IMPORTANCE Anticoagulants are high-risk medications with the potential to cause significant patient harm or death. Digital transformation is occurring in hospital practice and it is essential to implement effective, evidence-based strategies for these medications in an electronic medical record (EMR). OBJECTIVE To systematically appraise the literature to determine which EMR interventions have improved the safety and quality of therapeutic anticoagulation in an inpatient hospital setting. METHODS PubMed, Embase, CINAHL, and the International Pharmaceutical Database were searched for suitable publications. Articles that met eligibility criteria up to September 2018 were included. The review was registered with PROSPERO (CRD42018104899). The web-based software platform Covidence® was used for screening and data extraction. Studies were grouped according to the type of intervention and the outcomes measured. Where relevant, a bias assessment was performed. RESULTS We found 2624 candidate articles and 27 met inclusion criteria. They included 3 randomised controlled trials, 4 cohort studies and 20 pre/post observational studies. There were four major interventions; computerised physician order entry (CPOE) (n = 4 studies), clinical decision support system (CDSS) methods (n = 21), dashboard utilisation (n = 1) and EMR implementation in general (n = 1). Seven outcomes were used to summarise the study results. Most research focused on prescribing or documentation compliance (n = 18). The remaining study outcome measures were: medication errors (n = 9), adverse drug events (n = 5), patient outcomes (morbidity/mortality/length of hospital stay/re-hospitalisation) (n = 5), quality use of anticoagulant (n = 4), end-user acceptance (n = 4), cost effectiveness (n = 1). CONCLUSION Despite the research cited, limited benefits have been demonstrated to date. It appears healthcare organisations are yet to determine optimal, evidence-based-methods to improve EMR utilisation. Further evaluation, collaboration and work are necessary to measure and leverage the potential benefits of digital health systems. Most research evaluating therapeutic anticoagulation management within an EMR focused on prescribing or documentation compliance, with less focus on clinical impact to the patient or cost effectiveness. Evidence suggests that CPOE in conjunction with CDSS is needed to effectively manage therapeutic anticoagulation. Targets for robust research include the integration of 'stealth' alerts, nomograms into digital systems and the use of dashboards within clinical practice.

中文翻译：

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旨在提高住院电子病历中治疗性抗凝药物安全性和质量的干预措施。

重要事项抗凝剂是高风险药物，有可能导致严重的患者伤害或死亡。数字化转型正在医院实践中发生，对于在电子病历（EMR）中对这些药物实施有效的，循证的策略至关重要。目的系统评估文献，以确定哪些EMR干预措施可改善住院医院环境中抗凝治疗的安全性和质量。方法在PubMed，Embase，CINAHL和国际药物数据库中进行搜索以寻找合适的出版物。包括截至2018年9月符合资格标准的文章。该评论已在PROSPERO（CRD42018104899）中注册。基于网络的软件平台Covidence®用于筛选和数据提取。根据干预类型和测量结果将研究分组。在相关的地方，进行了偏差评估。结果我们发现2624篇候选文章和27篇符合入选标准。他们包括3项随机对照试验，4项队列研究和20项观察前后的研究。有四项主要干预措施。电脑化医师订单输入（CPOE）（n = 4项研究），临床决策支持系统（CDSS）方法（n = 21），仪表板利用率（n = 1）和一般的EMR实施（n = 1）。七个结果被用来总结研究结果。大多数研究集中在处方或文件合规性上（n = 18）。其余研究结局指标为：用药错误（n = 9），药物不良事件（n = 5），患者结局（发病率/死亡率/住院时间/重新住院）（n = 5），高质量使用抗凝剂（n = 4），最终用户接受度（n = 4），成本效益（n = 1）。结论尽管引用了研究，但迄今为止已证明了有限的益处。看来医疗机构尚未确定最佳的，循证的方法来改善EMR的利用。为了评估和利用数字医疗系统的潜在利益，有必要进行进一步的评估，协作和工作。大多数评估EMR中的治疗性抗凝管理的研究都集中在处方或文件的依从性上，而很少关注对患者的临床影响或成本效益。有证据表明，CPOE与CDSS结合需要有效治疗抗凝治疗。进行稳健研究的目标包括集成“隐形”警报，