Evidence Table 9KQ1: primary clinical outcomes for all technologies assisting all medication phases

Article InformationMM Phase(s)HIT Studied
Integrated System
SettingsOutcomes MeasuredResultsOutcome
Ali (2005)4
Design: Before-after
N = 91 patients
Implementation: 02/2000
Study Start: 05/2000
Study End: 05/2002
PrescribingCPOE/POE systemCritical care units (CCU, ICU, NICU) 25 Beds AcademicLOS - Secondary OutcomeLOS did not differ between patients cared for with the initial CPOE vs. the modified CPOE (9.9 days vs. 9.0 days, NS)
Balcezak (2000)292
Design: Cohort study
N = 747 Patients
Implementation: 00/0000
Study Start: 10/1996
Study End: 01/1997
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
EHR/EMR system
Acute care/tertiary, 900 Beds AcademicaPPT exceeding therapeutic threshold by 24 hours, aPPT exceeding therapeutic threshold by 48 hours, aPPT within therapeutic threshold by 48 hoursUse of the nomogram was 10% (low). More patients who received the nomogram ordering exceeding the therapeutic threshold by 24 hours and by 48 hours were 79% vs. 56% (p <0.001), and 88% and 66% (p <0.001) respectively. More patients achieved a therapeutic range by 24 hours and 48 hours with the weight- based nomogram compared with physician-guided dosing were 47% vs. 39% (p = 0.027), and 69% and 52% (p = 0.019) respectively. Use of the nomogram also had a higher rate of being within the therapeutic range by 48 hours (69% vs. 52%, RRR 25%, p = 0.02).+
Barenfanger (2001)287
Design: Cohort study
N = 450 patients
Implementation: 00/0000
Study Start: 10/1998
Study End: 02/1999
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
EHR/EMR system, Pharmacy
Acute care/tertiary, 450 Beds Pharmacy, Inpatient hospital based, Academicmortality rate, average length of stayIn matched patient analysis, the study patients did not differ for mortality (10% vs. 11%, p = 0.7). The control group patients stayed longer in the hospital (13.7 vs. 11.0 days, p = 0.04).+
Baroletti (2008)293
Design: Cohort study
N = 9,527 patients
Implementation: 00/000
Study Start: 01/2004
Study End: 07/2006
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
Unspecified Hospitalsymptomatic VTE or PE*The primary end point of symptomatic DVT or PE at 90 days occurred in 5.1% of patients in the cohort group and 4.9% of patients in the historical alert group, respectively, p = 0.82
Beccaro (2006)294
Design: Before-after
N = 2,533 patients
Implementation: 11/2003
Study Start: 10/2002
Study End: 12/2004
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Hospital information system, Imaging systems, Laboratory system
Pediatric stand alone hospital, 270 Bedsunadjusted total mortalityIntroduction of the CPOE system was not associated with changes in mortality rates measured 13 months after implementation. The unadjusted mortality rates before implementation was 4.2% and after 3.4%, RRR 18%, (95% CI −21% to 45%), NS. No mortality difference was seen either for transfer patients (7.8% before and 9.6% after, RRR 34%, 95% CI −47% to 71%, NS) or for children with congenital cardiovascular disease (4.4% before and 2.6% after, RRR 41%, 95% CI −63% to 79%, NS).
Boord (2007)295
Design: Before-after
N = 351 ICU patients
Implementation: 11/2004
Study Start: 10/2004
Study End: 01/2005
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders, CPOE/POE system, e-Rx
Integrated EHR/EMR system
Acute care/tertiary, Critical care units (CCU, ICU, NICU) 21 Beds Academicpercentage of patients within ideal glucose range*, time spent in ideal glucose range (minutes)*Patients were studied for 5 days in the SICU. The percentage of patients with their blood glucose in the ideal range increased with the CPOE insulin protocol (29.3% vs. 37.7%, RRR −29%, p = 0.006). Patients who were cared for under CPOE/CDSS also spent more time on average within normal glucose levels across all 5 days (mean difference 116 minutes, p = 0.029).+
Chabot (2003)296
Design: Cohort study
N = 100 people with hypertension
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated Pharmacy Computerized Prescription Management System
Pharmacy, OtherMean BP (mm Hg), Adherence, Controlled BP (Measure based on Recommendation before 1999) or in 1999The groups did not differ for blood pressure: mean SBP: 139 vs. 141, p = 0.747; DBP: 78 vs. 78, p = 0.357 or for adherence based on pharmacy recorded: 93% vs. 98%, p = 0.643 or self reported data: 83% vs. 68%, p = 0.085 or rates of controlled BP (recommendations before 1999) 81% vs. 78%, p = 0.684 (recommendations in 1999) 44% vs. 54%, p = 0.3
Chen (2010)297
Design: Case control
N = 200 patients
Implementation: 00/0000
Study Start: 08/2003
Study End: 00/0000
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
Unspecified HospitalLDL-C goal,Among the first 200 consecutive patients followed up more than 1 year, 65% reached the LDL-C goal in 1 year. For those whose treatment followed CAGES, 74% reached the LDL-C goal. For those whose treatment was entered without CAGES, 57% reached the LDL-C goal. The OR is 2.1 (1.2, 3.8, 95% CI) (p = 0.022), patients whose treatment followed CAGES were twice as likely to reduce their LDL-C+
Chertow (2001)18
Design: Time series
N = 19,982 admissions
Implementation: 00/0000
Study Start: 09/1997
Study End: 04/1998
PrescribingCDSS/CDS/CCDS/reminders CPOE/POE system
Integrated Hospital information system Imaging systems
Acute care/tertiary, 720 Beds Academiclength of stay, percentage of patients with a decline of creatinine clearance >10 mL/minLength of stay decreased with CPOE/CDSS (mean 4.5 days vs. 4.3 days, p = 0.009). No changes in renal function were observed+
Chisholm (2003)19
Design: Before-after
N = 790 children admitted to hospital with asthma exacerbations
Implementation: 10/2002
Study Start: 11/2001
Study End: 12/2003
Monitoring including patient adherence and compliance, PrescribingCPOE/POE system
Integrated Billing/administration system, EHR/EMR system, Laboratory system
Pediatric stand alone hospital, 323 Bedslength of stayNo difference was seen in LOS (1.8 vs. 1.9 days) NS
Cobos (2005)23
Design: RCT
N = 2,221 patients
Implementation: 04/2000
Study Start: 04/2000
Study End: 05/2002
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory careproportion of patients achieving successful lipoprotein- cholesterol goals or cardiovascular risk reassessment*Effectiveness was defined as success or failure for patients achieving either their LDL cholesterol goal or a reassessment of their cardiovascular risk maintained at <20%. The proportion of patients achieving success in the intention to treat analysis was similar between usual care and intervention groups (50.5% vs. 54%, NS).
