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Hung PL, Lin PC, Chen JY, Chen MT, Chou MY, Huang WC, Juang WC, Lin YT, Lin AC. Developing an Integrated Electronic Medication Reconciliation Platform and Evaluating its Effects on Preventing Potential Duplicated Medications and Reducing 30-Day Medication-Related Hospital Revisits for Inpatients. J Med Syst 2021; 45:47. [PMID: 33644834 DOI: 10.1007/s10916-021-01717-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/25/2021] [Indexed: 11/27/2022]
Abstract
The aims were to develop an integrated electronic medication reconciliation (ieMR) platform, evaluate its effects on preventing potential duplicated medications, analyze the distribution of the potential duplicated medications by the Anatomical Therapeutic and Chemical (ATC) code for all inpatients, and determine the rate of 30-day medication-related hospital revisits for a geriatric unit. The study was conducted in a tertiary medical center in Taiwan and involved a retrospective quasi pre-intervention (July 1-November 30, 2015) and post-intervention (October 1-December 31, 2016) study design. A multidisciplinary team developed the ieMR platform covering the process from admission to discharge. The ieMR platform included six modules of an enhanced computer physician order entry system (eCPOE), Pharmaceutical-care, Holistic Care, Bedside Display, Personalized Best Possible Medication Discharge Plan, and Pharmaceutical Care Registration System. The ieMR platform prevented the number of potential duplicated medications from pre (25,196 medications, 2.3%) to post (23,413 medications, 3.8%) phases (OR 1.71, 95% CI, 1.68-1.74; p < .001). The most common potential duplicated medications classified by the ATC codes were cardiovascular system (28.4%), alimentary tract and metabolism (26.4%), and nervous system (14.9%), and by chemical substances were sennoside (12.5%), amlodipine (7.5%), and alprazolam (7.4%). The rate of medication-related 30-day hospital revisits for the geriatric unit was significantly decreased in post-intervention compared with that in pre-intervention (OR = 0.12; 95% CI, 0.03-0.53; p < .01). This study indicated that the ieMR platform significantly prevented the number of potential duplicated medications for inpatients and reduced the rate of 30-day medication-related hospital revisits for the patients on the geriatric unit.
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Affiliation(s)
- Pi-Lien Hung
- Department of Pharmacy, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist, Kaohsiung City, 80708, Taiwan
| | - Pei-Chin Lin
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, No.100, Shih-Chuan 1st Road, Sanmin Dist, Kaohsiung City, 80708, Taiwan.
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan.
| | - Jung-Yi Chen
- Department of Pharmacy, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan, Taiwan
| | - Miao-Ting Chen
- Department of Pharmacy, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- Aging and Health Research Center, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei City, 11221, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Beitou District, Taipei City, 11221, Taiwan
- Department of Physical Therapy, Fooyin University, No. 151, Jinxue Road Daliao District, Kaohsiung City, 83102, Taiwan
| | - Wang-Chuan Juang
- Quality Management Center, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
- Department of Business Management, National Sun Yat-sen University, 70 Lienhai Rd, Kaohsiung, 80424, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City, 81362, Taiwan
| | - Alex C Lin
- Division of Pharmacy Practice and Administrative Sciences, The James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, 45267-0004, USA.
