A Retrospective Study on the Impact and Benefits of Commercial Clinical Decision Support Systems in Clinical Decision-Making and Pharmaceutical Care.

Abstract

Purpose: Pharmacists ensure prescription accuracy to safeguard patient safety. Clinical decision support systems (CDSS), integrated with computerized physician order entry (CPOE), help detect medication errors and enhance care quality. Traditional homegrown CDSS (HG systems) require manual updates, while commercial CDSS offer real-time, curated drug data but come with licensing costs. To evaluate the impact and benefits of integrating a commercial CDSS with a CPOE system on clinical decision-making and pharmaceutical care in a Taiwanese medical center.

Patients and methods: This retrospective study was conducted in a 1,354-bed teaching hospital in southern Taiwan in 2022. Alerts generated by a homegrown (HG) CDSS and a commercial CDSS, both integrated with CPOE, were compared. Fifty-six trained inpatient pharmacists reviewed prescription alerts. Effective alerts were defined as those initially missed by physicians but corrected after pharmacist intervention. Alerts were categorized by clinical issue type and severity. A model incorporating the probability of adverse drug events (ADEs), extended hospital stays, and daily costs was used to estimate cost savings. A benefit-cost ratio was calculated to assess the added value of the commercial CDSS.

Results: The commercial CDSS generated 357 effective alerts, and the HG system generated 251. Over 95% of pharmacist interventions were accepted by physicians. The commercial CDSS helped avoid inappropriate prescriptions, which resulted in estimated cost savings from USD 78,540 to USD 103,530 and reduced hospital stays by 470-620 days.

Conclusion: Using a commercial CDSS to assist pharmacists in prescription verification provides the most real-time information and efficiently identifies inappropriate prescriptions. This reduces medical costs and avoids prolonged hospitalization owing to ADEs.