcomes - describe the costs and health outcomes related to the provision of specialised dosing programmes for medications with a narrow safety profile for which blood concentrations can accurately, reliably and quickly be determined and that utilise a Bayesian approach to pharmacokinetics - undertake evaluations of the safety features of electronic prescribing systems and their ability to appropriately cope with patient emergencies or detect and respond to their own electrical and mechanical problems - ascertain the health outcomes and the cost effectiveness of computer generated anticoagulation therapy for both the initiation and maintenance of heparin or warfarin treatment in hospital or outpatient settings. Relative effectiveness of different types of electronic advice for different types of prescribers in a variety of settings that: - undertake comparisons of the use of warnings at the time of prescribing versus the provision of alerts after the prescription has been completed - explore the use of critiquing systems that check for alerts after prescriptions have been completed for audit and quality improvement purposes - determine the effects of decision support on junior doctors who subsequently work in paperbased organisations - evaluate the use of electronic prescribing in primary care - consider whether decision support is more beneficial for doctors with different characteristics - address what decision support material should be presented simultaneously with prescribing or what should be available by an additional step - examine electronic prescribing interventions in New Zealand - elucidate reliable indicators of the risk of an ADE - examine the effectiveness of the provision of additional clinical information with the prescribing information that is electronically checked by the warning system - consider the relative or additional benefits of POE relative to other interventions (such as unit dosing, bar coding and automated dispensing systems) that aim to reduce medication errors.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://nzhta.chmeds.ac.nz/publications.htm

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: New Zealand

Organisation Name: New Zealand Health Technology Assessment

Contact Address: Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, P.O. Box 4345, Christchurch, New Zealand. Tel: +64 3 364 1145; Fax: +64 3 364 1152;

Contact Name: nzhta@chmeds.ac.nz

Contact Email: nzhta@chmeds.ac.nz

Copyright: New Zealand Health Technology Assessment (NZHTA)