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Many e-Rx alerts are being ignored

November 4, 2013
by Richard R. Rogoski
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Electronic prescribing systems are designed to make medication ordering more efficient and to reduce medication errors. But a study published in the Journal of the American Medical Informatics Association at the end of October has shown that healthcare providers typically override more than half of clinical decision support alerts and that half of those overridden alerts are deemed medically appropriate.

The research team, headed by Dr. Karen C. Nanji of Massachusetts General Hospital, reviewed 157,483 CDS alert overrides on 2,004,069 medication orders. They found that 82,889 (52.6%) of alerts were overridden.

The most common alerts received were for duplicate drugs, patient allergy and drug-drug interactions.

But the most common alerts being overridden were formulary substitutions (85.0%), age-based recommendations (79.0%), renal recommendations (78.0%), and patient allergies (77.4%).

An average of 53% of overrides were classified as appropriate, and the rate of appropriateness varied from 12% for renal recommendations to 92% for patient allergies.

In order to reduce the number of overrides, the researchers recommend refining the system of alerts to improve their relevance and to reduce “alert fatigue.”