• Jesse I Wolfstadt, Jerry H Gurwitz, Terry S Field, Monica Lee, Sunila Kalkar, Wei Wu, and Paula A Rochon.
• Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, Toronto, Ontario, Canada.
• J Gen Intern Med. 2008 Apr 1; 23 (4): 451458451-8.

ContextComputerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE).ObjectiveTo systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure.Data SourcesPUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists of included studies were also searched.MethodsWe searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed.ResultsOf the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P < or = .05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates.ConclusionsFew studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings.

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