Cook (2004) 298
Design: Time series
N = 334 paired visits
Implementation: 11/2001
Study Start: 11/2001
Study End: 05/2002
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Handheld
Ambulatory carefasting glucose levels*, random glucose*, A1c*For 117 paired visits using fasting glucose for insulin adjustment, paired fasting glucose levels decreased from 220 ± 85 to 149 ± 61 mg/dL (p <0.0001). For 103 paired visits where random glucose was used for dosing, random glucose decreased from 249 ± 93 to 168 ± 69 mg/dL (p <0.0001). For 114 paired visits using A1c for insulin adjustment, A1c levels improved from 10.4 ± 2.9% to 7.9 ± 2.0% (p <0.0001).+
Evans (1995)284
Design: Before-after
N = 962 patients
Implementation: 07/1994
Study Start: 07/1993
Study End: 02/1995
PrescribingCDSS/CDS/CCDS/reminders
Integrated Hospital information system
Critical care units (CCU, ICU, NICU)ADE rate, Length of StayThe rate of ADE did not differ before and after implementation (2.4% vs. 0.,9%, NS). The length of stay in the unit did not differ (mean 6.2 vs. 5.8 days, NS).
Evans (1998)35
Design: Before-after
N = 1,681 patients
Implementation: 00/0000
Study Start: 07/1992
Study End: 06/1995
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Imaging systems, Laboratory system
Acute care/tertiary, 520 Beds AcademicADE*ADE rate decreased significantly following the implementation of the reminder (3.7% vs. 1%, RRR 73%, p = 0.018)+
Evans (1992)283
Design: Before-after
N = 45,544 patients (May ‘89–Apr ‘91)
Implementation: 05/1989
Study Start: 05/1989
Study End: 00/1991
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders surveillance system
Integrated EHR/EMR system, Hospital information system, Laboratory system, Pharmacy
Unspecified Hospitalrate of type B ADEs, rate of severe ADEs, length of stayRate of type B ADEs declined following the use of the surveillance system and the addition of computer alerts (15% vs. 1.4%, p <0.001). The rate of severe ADEs with early notification of physicians to all ADEs as soon as they were verified reduced from 7.6% to 2.2% (p <0.001). The average length of stay for patients with type B ADEs to hospital-administered drugs was 17 days compared to 14 days (p <0.013) for patients with type A ADEs and only five days for the control patients that did not have ADEs. The average length of hospitalization for patients with severe ADEs was 20 days compared to 13 days for patients with moderate (p <0.024).+
Evans (1994)299
Design: Time series
N = 1,865 ADEs
Implementation: 00/1980s
Study Start: 05/1989
Study End: 04/1992
Monitoring including patient adherence and complianceHealth Information System
Integrated Laboratory system, Pharmacy
Acute care/tertiary, 520 Beds AcademicADE-known drug allergies*, ADE-rapid antibiotic administration rates*The ADE surveillance system identified drug allergy and rapids antibiotic administration rates as areas of concern. In year 2 and 3, when clinicians were alerted to all ADEs and had in service for antibiotic admin rates, the number of known drug allergy ADEs declined to 0 (p <0.002) and there was a significant decrease in the number of ADEs related to antibiotic administration rates (p <0.01).+
Evans (1999)214
Design: Before-after
N = 13,384 Patients
Implementation: 01/1005
Study Start: 04/2005
Study End: 03/2006
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated Pharmacy
Critical care units (CCU, ICU, NICU), 12 beds in the shock/trauma/respiratory ICU. of a 520 bed academic hospital Beds Not specified, Inpatient hospital based, AcademicRates of adverse drug events*The rate of adverse drug events related to 5 antibiotics was lower in patients who were followed with the drug monitoring system (0.9% vs. 0.3%, RRR 67%, p <0.001).+
Fiumara (2010)300
Design: Cohort study
N = 880 patients
Implementation: 00/0000
Study Start: 07/2006
Study End: 05/2008
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system, EHR/EMR system, Hospital information system
Unspecified HospitalSymptomatic DVT or PE at 90 days*, PE at 90 days, DVT at 90 days, Death at 90 days, Major haemorrhage at 30 daysThere was no significant difference in symptomatic 90-day VTE rates between the two cohorts (2.8% for the one-screen vs. 2.2% for the three-screen, p = 0.55). PE at 90 days was 1.1% vs. 0.9%, p = 0.25. DVT at 90 days was 1.1% vs. 1.9%, p = 0.14. Death at 90 days was less frequent among patients in the one-screen alert cohort than the three-screen alert cohort (14.6% vs. 22.2%, p = 0.004). The frequency of major haemorrhage was similar in both alert cohorts (1.3% vs. 1.8%, p = 0.51).
Frances (2001)48
Design: RCT
N = 63 physicians and 730 patients
Implementation: 00/0000
Study Start: 03/1997
Study End: 06/1997
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Pharmacy
Ambulatory careLDL level <100 mg/dL*The proportion of patients with a level of LDL cholesterol in the desired range (< 100 mg/dL) Did not improve cholesterol management in patients (73.2 % vs. 71.0%, p = 0.512) with CAD.
Garthwaite (2004)301
Design: Cohort study
N = 939 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Acute care/tertiary, Ambulatory care, AcademicSerum cholesterol, creatinine kinase, alkaline phosphatase levels, creatinine clearance, cyclosporine dose, cyclosporine trough levels, DBP, SBPSerum cholesterol*, creatinine kinase, alkaline phosphatase levels*, creatinine clearance*, cyclosporine doses and trough levels, lipid- lowering drugs, and dia*- and SBP measurements were compared between baseline and 6 months. * indicates significant improvements.+
Gill (2009)60
Design: RCT
N = 64,150 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 10/2006
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory careLipids at goal*After controlling for confounding variables and for clustering in multilevel modeling, the proportion of patients with lipids at goal was not significantly different between control and intervention groups.