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Tsapepas D, Der-Nigoghossian C, Patel K, Berger K, Vawdrey DK, Salmasian H. Medication stewardship using computerized clinical decision support: A case study on intravenous immunoglobulins. Pharmacol Res Perspect 2019; 7:e00508. [PMID: 31485333 PMCID: PMC6715593 DOI: 10.1002/prp2.508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/06/2019] [Indexed: 11/08/2022] Open
Abstract
Background Healthcare delivery organizations face increasing pressure to manage the use of medications in terms of safety, waste reduction, and cost containment. Objective To describe a computerized provider order entry (CPOE) system intervention to optimize use of a commonly ordered, high-cost therapeutic: intravenous immune globulin (IVIG). Design Description of IVIG order configuration, medication use patterns, and subsequent order set configuration development in a CPOE system. Measurements IVIG orders were extracted from the CPOE system before and after the implementation of a specialty orderset to determine the indications for use, dosing, and duration of therapy. Orders were compared to a theoretical dosing schedule created from published evidence and data from a prior medication use evaluation. Results During 36 months before the implementation of the IVIG order set, 1965 IVIG orders were reviewed. The prescribed IVIG dose varied considerably from the expected dose (mean = -1.8, range = -4.9-1.5). In the 27 months after order set implementation, 848 IVIG orders were reviewed. The prescribed IVIG dose was closer to the expected dose (mean = -1.2, range = -3.9-2.6, P < .0001). Conclusions Order configuration processes are cumbersome and time-consuming, but can be streamlined to enhance a medication's usage in the healthcare system. A better understanding of institution-specific ordering patterns may facilitate more efficient and effective order configuration and optimize drug use.
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Affiliation(s)
- Demetra Tsapepas
- NewYork‐Presbyterian HospitalNew YorkNYUSA
- Columbia UniversityNew YorkNYUSA
| | | | | | | | - David K Vawdrey
- NewYork‐Presbyterian HospitalNew YorkNYUSA
- Columbia UniversityNew YorkNYUSA
| | - Hojjat Salmasian
- NewYork‐Presbyterian HospitalNew YorkNYUSA
- Columbia UniversityNew YorkNYUSA
- Brigham and Women’s HospitalBostonMAUSA
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Akhloufi H, Verhaegh SJC, Jaspers MWM, Melles DC, van der Sijs H, Verbon A. A usability study to improve a clinical decision support system for the prescription of antibiotic drugs. PLoS One 2019; 14:e0223073. [PMID: 31553785 PMCID: PMC6760771 DOI: 10.1371/journal.pone.0223073] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/12/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE A clinical decision support system (CDSS) for empirical antibiotic treatment has the potential to increase appropriate antibiotic use. Before using such a system on a broad scale, it needs to be tailored to the users preferred way of working. We have developed a CDSS for empirical antibiotic treatment in hospitalized adult patients. Here we determined in a usability study if the developed CDSS needed changes. METHODS Four prespecified patient cases, based on real life clinical scenarios, were evaluated by 8 medical residents in the study. The "think-aloud" method was used, and sessions were recorded and analyzed afterwards. Usability was assessed by 3 evaluators using an augmented classification scheme, which combines the User Action Framework with severity rating of the usability problems and the assessment of the potential impact of these problems on the final task outcomes. RESULTS In total 51 usability problems were identified, which could be grouped into 29 different categories. Most (n = 17/29) of the usability problems were cosmetic problems or minor problems. Eighteen (out of 29) of the usability categories could have an ordering error as a result. Classification of the problems showed that some of the problems would get a low priority based on their severity rating, but got a high priority for their impact on the task outcome. This effectively provided information to prioritize system redesign efforts. CONCLUSION Usability studies improve lay-out and functionality of a CDSS for empirical antibiotic treatment, even after development by a multidisciplinary system.
