Preventing Adverse Drug Events (ADEs): The Role of Computer Information Systems
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PREVENTING ADVERSE DRUG EVENTS (ADEs): THE ROLE OF COMPUTER INFORMATION SYSTEMS QINGYAN,MD, MS Program in Medical Information Science
C. ANTHONY HUNT,PHD Program in Medical Information Science and Department of Biopharmaceutical Sciences University of California, San Francisco, California
The occurrence of adverse drug events (ADEs) is recognized as an important health care issue. This paper provides a review of the computer information systems that have been developed and used for the prevention of ADEs. Following an introductory section that defines concepts and terms, the clinical manifestations, influences, and costs of ADEs are reviewed, along with the medication classes, types, and causes of ADEs. Information systems that target different stages of the drug ordering and delivery process are discussed. Different studies show that computerized physician order entry systems are essential in the prevention of ADEs. Computer-assisted decision support programs that are integrated with systems that cover each stage of the drug ordering and delivery process provide the most powerjiul prevention tools. Through comparison with other methods, computer-based information systems are shown to be the most cost-effective and promising strategy for preventing ADEs. Further challenges and possible improvements are also discussed. Key Words: Adverse drug event; Computer information system; Prevention; Drug ordering; Drug delivery
INTRODUCTION OVER THE LAST 30 years, adverse drug reactions (ADRs) have been recognized as a stable and leading cause of death in the United States, ranking fourth, ahead of diabetes and pneumonia (1). An ADR, as defined by the World Health Organization, is an effect that is “noxious and unintended,” undesired, and that “occurs at doses used in humans for prophylaxis, diagnosis, or therapy.” Thus, the above ranking covers just
Reprint address: Prof. C. Anthony Hunt, 513 Parnassus Ave., S-926, Box 0446, University of California, San Francisco, CA 94143-0446. E-mail: [email protected]. edu or [email protected].
those events that followed a drug being properly prescribed and administered. Events caused by errors in drug administration were excluded. Jha et al. (2) prefer a broader definition under which all the injuries resulting from administration of drugs are referred to as adverse drug events. The more common clinical manifestations of ADEs include nausea, drowsiness, diarrhea, vomiting, and rash (3). Severe ADEs manifest as arrhythrma, bonemarrow depression, central-nervous-system depression, fluid and electrolyte disturbance, and bleeding, and may lead to death. Johnson and Bootman (4)estimate that the nationwide cost of drug-related morbidity and mortality due to ADEs is more than $76.6 billion annually. This estimate, how-
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Qing Yun and C. Anthony Hunt
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ever, considers only direct costs related to the therapy of preventable dru
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