Gilutz (2009)61
Design: RCT
N = 7,448 patients from 56 control and 56 intervention clinics
Implementation: 00/0000
Study Start: 01/2000
Study End: 12/2003
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated Hospital information system, Laboratory system, Pharmacy
Ambulatory care, AcademicLDL level reduction*In the group of patients with initial LDL levels above 120 mg/dl, a significant decrease in LDL levels was observed in the two groups, which was minimally more pronounced in the intervention arm from 145.5 ± 22.3 mg/dl to 121.9 ± 34.2, mg/dl, 16.2% reduction than in the control arm from 145.8 ± 22.9 to 124.3 ± 34.6, 14.8% reduction; (p <0.02).+
Grant (2008)217
Design: RCT
N = 244 patients
Implementation: 00/2002
Study Start: 09/2005
Study End: 03/2007
Monitoring including patient adherence and compliancePHR
Integrated Billing/administration system, EHR/EMR system, Imaging systems, Laboratory system, Patient decision support system
General Hospital, Ambulatory care, HomeHbA1c levels*For the primary outcome, study participants had relatively good glycemic control (mean HbA1c levels) at baseline with modest improvement over the study period that did not differ by treatment arm (7.1% vs. 7.2%, p = 0.45), with nearly three- quarters of all patients at goal (73% vs. 68% among control patients; p = 0.53).
Graumlich (2009)237
Graumlich (2009)238
Design: RCT
N = 631 patients
Implementation: 00/0000
Study Start: 11/2004
Study End: 01/2007
PrescribingCDSS/CDS/CCDS/reminders
CPOE/POE system
Acute care/tertiary, 730 Beds AcademicReadmitted within 6 months*, emergency department visit within 6 months, adverse events within 1 monthWhen comparing patients assigned to discharge software vs. usual care, there was no difference in hospital readmission within 6 months (37.0% vs. 37.8%; OR 0.005 [95% CI, − 0.074 to 0.065]; p = 0.894), emergency department visit within 6 months (35.4% vs. 40.6%; OR 0.052 [95% CI, −0.115 to 0.011]; p = 0.108), or adverse events within 1 month (7.3% vs. 7.3%; OR 0.003 [95% CI, −0.037 to 0.043]; p = 0.884)
Gurwitz (2008)302
Design: RCT
N = 1,118 residents
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
Laboratory system
Long term care (nursing homes)ADE rates per 100 resident months*, Preventable ADE targeted by alertsADE rates per 100 resident months were similar for control and intervention units (10.4 vs. 10.8, NS). The same was found for the rate of preventable ADEs per 100 resident months (3.9 vs. 4.0, NS). Of the 152 preventable events on the intervention units, 59 (38.8%) might have been prevented as a result of one or more of the alerts. Of the 126 preventable events identified on the control units, 56 (44.4%) might have been prevented as a result of one or more of the alerts. NS.
Han (2005)303
Design: Before-after
N = 1,942 patients
Implementation: 10/2002
Study Start: 10/2001
Study End: 03/2003
Dispensing, Transmission, order communicationCDSS/CDS/CCDS/reminders CPOE/POE system
Integrated Hospital information system
Acute care/tertiary, Pediatric stand alone hospital, Academicmortality rateThe unadjusted mortality rate after implementation was 3.9%. A step- wise regression analysis was done using 19 variables. For the model that was adjusted for PRISM score 7 factors including use of CPOE were associated with mortality: shock, Glasgow Coma scale score, surgical referral, prematurity, cardiovascular problems, and PRISM score. The OR for mortality for the presence of CPOE is 3.71, 95% CI 2.13 to 6.46. Post CPOE mortality affected children and ICU admission most severely. In the primary regression model that adjusted for PRISM score, shock was highly associated with increased odds of mortality (OR: 6.24; 95% CI:2.94 to 13.26), followed by CPOE (OR: 3.71; 95% CI:2.13 to 6.46) and severe coma (OR: 3.43; 95% CI: 1.88 to 6.25).+
Hetlevik (1999)304
Design: RCT
N = 1,998 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
PrescribingCDSS/CDS/CCDS/reminders
CPOE/POE system
Integrated EHR/EMR system
Ambulatory careSBP mmHg, DBP mmHg, Serum cholesterol mmol/1, BMI kg/m2The groups did not differ for BP, cholesterol levels or BMI: SBP was 155.6 vs. 156.8 mmHG (95 % CI −0.6 to 3.0) between the control and the intervention group. DBP was 89.8 vs. 88.8 mmHg (95% CI −1.9 to −0.2). Serum cholesterol was 6.57 mmol/l vs. 6.64 mmol/l (95% CI −0.1 to 0.2) between the two groups. BMI was 27.7 kg/m2 vs. 27.8 kg/m2 (95% CI − 0.4 to 0.07).
Holdsworth (2007)305
Design: Before-after
N = 2,407 patient admissions
Implementation: 00/0000
Study Start: 00/0000
Study End: Oct 2004
Administering, PrescribingCPOE/POE system
Integrated EHR/EMR system, Pharmacy
Acute care/tertiary, 50 BedsTotal ADEs per 100 admissions* Preventable ADEs per 100 admissions*, Potential ADEs per 100 admission*,Patients were classified as having an ADE, a preventable ADE or potential ADE. All rates of ADEs were reduced after implementation of the CPOE system. Total ADEs per 100 admissions: 6.3 vs. 3.1 RRR 37%, 95% CI 0.05 to 0.57. Preventable ADEs per 100 admissions: 3.8 vs. 2.2, RRR 44%, 95% CI 0.09 to 0.66.
Potential ADEs per 100 admissions: 7.9 vs. 2.2, RRR 63%, 95% CI 0.45 to 0.75.
