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The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour & improve safety
  1. Oliver Cerqueira1,
  2. Mohsain Gill2,
  3. Bishr Swar2,
  4. Katherine Ann Prentice3,
  5. Shannon Gwin1,
  6. Brent W Beasley1
  1. 1 Department of Internal Medicine, The University of Oklahoma School of Community Medicine, Tulsa, Oklahoma, USA
  2. 2 Internal Medicine, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
  3. 3 Houston Academy of Medicine–Texas Medical Center Library, Houston, Texas, USA
  1. Correspondence to Dr Brent W Beasley, Department of Internal Medicine, The University of Oklahoma Health Sciences Center, Tulsa, OK 73104, USA; bbeasle3{at}


Background Prescribing alerts of an electronic health record are meant to be protective, but often are disruptive to providers. Our goal was to assess the effectiveness of interruptive medication-prescriber alerts in changing prescriber behaviour and improving patient outcomes in ambulatory care settings via computerised provider order entry (CPOE) systems.

Methods A standardised search strategy was developed and applied to the following key bibliographical databases: PubMed, Embase, CINAHL and The Cochrane Library. Non-comparison studies and studies on non-interrupted alerts were eliminated. We developed a standardised data collection form and abstracted data that included setting, study design, category of intervention alert and outcomes measured. The search was completed in August 2018 and repeated in November of 2019 and of 2020 to identify any new publications during the time lapse.

Results Ultimately, nine comparison studies of triggered alerts were identified. Each studied at least one outcome measure illustrating how the alert affected prescriber decision-making. Provider behaviour was influenced in the majority, with most noting a positive change. Alerts decreased pharmaceutical costs, moved medications toward preferred medications tiers and steered treatments toward evidence-based choices. They also decreased prescribing errors. Clinician feedback, rarely solicited, expressed frustration with alerts creating a time delay.

Conclusion The current evidence shows a clear indication that many categories of alerts are effective in changing prescriber behaviour. However, it is unclear whether these behavioural changes lead to improved patient outcomes. Despite the rapid transition to CPOE use for patient care, there are few rigorous studies of triggered alerts and how workflow interruptions impact patient outcomes and provider acceptance.

  • ambulatory care
  • healthcare quality improvement
  • information technology
  • interruptions
  • medication safety

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • MG and BS contributed equally.

  • Contributors All authors above have contributed to this paper and have provided the final version to review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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