How to improve the delivery of medication alerts within computerized physician order entry systems: an international Delphi study

OBJECTIVES To determine what information can be helpful in prioritizing and presenting medication alerts according to the context of the clinical situation. To assess the usefulness of different ways of delivering medication alerts to the user. DESIGN An international Delphi study with two quantitative rounds. 69 researchers with expertise in computerized physician order entry (CPOE) systems were asked to estimate the usefulness of 20 possible context factors, and to assess the potential impact of six innovative ways of delivering alert information on adverse drug event (ADE) rates. RESULTS Participants identified the following top five context information items (in descending order of usefulness): (1) severity of the effect of the ADE the alert refers to; (2) clinical status of the patient; (3) probability of occurrence of the ADE the alert refers to; (4) risk factors of the patient; and (5) strength of evidence on which the alert is built. The ways of delivering alert information with the highest estimated ADE reduction potential are active alerting, proactive prescription simulation and a patient medication module that gives patient-oriented alert information. LIMITATIONS Most participants had a research-oriented focus; therefore the results may not reflect the opinions of CPOE users or CPOE implementers. CONCLUSION The study results may provide CPOE system developers and healthcare institutions with information on how to design more effective alert mechanisms.