+
Holman (1996)306
Design: RCT
N = 5 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Administering, Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated Handheld
HomePre-prandial blood glucose levels*Pre-prandial blood glucose levels* were significantly less during the ‘advice on’ period compared to the ‘advice off’ period (7.5 vs. 8.9 mmol/l, p = 0.015)+
Hwang (2002)70
Design: Time series
N = 171 patients
Implementation: 10/1999
Study Start: 06/1999
Study End: 05/2000
PrescribingCPOE/POE system
Integrated Hospital information system Imaging system
Acute care/tertiary, 1,000 plus Beds AcademicLOS (mean number of days)LOS in mean number of days decreased over the three time periods (11.4 vs. 10.3 vs. 8.2), with a significant reduction before implementation to 6 months postimplementation (p = 0.049).+
Janssen (2009)307
Design: Observational study
N = 522 patients
Implementation: 00/0000
Study Start: 10/2000
Study End: 04/2002
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
Ambulatory carePANSS Positive score*, PANSS Negative score*Pronounced group-effect was found when comparing the Düsseldorf group using the Decision-Support System and the control group (Munich 1) providing treatment-as- usual, 14.1 (6.5) vs. 13.8 (6.7), p = 0.004) with respect to positive symptoms. No group effects were apparent concerning negative symptoms. The interaction effect of time 9 group was significant with regard to the negative score (p <0.039) and the positive score (p <0.001) (Figs. 1, 2).
Javitt (2005)218
Design: RCT
N = 39,462 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated Insurance
Ambulatory careAdmissions per 1,000 persons*Among those in both groups who triggered recommendations, there were 19% fewer hospital admissions in the intervention group compared with the control group (213.8 ± 5.7 vs. 264.6 ± 5.7, p <0.001).+
Keene (2007)308
Design: Before-after
N = 1,291 patients
Implementation: 00/2001
Study Start: 09/2000
Study End: 02/2003
PrescribingCPOE/POE system
Integrated EHR/EMR system, Laboratory system, Pharmacy
Critical care units (CCU, ICU, NICU), Academicmortality*Overall, 29 (3.16%) patients admitted during the pre-CPOE period and nine (2.41%) patients admitted in the post- CPOE period died under MMC care (p = 0.466).
Kucher (2005)89
Design: RCT
N = 2,506 patients
Implementation: 00/0000
Study Start: 09/2000
Study End: 01/2004
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system, Hospital information system
Acute care/tertiary, AcademicClinically diagnosed DVT at 90 Days, Clinically Diagnosed PE at 90 daysThe primary end point for clinically diagnosed DVT at 90 days occurred in 103 (8.2%) in the control group as compared with 61 patients (4.9%) in the intervention group (RRR 40%, p = 0.001). For clinically diagnosed PE at 90 days the numbers were 35 (2.8%) in the control group as compared with 14 (1.1%) in the intervention group (RRR 61%, p = 0.004). The groups did not differ for proximal- or distal DVT, DVT of the arms, death, or hemorrhage.+
Lecumberri (2008)91
Design: Time series
N = 19,338 patients
Implementation: 09/2005
Study Start: 01/2005
Study End: 06/2007
PrescribingCDSS/CDS/CCDS/reminders
Integrated hospital guidelines
Unspecified Hospital, Academicrate of VTE during hospitalization*, control to year 1, rate of VTE during hospitalization*, year 1 to year 2A non-significant reduction of VTE during hospitalization was achieved. Compared with the first semester of 2005, before implementing the computer-alert program, the overall rate of VTE during hospitalization was reduced from 3.26/1,000 (21 episodes in 6,441 patients) to 1.74/1,000 patients, (relative reduction 46.6%) in 2006. During the first semester of 2007, the rate of VTE during hospitalization was 1.67/1,000. OR: 0.53, 95% CI 0.25 to 1.10 and OR: 0.51, 95% CI 0.24 to 1.05 during the first semesters of 2006 and 2007 respectively, the impact being significant (p <0.05) among medical patients in 2007, OR: 0.36, 95%CI 0.12 to 0.98.
Lesprit (2009)93
Design: Observational study
N = 932 prescriptions
Implementation: 11/2006
Study Start: 11/2006
Study End: 10/2007
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Laboratory system
Acute care/tertiary, 960 Beds Academicmortality rate*, median LOS*, readmission rate*Clinical outcomes mortality (5.6% vs. 4.1%, RRR 27%, p = 0.348) and readmission (15.2% vs. 15.4%, RRR -1%, p = 0.936) were similar between intervention and non-intervention patients, LOS was significantly longer for intervention patients (15 days vs. 19 days, p = 0.011).
Lester (2005)94
Design: RCT
N = 235 patients and 14 clinicians
Implementation: 07/2003
Study Start: 07/2003
Study End: 07/2004
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory care, AcademicLDL cholesterolFor the first assessment of LDL levels, the email group had lower levels of LDL cholesterol (138 vs. 119 mg/dL, p = 0.004). At the end of the study both groups had decreased their cholesterol levels and the difference between them was no longer seen (129 vs. 111 mg/dL, p = 0.055).
Liu (2008)97
Design: Time series
N = 858 patients
Implementation: 00/1989
Study Start: 01/2005
Study End: 12/2006
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system, EHR/EMR system
Acute care/tertiarypost-operative wound infection rates-clean procedures, post- operative wound infection rates- clean-contaminated proceduresThe post-operative wound infection rate did not change significantly among 3 groups. In clean procedures, the post-operative wound infection rates were 0.63, 0.72 and 0.71% in group 1, group 2 and group 3, respectively (p = 0.995). In clean-contaminated procedures, the postoperative wound infection rates were 8.5%, 12.0%, and 9.4% in group 1, group 2, and group 3, respectively (p = 0.736).
Macdonald (2002)285
Design: Before-after
N = 5,008 patients
Implementation: 07/1994
Study Start: 07/1994
Study End: 12/1998
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated Laboratory system
Acute care/tertiary, Academicproportion of time within normal INR range*, readmission rates*Patients in the computer group spent more time with INRs in the normal range (52% vs. 62%, p <0.05). No difference is readmission rates were found (3.8% vs. 3.0%, p = 0.9).
