The effect of electronic prescribing on medication errors and adverse drug events: a systematic review.

The objective of this systematic review is to analyse the relative risk reduction on medication error and adverse drug events (ADE) by computerized physician order entry systems (CPOE). We included controlled field studies and pretest-posttest studies, evaluating all types of CPOE systems, drugs and clinical settings. We present the results in evidence tables, calculate the risk ratio with 95% confidence interval and perform subgroup analyses for categorical factors, such as the level of care, patient group, type of drug, type of system, functionality of the system, comparison group type, study design, and the method for detecting errors. Of the 25 studies that analysed the effects on the medication error rate, 23 showed a significant relative risk reduction of 13% to 99%. Six of the nine studies that analysed the effects on potential ADEs showed a significant relative risk reduction of 35% to 98%. Four of the seven studies that analysed the effect on ADEs showed a significant relative risk reduction of 30% to 84%. Reporting quality and study quality was often insufficient to exclude major sources of bias. Studies on home-grown systems, studies comparing electronic prescribing to handwriting prescribing, and studies using manual chart review to detect errors seem to show a higher relative risk reduction than other studies. Concluding, it seems that electronic prescribing can reduce the risk for medication errors and ADE. However, studies differ substantially in their setting, design, quality, and results. To further improve the evidence-base of health informatics, more randomized controlled trials (RCTs) are needed, especially to cover a wider range of clinical and geographic settings. In addition, reporting quality of health informatics evaluation studies has to be substantially improved.

HIS-monitor: quality of information processing in hospitals.

Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed the HIS-Monitor questionnaire, focusing on how a hospital information system (HIS) does efficiently support clinical and administrative tasks. HIS-Monitor was applied in a feasibility study with 102 nursing participants. Results point to strengths and weaknesses of information processing in the participating departments. Based on the experiences of the feasibility study, HIS-Monitor is now further being optimized.

Publication bias in medical informatics evaluation research: is it an issue or not?

The phenomenon of publication bias has probably existed since results of scientific research are being published. Positive and/or statistically significant results seem more likely to be published than negative and/or insignificant results. However, it is unclear if there is a remarkable impact of publication bias in medical informatics evaluation literature and how aware researchers are of its effect. We conducted a small-scale study in order to find out what the ratio of papers describing positive results vs. negative results is, tried to find enough studies to a certain subject to carry out a meta-analysis and assess publication bias by statistical methods, and finally examined reviews and meta-analyses for their results and their quality. A random sample of 86 studies showed a remarkably high percentage of descriptions of positive results (69.8%). 19 (36.6%) of the analyzed 54 reviews and meta-analyses came to a positive conclusion with regard to the overall effect of the analyzed system, 32 (62.5%) were inconclusive, and only one review came to a negative conclusion. Quantitative assessment of publication bias for health informatics studies was found difficult due to the low number of comparable studies. Although there is no clear evidence for a great impact of publication bias in medical informatics evaluation literature, further research should carried out.