TY - JOUR
T1 - The use of a CPOE log for the analysis of physicians' behavior when responding to drug-duplication reminders
AU - Long, An Jim
AU - Chang, Polun
AU - Li, Yu Chuan
AU - Chiu, Wen Ta
N1 - Funding Information:
The study was supported by the grant DOH94-TD-D-113-003 and DOD95-TD-M-113-030 from Department of Health, Taiwan.
PY - 2008/8
Y1 - 2008/8
N2 - Introduction: There is evidence that patients are being prescribed a significant number of duplicated prescriptions despite the use of computerized safety reminder systems. Nonetheless, the physicians' behavior with respect to the computer reminders has not been well studied as yet. This problem is important because drug duplication can result in patient overdose with unpredictable or undesirable effects; furthermore, it is also a waste of significant healthcare resources. Methods: In 2005, a computerized drug-duplication reminder system on the computerized physician order entry (CPOE) was implemented at a 737-bed teaching hospital in northern Taiwan. The log file, combined with the physicians' profiles, was statistically examined using the Mantel-Haenszel technique over the second half of 2005. Results: A total of 11,298 orders (1.26%) involved drug-duplication reminders and this was out of 896,131 orders in 188,182 order set during the study period. The physicians related variables (workload, department, educational background, years in practice at the target hospital and age), policy related variables (intervention from the insurer and hospital administration), the order itself (drug price and medication class) and patients' resistance were found to be most critically related to physicians' behaviors in terms of the reminders. Intervention by Taiwan's National Insurance reimbursement policy appeared to be ineffective as a way of affecting the physicians' behavior. Conclusion: The log file appears to be a valuable source for analyzing physicians' behavior on reminders if well designed with the CPOE. Hospitals, clinicians and patients should pay more attention and be seriously concerned about CPOE reminders. It is also important to reexamine the physicians' workload and the insurer reimbursement policy in relation to drug duplication.
AB - Introduction: There is evidence that patients are being prescribed a significant number of duplicated prescriptions despite the use of computerized safety reminder systems. Nonetheless, the physicians' behavior with respect to the computer reminders has not been well studied as yet. This problem is important because drug duplication can result in patient overdose with unpredictable or undesirable effects; furthermore, it is also a waste of significant healthcare resources. Methods: In 2005, a computerized drug-duplication reminder system on the computerized physician order entry (CPOE) was implemented at a 737-bed teaching hospital in northern Taiwan. The log file, combined with the physicians' profiles, was statistically examined using the Mantel-Haenszel technique over the second half of 2005. Results: A total of 11,298 orders (1.26%) involved drug-duplication reminders and this was out of 896,131 orders in 188,182 order set during the study period. The physicians related variables (workload, department, educational background, years in practice at the target hospital and age), policy related variables (intervention from the insurer and hospital administration), the order itself (drug price and medication class) and patients' resistance were found to be most critically related to physicians' behaviors in terms of the reminders. Intervention by Taiwan's National Insurance reimbursement policy appeared to be ineffective as a way of affecting the physicians' behavior. Conclusion: The log file appears to be a valuable source for analyzing physicians' behavior on reminders if well designed with the CPOE. Hospitals, clinicians and patients should pay more attention and be seriously concerned about CPOE reminders. It is also important to reexamine the physicians' workload and the insurer reimbursement policy in relation to drug duplication.
KW - Computerized physician order entry system
KW - Computerized reminder
KW - Drug duplication
KW - Log analysis
UR - http://www.scopus.com/inward/record.url?scp=45449116921&partnerID=8YFLogxK
U2 - 10.1016/j.ijmedinf.2007.10.002
DO - 10.1016/j.ijmedinf.2007.10.002
M3 - Article
C2 - 18182321
AN - SCOPUS:45449116921
SN - 1386-5056
VL - 77
SP - 499
EP - 506
JO - International Journal of Medical Informatics
JF - International Journal of Medical Informatics
IS - 8
ER -