Madaras-Kelly (2006)98
Design: Time series
N = not reported
Implementation: 00/0000
Study Start: 07/2001
Study End: 06/2004
PrescribingCDSS/CDS/CCDS/reminders
CPOE/POE system
Integrated Hospital information system
Acute care/tertiary, 87 Bedsnosocomial infections rates*All nosocomial infections decrease after the implementation of computer prompts, requirement for justification, and suggestion of alternate antibiotics beyond fluoroquinolones (1.37 cases/100 patient days vs. 0.62 cases, p = 0.02)+
McGregor (2006)104
Design: RCT
N = 4,507 patients
Implementation: 00/000
Study Start: 05/2004
Study End: 08/2004
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated Laboratory system, Pharmacy
Acute care/tertiary, 648 Beds Inpatient hospital based, Academicmortality, Length of stayThe groups did not differ form mortality. All patients 3.0% vs. 3.3%, p = 0.6) or for those patients who got alerts (8.2% vs. 7.8%, p = 0.5). Length of stay did not differ. All patients: 4.0 days vs. 3.8, p = 0.4 and 5 vs. 4 days for patients with alerts, p = 0.6
Meigs (2003)309
Design: RCT
N = 598 patients
Implementation: 05/1998
Study Start: 05/1997
Study End: 04/1999
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated Laboratory system
Ambulatory careHbA1c levels*The intervention had a modest but nonsignificant benefit on glycemic control; HbA1c levels tended to improve in the intervention group (change −0.23) and worsen in the control group (change +0.14). p = 0.09
Mekhjian (2002)186
Design: Before-after
N = 28,898 patients
Implementation: 05/2000
Study Start: 02/2000
Study End: 01/2001
Administering, Transmission, order communicationCPOE/POE system, e- Medication administration system (e-MAR, e-TAR)
Integrated Die-TARy system, EHR/EMR system, Imaging systems, Laboratory system
Acute care/tertiary, Other specialty hospital (rehab, oncology) Academicseverity-adjusted LOS *After POE and e-MAR, severity- adjusted length of stay was reduced in OSUH (3.9 to 3.7 days, p = 0.002) but not James Cancer (3.7 to 3.6 days, NS)+
Miskulin (2009)106
Design: Cohort study
N = 8,941 patients
Implementation: 00/2005
Study Start: 11/2005
Study End: 04/2006
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory careHb levels *In the model adjusted for only center, average Hb levels were 11.8 ± 0.2 (SE) g/dL in patients treated using manual dosing and 0.11 ± 0.04 (SE) g/dL lower (p <0.001) in those treated with CDS.+
Montgomery (2000)107
Design: RCT
N = 552 patients
Implementation: 00/0000
Study Start: 09/1996
Study End: 09/1998
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory careSBP, DBPSBP and DBP was not reduced in the CDSS group (SBP 153. vs. 153 mmHg) (DBP 85 vs. 85 mmHg) compared to the usual care group (EMR alone)
Murray (2004)310
Design: RCT
N = 712 patients
Implementation: 00/0000
Study Start: 01/1994
Study End: 05/1996
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Pharmacy
Ambulatory care, Pharmacy, Outpatient hospital based, AcademicSF-36 QoL*No intergroup differences were found for the primary endpoint the SF-36 QoL* scale (Table 3). No analysis presented.
Niiranen (2008)113
Design: Time series
N = 18,818 patient followups
Implementation: 03/2005
Study Start: 04/2005
Study End: 12/2007
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated Laboratory system
Ambulatory care, Homeproportion of patient followups with patients within p-INR, year 1 to 2The share of patient followups with patients within p-INR target range was significantly lower in year 2 than year 1 (67.1% vs. 63.1%, RRR 6%, p <0.001), then was constant from year 2 to year 3 (63.1% vs. 63.1%, RRR 0%, NS)
Novis (2010)114
Design: Before-after
N = 800 patients
Implementation: 08/2007
Study Start: 03/2007
Study End: 03/2008
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Acute care/tertiarypostoperative bleeds, 30-, 60-, and 90- day DVT ratesDespite the increase in preoperative prophylaxis administration, there was no significant change in postoperative bleeds, with the rate of confirmed bleeds actually decreasing from 4% to 3% after implementation of the risk assessment (p = 0.34; NS). Over the course of the study, there was a trend toward decreased DVT events. The 30-, 60-, and 90-day DVT rates prior to implementation were 1.5%, 1.8%, and 2.0% respectively. After implementation, the 30-, 60-, and 90- day DVT rates were 0.3%, 0.5%, 1.3% respectively. This represents an overall 80% decrease in the 30-day rate of DVT and a 36% decrease in the 90-day rate of DVT, NS (p <0.12, p <0.58 respectively). There were no confirmed PE events at 90 days postoperation in this study population.
Oliven (2005)115
Design: Cross- sectional
N = 1,350 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
PrescribingCDSS/CDS/CCDS/reminders
CPOE/POE system
Integrated Drug order database, EHR/EMR system, Hospital information system, Laboratory system
Acute care/tertiary, 88 Beds AcademicHospital staysThe average hospital stay was significantly shorter in department with CDOE than the department where prescriptions were handwritten and transcribed (6.9 ± 6.2 vs. 8.9 ± 7.9, p <0.001).+
Overhage (1997)117
Design: RCT
N = 86 physicians on 6 services (services randomized)
Implementation: 00/0000
Study Start: 10/1992
Study End: 04/1994
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system, EHR/EMR system, Laboratory system
General Hospital, AcademicLOSLOS was not different for intervention patients compared with control patients (8.12 vs. 7.62, a difference of −0.5 days, 95% CI −0.17 to 1.19; p = 0.94).
Peterson (2005)124
Design: Cohort study
N = 7,456 Medication orders
Implementation: 00/0000
Study Start: 10/2001
Study End: 05/2002
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system, EHR/EMR system
Acute care/tertiary, Critical care units (CCU, ICU, NICU), 720 Beds AcademicLOS per 100 patient days, Fall per 100 patients days, Altered mental status per 100 patient daysThere was no difference in the LOS between control and intervention period. (4 days for both, p = 0.43) or rate of altered mental status/100 patient days (21=% vs. 22%, p = 0.17). The rate of falls was reduced in the CPOE group (0.64 falls/100 patient days for control vs. 0.28/100 patient days for the CPOE group, p = 0.001.)
