Effect of Computerized Physician Order Entry Reminders on HLA-B*15:02 Screening Rates: A Retrospective Study in a...

Background: Carbamazepine (CBZ) is associated with severe cutaneous adverse reactions in individuals carrying the HLA-B*15:02 allele, which is prevalent in Asian populations. Genetic screening before the initiation of CBZ is recommended, yet screening is not always undertaken. Objectives: To determine the effect of implementing computerized physician order entry (CPOE) reminders on the screening rates of HLA-B*15:02 before CBZ prescription. Methods: We conducted a retrospective analysis of 1611 patients who were prescribed CBZ between 2012 and 2023 in a regional hospital in Taiwan. The intervention involved integrating automated HLA-B*15:02 screening reminders into the CPOE system in outpatient settings. Patients were divided into an outpatient (intervention) group and an inpatient (control) group, and their data were analyzed before and after the intervention. Screening rates were compared using Fisher's exact test, and subgroup analyses were conducted on the basis of age group and physician specialty. Results: After the intervention, the outpatient group exhibited an increase in screening rate from 23.7% to 55.6% (p < 0.001). However, no significant change was observed in the inpatient group. Subgroup analysis revealed major improvements among neurologists and patients aged 41-80 years in outpatient settings. Conclusions: Implementing CPOE reminders substantially improves rates of screening for HLA-B*15:02 in outpatient settings, indicating the effectiveness of informatic interventions in enhancing adherence to pharmacogenomic guidelines. Extending such interventions to inpatient settings may further mitigate the risk of CBZ-induced severe cutaneous adverse reactions.