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Clinicians Ignore most eRx Alerts

02/11/2009

What in medicine do we tolerance 90%+ false positive rates, without getting rid of it?
We have a long way to go in CDS.  Below is from a ASHP press release on a new Archives of IM study, recommended read.
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Clinicians Ignore Most e-Prescribing Alerts
Kate Traynor

BETHESDA, MD 09 February 2009—A large study of electronic prescribing in the outpatient setting suggests that prescribers override most warnings that indicate a medication allergy or drug interaction, according to a report in the February 9 Archives of Internal Medicine.

The analysis of data for 2872 prescribers in Massachusetts, New Jersey, and Pennsylvania over a nine-month period in 2006 found that the clinicians accepted 23% of alerts for medication allergies and 9.2% of drug interaction alerts. Alerts were almost always ignored for medications that had been previously prescribed for the patient.

The study examined more than 3 million electronic prescriptions generated using Zix Corporation’s PocketScript program. Of these, about 6.6% resulted in an interaction alert to the prescriber. Less than 2% of the alerts were for medication allergies; the rest informed the clinician that the selected medication potentially interacts with another drug currently taken by the patient.

Drug interactions were classified in the prescribing program as low, medium, or high severity, and the severity level was displayed on the prescribing device’s screen. About 62% of the alerts in the study were classified as high severity, and 29% were of medium severity. High-severity alerts were overridden about 90% of the time, and lower-level alerts were disregarded about 93% of the time.

According to the report, PocketScript’s severity classifications are produced by pharmacists at a health information technology company. The report’s authors suggested that reexamining and reclassifying some of the high-severity alerts, particularly those that are most often overridden, may increase prescribers’ acceptance of drug-interaction warnings.

Prescribers took some high-severity drug–drug interactions more seriously than others. For example, warnings not to use noncardioselective beta-blockers and macrolides together were accepted 43.1% of the time.

The next-most-commonl…

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