Approach for analysis of order check overrides in a computerized practitioner order entry system

While it has been established that electronic order entry systems can prevent transcription errors and check orders for severe drug allergies and interactions, continuous monitoring of the effectiveness of order checks is important. The goal of this study is to examine the rate at which high severity order checks generated in the electronic medical record at VA Puget Sound are overridden by clinicians. We compare our results to those of a previous study that found high override rates for Critical Drug Inter-action and Allergy-Drug Interaction order check categories. We are interested in determining whether system changes addressing these high rates have been successful in reducing the overall override rate in these categories. Because the method used previously to extract orders is no longer available, the first step in our study was to develop a new procedure to gather order entry data. This procedure is the subject of our report.