Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs' Computerized Patient Record System

To measure critical order check override rates in VA Puget Sound Health Care System's computerized practitioner order entry (CPOE) system and to compare 2006 results to a similar 2001 study. Analysis of ordering and order check data gathered by a post-hoc logging program. Use of Pearson's chi-square contingency table test comparing results from this study and the earlier study. Factors measured were total number of orders, frequency of order check types, frequency of order check overrides by order check type and comparisons of these results with previous results. A total of 37,040 orders generated 908 (2.5%) critical order checks. Drug-drug critical alert override rate was 74/85 (87%) in 2006 compared to 95/108 (88%) in 2001 (X2=0.04, df=1, p=0.85). The drug-allergy override rate was 341/420 (81%) compared to 72/105 (69%) in 2001 (X2=7.97, df=1, p=0.005). In 2001, 0.25% (105/42,621) orders generated a drug-allergy order check compared to 1.13% (420/37,040) in 2006 (X2=238.45, df=1, p