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Affiliation(s)
- H. Akhloufi
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S. J. C. Verhaegh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M. W. M. Jaspers
- Department of Medical Informatics, Center for Human Factors Engineering of Health Information Technology (HIT-Lab), Academic Medical Center, Amsterdam, the Netherlands
| | - D. C. Melles
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - H. van der Sijs
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A. Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
- * E-mail:
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Blumberg G, Kitai E, Vinker S, Golan-Cohen A. Changing electronic formats is associated with changes in number of laboratory tests ordered. Am J Manag Care 2019; 25:e179-e181. [PMID: 31211550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate if changes in how laboratory test requests are presented in the electronic health record (EHR) would lead to less testing. STUDY DESIGN Computerized laboratory data were used to compare the numbers of tests ordered before and after each change was introduced. METHODS Leumit Health Services (a health maintenance organization [HMO] in Israel) has a central laboratory that serves HMO members in 340 clinics all over the country. We were able to compare the numbers of gamma glutamyl transferase (GGT) tests ordered during different periods of time during which the ways of presenting the parameters on the main laboratory screen of the EHR were changed. RESULTS A dramatic reduction in orders occurred when GGT tests could be ordered only by the search engine function, instead of being ordered from 2 other lists that appear on the main screen-from about 36,000 to about 1000 per month. When the GGT test option was added back to just 1 place on the main screen, the numbers jumped back to 18,000, and when GGT returned to its original place in all the lists, back to more than 35,000. Since then, the GGT test is available on the main screen only in the batch of liver tests. CONCLUSIONS A slight decrease in the convenience of ordering a laboratory test that is not indicated for routine screening led to a dramatic decrease in the number of test orders sent. Convenience is a positive thing when it saves precious time, but if it leads to overtesting, we shall not have gained much.
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Affiliation(s)
- Gari Blumberg
- Leumit Health Services, 18 Ben Gurion St, Givat Shmuel, Israel.
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Panattoni L, Chan A, Yang Y, Olson C, Tai-Seale M. Nudging physicians and patients with autopend clinical decision support to improve diabetes management. Am J Manag Care 2018; 24:479-483. [PMID: 30325190 PMCID: PMC9245447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine the impact on routine glycated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support, which (1) routed provider alerts to a separate electronic folder, (2) automatically populated preauthorization forms, and (3) linked the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. STUDY DESIGN Observational pre-post study from November 2011 (1 year before autopend) through June 2014 (1.5 years after). METHODS The study included HMT reminders concerning an A1C test for patients with type 1 or type 2 diabetes (N = 15,630 HMT reminders; 8792 patients) in a large multispecialty ambulatory healthcare system. A Cox proportional hazard model, adjusted for patient and provider demographics, estimated the likelihood of laboratory test completion based on 3 HMT reminder characteristics: preautopend versus postautopend period, read versus unread, and the patient's time to reading. RESULTS In the postautopend period, the median time for patients to read reminders decreased (1 vs 3 days; P <.001) and the median time to complete laboratory tests decreased (40 vs 48 days; P <.001). Comparing preautopend HMT reminders with a similar time to reading, the likelihood of A1C laboratory test completion increased after autopend by between 21.1% (hazard ratio [HR], 1.211; P = .050), when time to reading was 57 days, and 33.9% (HR, 1.339; P = .003), when time to reading was 0 days. This result included 68% of the reminders. There was no statistical difference in A1C laboratory test completion for unread reminders in the preautopend versus postautopend period. CONCLUSIONS Automated patient-centered decision support can improve guideline-concordant monitoring of A1C among patients with diabetes, particularly among patients who read reminders in a timely fashion.
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Affiliation(s)
- Laura Panattoni
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109.
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Hulse NC, Lee J. Extracting Actionable Recommendations for Modifying Enterprise Order Set Templates from CPOE Utilization Patterns. AMIA Annu Symp Proc 2018; 2017:950-958. [PMID: 29854162 PMCID: PMC5977614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
As part of an enterprise-wide rollout of a new EHR, Intermountain Healthcare is investing significant effort in building a central library of best-practice order sets. As part of this effort, we have built analytics tools that can capture and determine actionable opportunities for change to order set templates, as reflected by aggregate user data. In order to determine the acceptability of this system and set meaningful thresholds for actual use, we extracted recommendations for additions, removals, and change in initial order selection status for a series of thirteen order sets. We asked local clinical experts to review the changes and classify them as acceptable or not. In total, the system identified 362 potential changes in the order set templates and 186 were deemed acceptable. While further enhancement will co sharpen the efficacy of the intervention, we expect that this type of utility will provide useful insight for content owners.
