Optimizing the acceptance of medication-based alerts by physicians during CPOE implementation in a community hospital environment.

There are significant challenges surrounding the implementation of CPOE systems in community hospitals without a mandate for system use. One of these is to incorporate clinical decision support such as medication-based alerts, which are key to benefit realization, but can be perceived adversely by busy physicians trying to learn a new system, without negatively affecting usability and adoption. We describe a phased, iterative approach to incorporating medical-based alerts into a successful CPOE deployment. During the first 8 months after system activation, we continuously monitored the frequency of alert presentation, the frequency of "positive" responses to the alerts and physician satisfaction with each of these. Responses included alterations in filtering strategies, changes in individual drug profiles; changes in user display options; and the addition or withdrawal of entire alert categories in order to decrease maximize value and acceptance. With this strategy we were able to document order removal or modification rates of 21-66% for 6 alert categories while still achieving CPOE adoption of 75-78% during this period.