Pielmeier (2010)311
Design: Before-after
N = 10 patients
Implementation: 00/0000
Study Start: 02/2009
Study End: 03/2009
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Critical care units (CCU, ICU, NICU)Mean log-normal BG ± standard deviation (mmol/L)Hypoglycemia (blood glucose [BG] b3.5 mmol/L) was not observed. Mean log-normal BG ± standard deviation was reduced from 8.6 ± 2.4 mmol/L preintervention to 7.0 ± 1.1 mmol/L during the Glucosafe intervention (p <0.01). Mean log- normal BG ± standard deviation was reduced from 7.0 ± 1.1 mmol/L Glucosafe intervention to 7.4 ± 1.5 mmol/L during the intervention (p<0.03)+
Piontek (2010)290
Design: Before-after
N = 229,463 patients
Implementation: 05/2001
Study Start: 00/0000
Study End: 00/0000
PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Laboratory system, Pharmacy
Unspecified Hospital, For Study group: bed sizes ranged from 58 to 303 (Indiana), 237 to 442 (Ohio), and 371 (California). For external control group: 460 (Maryland) and 365 (Idaho) Beds Inpatient hospital basedMortality ratesSimple mortality rates exhibited no statistically significant changes in either the study group(3.86% vs. 3.87%, p <=0.999) or the control groups (2.99% vs. 2.88%, p = 0.963). However, severity-adjusted mortality rates decreased significantly only in the study group (1.049% vs. 0.975%, p <0.001).
Plaza (2005)279
Design: RCT
N = 198 patients
Implementation: 03/2000
Study Start: 10/1999
Study End: 02/2001
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated Handheld
Ambulatory careQoL-St George’s Respiratory Questionnaire*Scores on the St George’s Respiratory Questionnaire were significantly lower for intervention patients (34.1 vs. 27.3, p = 0.002, difference 6.8 (95% CI 2.5 to 11.1).+
Quinn (2008)127
Design: RCT
N = 30 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Education of patients and clinicians but not pre- professional education, Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders Daibetes Management Tool
Integrated Web-based data analytics and therapy optimization tools
Ambulatory careAverage decrease in A1c valuesAverage decrease in A1c for intervention patients was 2.03% compared to .68% for control patients (p <0.04)+
Ralston (2009)312
Design: RCT
N = 83 patients
Implementation: 00/0000
Study Start: 08/2002
Study End: 05/2004
Monitoring including patient adherence and compliancePatient accessible Medical Record
Integrated CDSS/CDS/CCDS/reminders EHR/EMR system, Personal health records systems
Ambulatory care, AcademicAbsolute change in GHb*Absolute change in GHb declined significantly in the intervention group compared with the usual care group (0.2 vs. −0.9, change −0.7%; p = 0.01) at 12 months after adjusting for age, sex, and baseline GHb.+
Rasmussen (2005)132
Design: RCT
N = 253 patients
Implementation: 00/0000
Study Start: 00/2001
Study End: 00/0000
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated Internet based electronic diary
Ambulatory care (clinic, doctors office etc) AcademicImproved Symptoms, Improved Quality of Life (AQLQ), Improved lung function (FEV1>=300 mL), Improved Airway hyperresponsiveness (AHR)The treatment and monitoring with the Internet-based management tool lead to significant improvement in the Internet group regarding: Improved Asthma symptoms: Internet vs. specialist: OR 2.64 (95% CI 1.43 to 4.88), p = 0.002 Internet vs. GP: OR 3.26 (95% CI 1.71 to 6.19); p <0.0012) Improved QOL: Internet vs. specialist: OR 2.21 (95% CI 1.09 to 4.47), p = 0.03 Internet vs. GP: OR 2.10 (95% CI 1.02 to 4.31), p = 0.043) Lung function: Internet vs. specialist: OR 3.26 (95% CI 1.50 to 7.11), p = 0.002 Internet vs. GP: OR 4.86 (95% CI 1.97–11.94), p <0.0014)Airway responsiveness: Internet vs. Specialist: OR 1.26 (95% CI 0.57–2.79), p = NS Internet vs. GP: OR 3.06 (95% CI 1.13 to 8.31), p = 0.02+
Rind (1994)225
Design: Time series
N = 562 patients
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Formulary, Hospital information system, Laboratory system, Pharmacy
Acute care/tertiary, 504 Beds Academicdifference in change in creatinine levels at 3 days*, difference in change of creatinine level at 7 days*, serious renal impairmentFor medical service patients with changes in renal function, more patients had serious renal impairment in the control group compared (7.5% vs. 3.4%, p = 0.034). Difference in changes in creatinine levels at 3 days (14 mmol/L, p = 0.007) and 7 days (26 mmol/L, p <0.05) favored alerts medication event showed significant decreases for patients in the.+
Rohrig (2008 )135
Design: Before-after
N = 156 patients
Implementation: 00/1999
Study Start: 00/0000
Study End: 00/0000
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
EHR/EMR system
Critical care units (CCU, ICU, NICU) 14 bed unit Beds AcademicDelta-SOFA, length of stay ICU (hours) duration of ventilation (hours)Delta-SOFA decreased from 1.9% in the pre-period to 1.4% in the post- period, p = 0.23; length of stay (ICU) hours decreased from 472 to 337, p = 0.07; duration of ventilation hours decreased from 254 to 178, p = 0.07.+
Rollman (2002)136
Design: RCT
N = 200 Patients with documented major depression
Implementation: 00/0000
Study Start: 04/1997
Study End: 12/1998
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory caremean depression scores*All groups improved their mean depression scores at 3 and 6 months. However, the groups did not differ from each other in mean scores at 3 or 6 months.
Roumie (2006)226
Roumie (2007)227
Design: RCT
N = 871 patients
Implementation: 00/0000
Study Start: 06/2004
Study End: 12/2004
Monitoring including patient adherence and complianceCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system
Ambulatory care, Outpatient hospital basedthe proportion of patients achieving goal blood pressurePatients of providers who were randomly assigned to the patient education group had better blood pressure control (138/75 mm Hg) than those in the provider education and alert or provider education alone groups (146/76 mm Hg and 145/78 mm Hg, respectively). More patients in the patient education group had a systolic blood pressure of 140 mm Hg or less, compared with those in the provider education or provider education and alert groups RR 1.31 (95% CI, 1.06 to 1.62) p = 0.012. The proportion achieving goal blood pressure differed in the 3 groups: 107/255 (42.0%) vs. 148/362 (40.9%) vs. 213/358 (59.5%) (p = 0.003) in the provider education; provider education and alert; and provider education, alert, and patient education groups, respectively.