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Affiliation(s)
- Nathan C Hulse
- Intermountain Healthcare, Salt Lake City, UT
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
| | - Jaehoon Lee
- Intermountain Healthcare, Salt Lake City, UT
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT
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Razzano L, Box A, Corrick K, McDowell J, Vitoux RR. Collaboration Fuels Success of Infusion Management Interoperability Initiative. Biomed Instrum Technol 2018; 52:38-43. [PMID: 29350985 DOI: 10.2345/0899-8205-52.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Mitchell AL, Devine K, Lal V, Galloway P, House M, White K, Watson J, Parry S, Miller M, Morris M, James RA, Perros P, Pearce SHS, Quinton R. Improving the prehospital safety of steroid-dependent patients in northern England: A hospital-initiated ambulance service registration pathway. Clin Endocrinol (Oxf) 2017; 87:881-882. [PMID: 28834559 DOI: 10.1111/cen.13455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anna L Mitchell
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Kerri Devine
- Health Education North East, Newcastle upon Tyne, UK
| | - Vikram Lal
- Health Education North East, Newcastle upon Tyne, UK
| | - Paul Galloway
- Operations Centre, North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Steve Parry
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Margaret Miller
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Margaret Morris
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - R Andy James
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Petros Perros
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Simon H S Pearce
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Quinton
- Newcastle upon Tyne NHS Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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Abstract
The reduction of medication errors is largely dependent upon the structure of the medication management system and the role of the pharmacist in the acute care setting. The significance of this claim became evident in an ethnographic study of nurses' work in which data were generated from extensive observations, formal interviews, and document reviews. Each step of medication management-from ordering to administering-was microanalyzed, and spaces and places for error emerged. Results revealed medication errors defined by proximity to the patient. Pharmacists became a surprising "stop-gap" between the physicians and patients in the recognition and interception of medication errors occurring far removed from the bedside and did not formally support the reporting of these errors. Understanding the complexity of this process and the roles of involved personnel reminds us that there is presently no fool-proof plan for the reduction of medication errors and implies a culture of safety remains elusive.
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Affiliation(s)
- Sara F Hawkins
- 1 The University of Utah, Salt Lake City, Utah, USA
- 2 Brigham Young University-Idaho, Rexburg, Idaho, USA
| | - Nancy A Nickman
- 1 The University of Utah, Salt Lake City, Utah, USA
- 3 University of Utah Health, Salt Lake City, Utah, USA
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Motabar A, La V, Kim D. Emerging problem in medical education: ancillary staff and order sets. Int J Med Educ 2017; 8:135-136. [PMID: 28437246 PMCID: PMC5420462 DOI: 10.5116/ijme.58e8.fd5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/08/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ali Motabar
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA
| | - Van La
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA
| | - Daniel Kim
- Department of Internal Medicine, University of California, Riverside, School of Medicine, Riverside, CA, USA
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Hardardottir GA, Thoroddsen A. National eHealth Implementation: Country Experience. Stud Health Technol Inform 2016; 225:168-172. [PMID: 27332184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A national eHealth strategy is presumed to empower health professionals, patients and citizens to increase patient safety and quality of health care delivery. A national eHealth infrastructure encompassing a secure HealthNet, interconnected electronic health records, e-prescriptions, a national medication database and a patient portal has been implemented in Iceland. The timely and secure access to patient information by health professionals through a single portal, independent of where the patient received care, is expected to increase continuity of care, decrease duplication of data and tests, increase efficiency, increase cost effectiveness and benefit citizens in several ways. The eHealth strategy needs to be evaluated using comparable indicators.
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Westbrook JI, Raban MZ, Lehnbom EC, Li L. The Precise Observation System for the Safe Use of Medicines (POSSUM): An Approach for Studying Medication Administration Errors in the Field. Stud Health Technol Inform 2016; 228:629-633. [PMID: 27577460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Medication administration errors (MAEs) in hospital are frequent and significantly more likely to result in serious harm to patients than other medication error types. Many interventions have been proposed in order reduce MAEs and the amount of harm associated with these errors. A major limitation in assessing the effectiveness of these interventions has been the lack of robust measures for assessing changes in MAEs and associated harms. Drawing upon extensive foundational research we have developed a robust approach and data collection software to be applied in direct observational studies of nurses to allow measurement of changes in MAE rates. We report how this approach is being applied in a large stepped-wedge cluster randomised controlled trial to assess the effectiveness of an electronic medication management system to reduce MAEs in a paediatric hospital.
