A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring

Philip Chen, Milenko J. Tanasijevic, Ronald A. Schoenenberger, Julie Fiskio, Gilad J. Kuperman, David W. Bates

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatient serum AED levels during two 3-month periods were included in the study. During the 3-month period after implementation of the automated intervention, 13% of all AED tests ordered were canceled following computerized reminders. For orders appearing redundant, the cancellation rate was 27%. For nonredundant orders, 4% were canceled when information on specific AED monitoring and pharmacokinetics was provided. The cancellation rate was sustained after 4 years. There has been a 19.5% decrease in total AED testing volume since implementation of this intervention, despite a 19.3% increase in overall chemistry test volume. Inappropriateness owing to repeated testing before pharmacologic steady state was reached decreased from 54% of all AED orders to 14.6%. A simple, automated, activity-based intervention targeting a specific testordering behavior effectively reduced inappropriate laboratory testing. The sustained benefit supports the idea that computerized interventions may durably affect physician behavior. Computerized delivery of such evidence-based boundary guidelines can help narrow the gap between evidence and practice.

Original languageEnglish (US)
Pages (from-to)432-438
Number of pages7
JournalAmerican journal of clinical pathology
Issue number3
StatePublished - Mar 1 2003
Externally publishedYes


  • Antiepileptic drug level
  • Appropriateness
  • Benchmark
  • Evidence-based medicine
  • Guidelines
  • Indicators
  • Test ordering
  • Utilization

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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