JAMIA: CDS wields little influence on ward-round med ordering
Decision support is not having an observable influence on the medication ordering process that takes place on ward-rounds, according to report published online first in the June 14 edition of the Journal of American Medical Informatics Association.
Melissa T. Baysari, PhD, from the Australian Institute of Health Innovation, faculty of medicine at the University of New South Wales in Sydney, and colleagues sought to assess whether a low level of decision support within a hospital computerized provider order entry (CPOE) system has an observable influence on the medication ordering process on ward-rounds. They also assessed prescribers’ views of the decision support features.
“Senior doctors were the decision makers, yet junior doctors who used the [clinical decision support] system received the alerts. As a result, the alert information was generally ignored and not incorporated into the decision-making processes on ward-rounds,” Baysari and colleagues wrote.
Fourteen specialty teams comprised of 46 physicians were shadowed by an investigator while on their ward-rounds and 16 prescribers from these teams were interviewed.
Senior physicians were highly influential in prescribing decisions during ward-rounds but rarely used the CPOE system. “Most frequently, a junior physician (intern, resident, or registrar) adopted the role of ‘electronic prescriber’ and entered medication orders into the system,” the authors wrote. “Senior physicians told the junior prescribers what medications to order, and were occasionally seen calling out medication orders from a patient’s bedside to the junior doctors who stood at computers in the hallway.”
Of the 96 medication orders entered into the electronic medication management system during ward-rounds, 89 percent were performed using the long-hand method; prescribers rarely prescribed using the ‘quicklist’ or ‘protocol’ methods, Baysari and colleagues found. “During prescribing, 48 percent of medications were observed to trigger one or more alerts…Only 17 percent of alerts were ‘read’ by prescribers.”
Junior doctors entered the majority of medication orders into the system, nearly always ignored computerized alerts and never raised their occurrence with other doctors on ward-rounds, the authors summed.
The authors admitted limitations to the study such as it was only conducted at one site and many results may not be generalizable to other settings. “Participants were observed during ward-rounds only, and prescribers use the system to prescribe throughout the day and night,” the authors stated.
“Based on the results, we hypothesize that the likelihood of alerts being read by junior doctors is greater in the absence of senior doctors, and that the [reference viewer] tool is used more frequently by junior doctors in non-ward-round situations.”
“Identifying how prescribing systems are used during different clinical behaviors is important for designing decision support that effectively support users in making appropriate prescribing decisions,” concluded the authors. “The findings from this study suggest that the greatest value of decision support may be in non-ward-round situations where senior doctors are not available. If confirmed, this presents a specific focus and user group for designers of medication decision support.”
Melissa T. Baysari, PhD, from the Australian Institute of Health Innovation, faculty of medicine at the University of New South Wales in Sydney, and colleagues sought to assess whether a low level of decision support within a hospital computerized provider order entry (CPOE) system has an observable influence on the medication ordering process on ward-rounds. They also assessed prescribers’ views of the decision support features.
“Senior doctors were the decision makers, yet junior doctors who used the [clinical decision support] system received the alerts. As a result, the alert information was generally ignored and not incorporated into the decision-making processes on ward-rounds,” Baysari and colleagues wrote.
Fourteen specialty teams comprised of 46 physicians were shadowed by an investigator while on their ward-rounds and 16 prescribers from these teams were interviewed.
Senior physicians were highly influential in prescribing decisions during ward-rounds but rarely used the CPOE system. “Most frequently, a junior physician (intern, resident, or registrar) adopted the role of ‘electronic prescriber’ and entered medication orders into the system,” the authors wrote. “Senior physicians told the junior prescribers what medications to order, and were occasionally seen calling out medication orders from a patient’s bedside to the junior doctors who stood at computers in the hallway.”
Of the 96 medication orders entered into the electronic medication management system during ward-rounds, 89 percent were performed using the long-hand method; prescribers rarely prescribed using the ‘quicklist’ or ‘protocol’ methods, Baysari and colleagues found. “During prescribing, 48 percent of medications were observed to trigger one or more alerts…Only 17 percent of alerts were ‘read’ by prescribers.”
Junior doctors entered the majority of medication orders into the system, nearly always ignored computerized alerts and never raised their occurrence with other doctors on ward-rounds, the authors summed.
The authors admitted limitations to the study such as it was only conducted at one site and many results may not be generalizable to other settings. “Participants were observed during ward-rounds only, and prescribers use the system to prescribe throughout the day and night,” the authors stated.
“Based on the results, we hypothesize that the likelihood of alerts being read by junior doctors is greater in the absence of senior doctors, and that the [reference viewer] tool is used more frequently by junior doctors in non-ward-round situations.”
“Identifying how prescribing systems are used during different clinical behaviors is important for designing decision support that effectively support users in making appropriate prescribing decisions,” concluded the authors. “The findings from this study suggest that the greatest value of decision support may be in non-ward-round situations where senior doctors are not available. If confirmed, this presents a specific focus and user group for designers of medication decision support.”