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Affiliation(s)
- Johanna I Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Magdalena Z Raban
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Elin C Lehnbom
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Ling Li
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Vecellio E, Georgiou A. Integrating the Radiology Information System with Computerised Provider Order Entry: The Impact on Repeat Medical Imaging Investigations. Stud Health Technol Inform 2016; 227:126-131. [PMID: 27440300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Repeat and redundant procedures in medical imaging are associated with increases in resource utilisation and labour costs. Unnecessary medical imaging in some modalities, such as X-Ray (XR) and Computed Tomography (CT) is an important safety issue because it exposes patients to ionising radiation which can be carcinogenic and is associated with higher rates of cancer. The aim of this study was to assess the impact of implementing an integrated Computerised Provider Order Entry (CPOE)/Radiology Information System (RIS)/Picture Archiving and Communications System (PACS) system on the number of XR and CT imaging procedures (including repeat imaging requests) for inpatients at a large metropolitan hospital. The study found that patients had an average 0.47 fewer XR procedures and 0.07 fewer CT procedures after the implementation of the integrated system. Part of this reduction was driven by a lower rate of repeat procedures: the average inpatient had 0.13 fewer repeat XR procedures within 24-hours of the previous identical XR procedure. A similar decrease was not evident for repeat CT procedures. Reduced utilisation of imaging procedures (especially those within very short intervals from the previous identical procedure, which are more likely to be redundant) has implications for the safety of patients and the cost of medical imaging services.
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Affiliation(s)
- Elia Vecellio
- South Eastern Area Laboratory Services, Sydney, NSW, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, NSW, Australia
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Lichtner V, Hibberd R, Cornford T. Networking Hospital ePrescribing: A Systemic View of Digitalization of Medicines' Use in England. Stud Health Technol Inform 2016; 225:73-77. [PMID: 27332165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Medicine management is at the core of hospital care and digitalization of prescribing and administration of medicines is often the focus of attention of health IT programs. This may be conveyed to the public in terms of the elimination of paper-based drug charts and increased readability of doctors' prescriptions. Based on analysis of documents about hospital medicines supply and use (including systems' implementation) in the UK, in this conceptual paper electronic prescribing and administration are repositioned as only one aspect of an important wider transformation in medicine management in hospital settings, involving, for example, procurement, dispensing, auditing, waste management, research and safety vigilance. Approaching digitalization from a systemic perspective has the potential to uncover the wider implications of this transformation for patients, the organization and the wider health care system.
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Affiliation(s)
| | - Ralph Hibberd
- Department of Management, London School of Economics and Political Science
| | - Tony Cornford
- Department of Management, London School of Economics and Political Science
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Seidling HM, Bates DW. Evaluating the Impact of Health IT on Medication Safety. Stud Health Technol Inform 2016; 222:195-205. [PMID: 27198103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health IT is becoming an increasingly powerful tool for improving medication safety. While errors may happen at all stages of the medication process, different tools have been developed to support the prescribing process (e.g. computerized prescribing with decision support), the dispensing process (e.g. barcoding or automated dispensing and unit-dose systems), or the administration process (e.g. electronic medication administration records and smart pumps). Health IT can reduce medication error and preventable adverse drug event rates by increasing documentation quality and transparency, enhancing accuracy and correctness of the medication process, and supporting information exchange and interlinking different stages of the medication process. Typical evaluated endpoints comprise process-related outcomes such as number of medication errors, harm-related outcomes such as adverse drug events, or cost-related outcomes. Typical study design to measure effectiveness of health IT in medication safety comprises before-after studies and randomized controlled trials. However, implementation is challenging; it often has a major impact on the overall workflow and such technologies must be carefully introduced and their effects must be closely monitored in order to achieve the desired reductions, as in addition to preventing errors they nearly always introduce new ones. As complex interventions, their impact depends crucially on the real world setting and the implementation details and thus, transferability of study results is variable.