Safran (1995)141
Safran (1993)142
Design: RCT
N = 349 patients with HIV
Implementation: 00/0000
Study Start: 05/1992
Study End: 09/1993
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
CPOE/POE system
Integrated EHR/EMR system
Ambulatory care, Academicrate of hospitalizations, rate of mortalityPatients in the control group had a higher rate of hospitalizations than those in the intervention group (44% vs. 35%, RRR 20%, p = 0.04). No significant difference in mortality rate (p = 0.18)
Schmidt (2008)267
Design: Cohort study
N = 62 patients with CHF
Implementation: 00/0000
Study Start: 00/0000
Study End: 00/0000
Monitoring including patient adherence and compliancepatient adherence reporting
Integrated EHR/EMR system
Ambulatory careSel-reported compliance, physical and mental health status in regard to health-related quality of lifeThe concordance between self- reported compliance (Yes/No) and telematic compliance monitoring was high; patients of the study group, who reported as noncompliant, highly significantly showed lower compliance scores, measured across a 2 month monitoring period with the telematic approach (T = 9.71, p <0.001). The same effect was true to the 6 month period (T = 3.51, p <0.01). Pre–post comparisons with respect to both physical and mental health status in regard to health-related quality of life showed significant differences between baseline and 1-month followup (T = −3.09, p 0.01), as well as baseline and 6- month followup (T = 1.81, p = 0.05). However, there were neither significant increases nor decreases between 1-month followup and 6- month followup. The changes from baseline to 1-month followup were stronger with respect to mental health than to physical health. Changes were insignificant in the control group.
Schnipper (2009)313
Design: RCT
N = 322 patients
Implementation: 00/0000
Study Start: 05/2006
Study End: 06/2006
Medication Reconciliationmedication reconciliation application
Integrated CPOE/POE system
Acute care/tertiary AcademicPADE rate per patient*, PADE rate per patient per hospital, rate of hospital readmission or emergency department visit within 30 daysAmong 160 control patients, there were 230 PADEs (1.44 per patient), while among 162 intervention patients there were 170 PADEs (1.05 per patient) (ARR, 0.72; 95% CI, 0.52 to 0.99). A significant benefit was found at hospital 1 (ARR, 0.60; 95% CI, 0.38 to 0.97) but not at hospital 2 (ARR, 0.87; 95% CI, 0.57 to 1.32) (p = 0.32 for test of effect modification). Hospitals differed in the extent of integration of the medication reconciliation tool into computerized provider order entry applications at discharge. The rate of hospital readmission or emergency department visit within 30 days was 20% in the intervention arm and 24% in the usual care arm (clustered OR, 0.76; 95% CI, 0.43 to 1.35).+
Schnipper (2009)314
Design: Before-after
N = 169 patients
Implementation: 00/2006
Study Start: 07/2005
Study End: 06/2006
Monitoring including patient adherence and complianceCPOE/POE system
Integrated EHR/EMR system, Hospital information system, Laboratory system, Pharmacy
Acute care/tertiary, AcademicMean percent glucose readings 60–180 mg/dL per patient*Mean percent of glucose readings between 60 and 180 mg/dL per patient, was 59.1% in the preintervention period and 64.7% in the postintervention (p = 0.13 in unadjusted analysis). When adjusted for A1c, admission glucose, and insulin use prior to admission, the adjusted absolute difference in the percent of glucose readings within range was 9.7% (95% CI [CI], 0.6%–18.8%; p =0.04)+
Sintchenko (2005)152
Design: Before-after
N = not reported n/a
Implementation: 10/2002
Study Start: 04/2002
Study End: 03/2003
PrescribingCDSS/CDS/CCDS/reminders
Integrated Laboratory system
Acute care/tertiary, Critical care units (CCU, ICU, NICU) 800 (18 bed ICU) Beds AcademicLOS, mean number of days*, mortality rate*LOS decreased significantly from a mean of 7.12 days to 6.22 days (p = 0.02). Mortality rate was not different before and after the intervention (11.5% vs. 13.2%, NS)+
Steele (2005)157
Design: Before-after
N = 54,206 patient visits
Implementation: 12/2002
Study Start: 08/2002
Study End: 04/2003
PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
EHR/EMR system, Laboratory system
Ambulatory care“definite” or “probable” ADE rateThere was a non-statistically significant difference towards less “definite” or “probable” adverse drug events defined by Naranjo scoring (10.3% at baseline vs. 4.3% during postintervention, p = 0.23).
Takada (2003)315
Design: Before-after
N = 374 patients
Implementation: 00/1995
Study Start: 01/1998
Study End: 06/2002
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system
Other specialty hospital (rehab, oncology), 650 Bedstesting for renal function at 1 month*, 6 months*, decreased renal function at 1 month*, 6 months*Introduction of the CDSS was not associated with testing for renal function at 1 month (43.8 vs. 48.3, p = 0.46 NS) or 6 months (85.3% vs. 84.5%, p = 0.84 ) or for having decreased renal function at 1 month (3.1% vs. 3.4%, p = 0.86) or at 6 months (5.4% vs. 5.1%, p = 0.92). NS at each stage.
Tierney (2003)166
Design: RCT
N = 706 patients, 20 pharmacists, 94 physicians and 1 nurse practitioner
Implementation: 00/0000
Study Start: 01/1994
Study End: 05/1996
Monitoring including patient adherence and compliance, PrescribingCDSS/CDS/CCDS/reminders
Integrated EHR/EMR system, Pharmacy
Ambulatory care, Outpatient hospital based, AcademicQOL SF-36*, heart failure exacerbation*Across the 4 groups (physician intervention, pharmacist intervention, both interventions, and controls) the SF-36 (8 subscales), or for Heart Failure exacerbation (4 subscales), and emergency department visits or hospitalizations (all or related to HF) were NS.
Tierney (2005)167
Design: RCT
N = 706 patients
Implementation: 00/0000
Study Start: 01/1994
Study End: 05/1996
Monitoring including patient adherence and compliance PrescribingCDSS/CDS/CCDS/reminders
Integrated CPOE/POE system, EHR/EMR system, Pharmacy
Ambulatory care, Pharmacy, Outpatient hospital based AcademicQOL SF-36, Chronic Respiratory Disease Questionnaire, hospitalizations (Control vs. Physician intervention vs. Pharmacist Intervention vs. Both Intervention).No significant change in QOL measures. Hospitalization was measured and not affected.
