Physicians' Compliance with a Clinical Decision Support System Alerting during the Prescribing Process

Clinical decision support systems have been shown to improve practitioner performance. Most systems designed to prevent medication errors generate lists with patients who fulfill the criteria of the algorithm. These lists are reviewed by a pharmacist and physicians are contacted by telephone. Presenting pop-up alerts as part of the workflow with a clear recommendation is a feature critical to success. Therefore we implemented three algorithms in a clinical decision support system alerting during the medication ordering process. We analyzed whether the recommendations in these alerts were followed. We evaluated 1. whether folic or folinic acid was co-prescribed more frequently within 48 h after ordering methotrexate, 2. whether vitamin D or analogues were co-prescribed more frequently within 48 h after ordering bisphophonates and 3. whether sodium lowering drugs were stopped more frequently within one hour in patients with hyponatremia. We analyzed the difference in the 48 days before implementation and the 43 days after implementation, using Pearson's Chi² test. Co-prescription of folic or folinic acid increased from 54 to 91% (p = 0.014), co-prescription of vitamin D or analogues increased from 11 to 40% (p = 0.001) and the number of stopped orders for sodium lowering drugs increased from 3 to 14% (p = 0.002). This clinical decision support system that alerts physicians for preventable medication errors during the medication ordering process is an effective approach to improve prescribing behavior.