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*215. Effects of Computerized Patient Record System (CPRS) on Safety and Quality of Paitent Care: Clinicians’ Perspectivities

P Glassman, VA Greater Los Angeles Healthcare System; P Belperio, VA Greater Los Angeles Healthcare System; B Simon, VA Greater Los Angeles Healthcare System; K Lim, VA Greater Los Angeles Healthcare System; J Sayers, VA Greater Los Angeles Healthcare System

Objectives: Improving patient safety is a critical VA concern. As part of a larger evaluation study designed to reduce adverse drug events, we conducted a baseline survey on clinicians’ attitudes towards and knowledge of the Computerized Patient Record System (CPRS) and associated drug interaction alerts.

Methods: We surveyed 319 clinicians at 12 sites within an integrated VA Healthcare System located in Southern California. Clinicians included attending-level physicians, nurse practitioners and physician assistants. The questionnaire, developed and tested locally, assessed extent of and comfort with CPRS. Questions assessed how CPRS in general, and clinician order entry and drug interaction alerts in particular, have affected clinician efficiency and patient care. Additionally, we assessed general knowledge about 21 common drug-drug and drug-disease interactions. We report the results of the first 63 (20%) respondents in this on-going survey.

Results: In this preliminary analysis respondents were 71% male, 87% full-time employees and 72% Internists. Participants averaged 48 years of age, practiced 2.5 days per week in outpatient clinics and wrote 53 prescriptions per week. A majority of clinicians (range: 70% to 86%) preferred using CPRS to conventional written methods for entering patient notes, requesting consults, ordering radiological procedures, ordering laboratory tests, and prescribing medications. Overall, clinicians reported that CPRS improved the safety and quality of patient care but reduced clinician efficiency. For example, 81% of clinicians felt that drug interaction alerts increased the potential for prescribing safely but 70% perceived that clinician order entry increased the time required to write prescriptions. Also, while 71% felt that clinician order entry reduced errors in ordering laboratory tests, 68% reported that doing so required extra time.

Clinicians recognized a median of 53% (range: 17% to 89%) of 21 common drug interactions. Eighty five percent (85%) of clinicians reported that they would have felt more confident about their answers had they had drug alerts to identify these interactions. In practice, however, respondents reported that they would be more likely to change a patient's medication based on personal interaction with a pharmacist (58%) rather than depend on a CPRS drug interaction alert (4%). Thirty-eight percent were equally likely to change medications based on an alert from either source. Clinicians reported the greatest barriers to effective use of drug alerts included non-relevant alerts (72%), system slowdowns and shutdowns (65%), and lack of time to review alerts (57%).

Conclusions: Early analysis of an on-going survey suggests that clinicians perceive that CPRS improves the quality and safety of patient care but decreases efficiency. Clinicians favor the CPRS drug alert system as a means to improve their recognition of drug interactions, an issue that needs to be addressed based on our data, but note several implementation problems that impede effective utility.

Impact: CPRS appears to provide important patient care benefits, especially with regard to prescribing. The resultant increase in the time needed to complete tasks associated with patient encounters may require adjusting staffing levels or appointment duration. In addition, effectiveness of drug alerts should be systematically assessed as to actual impact on patient safety.