Reviewing the impact of computerized provider order entry on clinical outcomes: The quality of systematic reviews

PurposeComputerized provider order entry (CPOE) is central to current efforts at improving clinical care. Understanding the quality of the evidence for CPOE is important to the practical decision of implementation, patient safety and future design efforts. This paper presents the results of a systematic analysis of the quality of systematic reviews of empirical CPOE research.MethodsThe systematic search process included PubMed, CINAHL, Scopus, Cochrane, INSPEC, and PsychInfo databases from the years 1987–mid 2010 in English only. All reviews with a focus on CPOE, electronic ordering, Electronic Health Record, or Health Information Technology were included. Studies were excluded if they did not mention a systematic review in the title or text, report a formal search process, report results of the search, or specifically include a separate section on CPOE in the results. Quality was assessed using systematic criteria developed by Oxman and Guyatt, QUOROM, and PRISMA. All three authors conducted the reviews independently. Disagreements were resolved through discussion. Descriptive data was extracted.ResultsThe search process yielded 185 initial unique references with 13 final reviews meeting the inclusion criteria. The rating of overall quality in the Oxman and Guyatt scale averaged 4.9 out of a possible 7 and the average mean of the sum of the other questions was 5.69. The overall QUOROM/PRISMA ratings averaged 63% completion and ranging from 45% to 81%.ConclusionsThe quality of these reviews were moderate. Only one study conducted a full quantitative synthesis, and overall heterogeneity was reported as very high in the 3 studies that measured it. Recommendations emphasize clarifying the phenomenon of CPOE by avoiding reporting conclusions across sub-group analyses, increasing emphasis on the development of theoretical models, including more quantitative assessments, and increasing breadth of outcomes.

► None of the 13 reviews on CPOE include studies comparing CPOE against non-CPOE interventions.
► The quality ratings of the 13 systematic reviews were in the moderate range.
► Only one study conducted a full quantitative synthesis.
► Future researchers will want to clarify the phenomenon of CPOE.