Upperman (2005)168
Design: Before-after
N = Not reported ADE/1,000 doses
Implementation: 00/2002
Study Start: 01/2002
Study End: 00/0000
PrescribingCPOE/POE system
Integrated EHR/EMR system
Acute care/tertiary, Pediatric stand alone hospital, Academicrate of harmful ADEsAfter implementation of CPOE the rate of harmful ADEs decreased (0.05/1,000 doses vs. 0.03/1,000 doses, p = 0.05).+
Vartak (2009)316
Design: Before-after
N = 41,865 patients
Implementation: 00/2005
Study Start: 10/2004
Study End: 07/2005
PrescribingCPOE/POE system, EHR and Emergency Room (ER) event tracking system
Integrated CPOE/POE system, EHR/EMR system, Hospital information system, Imaging systems, Laboratory system, Pharmacy
Emergency department, 193 BedsMean LOS*, number of patients treated in ED*Although the system was designed to enhance efficiency, the mean (LOS) increased significantly from 116.8 minutes during the preimplementation period to 134.2 minutes during the postimplementation period (p <0.0001). The volume of patients treated in the ED however decreased significantly (p <0.0001) from preimplementation (n = 22,936) to postimplementation (n = 18,929).
Weingart (2008)275
Design: Cohort study
N = 267 patients
Implementation: 09/2000
Study Start: 04/2001
Study End: 06/2002
Monitoring including patient adherence and compliancepatient messaging via PHR
Integrated Billing/administration system, EHR/EMR system, Imaging systems, Laboratory system
Ambulatory care, AcademicADE ratePatients experienced 21 total ADEs; responders reported significantly more ADEs electronically (13%) than non-responders (3%) RRR-333%, p = 0.01.+
Wrona (2007)177
Design: Observational study
N = 536 PCA patients
Implementation: 00/2003
Study Start: 01/2003
Study End: 03/2004
Monitoring including patient adherence and compliance, PrescribingCPOE/POE system
Integrated EHR/EMR system, Imaging systems, Laboratory system
Pediatric stand alone hospitalOccurrences of low respiratory rate, low oxygen saturation rateOccurrences of low respiratory rate and low oxygen saturation were compared between ‘no order set’ and each of the two order sets groups (3.3% vs. 4.3% vs. 9.9%); the Acute Pain Service order set group had significantly higher rate of low respiratory rate (3.3% vs. 9.9%, − 200%, p <0.05). No significant differences were found in the number of cases in which low oxygen saturation was recognized (13.4% vs. 20.9% vs. 14.6%).+
Yu (2009)317
Design: Case control
N = 22,665 patients
Implementation: 00/0000
Study Start: 10/2005
Study End: 09/2006
PrescribingCPOE/POE system
Integrated Imaging systems, Laboratory system, Pharmacy
Pediatric stand alone hospitalReportable ADE, no CPOE vs. some CPOE*Univariate conditional logistic regression analysis showed that the lack of CPOE in hospitals was associated with increased risk of ADE. Specifically, after controlling for co-morbidities, the odds of experiencing a reportable ADE were 42% higher for hospitals without CPOE compared with those with CPOE, after adjusting for the number of co-morbidities. OR of experiencing a reportable ADE, no CPOE vs. some CPOE 1.42 (95% CI 1.28 to 1.57)+
Zanetti (2003)180
Design: RCT
N = 273 patients
Implementation: 00/0000
Study Start: 03/2000
Study End: 06/2000
PrescribingCDSS/CDS/CCDS/reminders
Integrated Hospital information system
Acute care/tertiary, Academicrate of infectionThe rate of infection was similar in both groups (4% in alarm plus reminder group vs. 6% in the control, p = 0.4) and both were lower than before the study (p = 0.2)

The HIT system studied is in bold, followed by the systems that it was integrated with. The outcome column indicates whether at least 50% of the relevant outcomes abstracted were positively impacted by the MMIT (+) or not (−).

*

indicates outcomes noted as being the primary outcome by the paper’s authors

Abbreviations: A1c = hemoglobin A1c; ADE = Adverse Drug Event; AHR = Airway Hyper-responsiveness; aPTT = Activated Partial Thromboplastin Time; AQLQ = Asthma Quality of Life Questionnaire; ARR = Adjusted Relative Risk; BMI = Body Mass Index; BG = blood glucose; BP = Blood Pressure; CAGES = computer assisted guideline enhancement system; CCDS = Computerized Clinical Decision Support; CDS = Clinical/Computerized Decision Support; CDSS = Clinical Decision Support System; CI = Confidence IntervalI; CPOE = Computerized Provider Order Entry; DBP = Diastolic Blood Pressure; DVT = Deep Vein Thrombosis; EHR = Electronic Health Record; e-MAR = Electronic Medication Administration Record; EMR = Electronic Medical Records; e-TAR = Electronic Treatment Authorization Request; FEV1 = Forced Expiratory Volume in the first second.; GHb = Glycohemoglobin; GP = General Practitioner; HbA1c = Glycated hemoglobin; HF = Hear Failure; HIT = Health Information Technology; ICU = Intensive Care Unit; INR = International Normalized Ratio; Kg/m2 = Kilogram per square metre; LDL = Low density Lipoprotein; LOS = Length of Stay; mg/dL = milligrams per decilitre; micro-moL/L = micro moles per litre; mL/min = millilitre per minute; MM = Medication Management; MMC = Montefiore Medical Center; mmHg = millimeter of mercury; mmol/l = millimoles per litre; N or n = Sample Size; NS = Not Statistically Significant; OR = OR; OSUH = Ohio State University Health System; p = Probability; PADEs = Potential Adverse Drug Events; PANSS = Positive and Negative Syndrome Scale PCA = Patient-Controlled Analgesia; PE = Pulmonary Embolism; PHR = Patient Health Record; POE = Provider Order Entry; PRISM = Pediatric Risk of Mortality; QoL = Quality of Life; RCT = Randomized Controlled Trial; RRR = Relative Risk Reduction; SBP = Systolic Blood Pressure; SD = Standard Deviation; SF-36 = Short Form 36; SICU = Surgical Intensive Care Unit; vs. or vs. = Versus; VTE = Venous thromboembolism

From: Appendix C, Evidence Tables

Cover of Enabling Medication Management Through Health Information Technology
Enabling Medication Management Through Health Information Technology.
Evidence Reports/Technology Assessments, No. 201.
McKibbon KA, Lokker C, Handler SM, et al.

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