The use of a CPOE log for the analysis of physicians' behavior when responding to drug-duplication reminders

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.