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Affiliation(s)
- Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
| | - David W Bates
- Department of Medicine, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston MA, USA
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Atique S, Hsu CY, Shabbir SA. Organizational Benefits of Computerized Physican Order Entry (CPOE) System in Pakistan. Stud Health Technol Inform 2016; 225:903-904. [PMID: 27332401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Electronic prescribing is also known as Computerized Physician Order Entry (CPOE). It is a computer-aided system which offers the health professionals a robust platform for entering the prescription electronically. Due to paucity of facilities in Pakistan which are available around the world, there is an observable overburden on the health professionals and practitioners. CPOE system has shown to be very effective in minimizing medication errors. CPOE is beneficial for both patient and health organizations. There is great deal of interest in the adoption of this system in our healthcare system. The results state clearly that this system is equally beneficial for organizations who want to adopt this system as perceived by the health professionals. It supports the idea of adoption and implementation of CPOE in healthcare facilities healthcare institutes. CPOE must be adopted to ease and optimize nursing services in Pakistani healthcare system.
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Affiliation(s)
- Suleman Atique
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taiwan
| | - Chien-Yeh Hsu
- Department of Information Management, National Taipei University of Nursing and Health Sciences
| | - Syed-Abdul Shabbir
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taiwan
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Abstract
BACKGROUND Many hospitalised patients are affected by medication errors (MEs) that may cause discomfort, harm and even death. Children are at especially high risk of harm as the result of MEs because such errors are potentially more hazardous to them than to adults. Until now, interventions to reduce MEs have led to only limited improvements. OBJECTIVES To determine the effectiveness of interventions aimed at reducing MEs and related harm in hospitalised children. SEARCH METHODS The Effective Practice and Organisation of Care Group (EPOC) Trials Search Co-ordinator searched the following sources for primary studies: The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), the Economic Evaluation Database (EED) and the Health Technology Assessments (HTA) database; MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Proquest Dissertations & Theses, Web of Science (citation indexes and conference proceedings) and the EPOC Register of Studies. Related reviews were identified by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects (DARE). Review authors searched grey literature sources and trial registries. They handsearched selected journals, contacted researchers in the field and scanned reference lists of relevant reviews. They conducted searches in November 2013 and November 2014. They applied neither language nor date limits. SELECTION CRITERIA Randomised controlled trials, controlled before-after studies and interrupted time series investigating interventions to improve medication safety in hospitalised children (≤ 18 years). Participants were healthcare professionals authorised to prescribe, dispense or administer medications. Outcome measures included MEs, (potential) patient harm, resource utilisation and unintended consequences of the interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed study quality using the EPOC data collection checklist. We evaluated the risk of bias of included studies and used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the quality of the body of evidence. We described results narratively and presented them using GRADE tables. MAIN RESULTS We included seven studies describing five different interventions: participation of a clinical pharmacist in a clinical team (n = 2), introduction of a computerised physician order entry system (n = 2), implementation of a barcode medication administration system (n = 1), use of a structured prescribing form (n = 1) and implementation of a check and control checklist in combination with feedback (n = 1).Clinical and methodological heterogeneity between studies precluded meta-analyses. Although some interventions described in this review show a decrease in MEs, the results are not consistent, and none of the studies resulted in a significant reduction in patient harm. Based on the GRADE approach, the overall quality and strengfh of the evidence are low. AUTHORS' CONCLUSIONS Current evidence on effective interventions to prevent MEs in a paediatric population in hospital is limited. Comparative studies with robust study designs are needed to investigate interventions including components that focus on specific paediatric safety issues.
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Affiliation(s)
- Jolanda M Maaskant
- Academic Medical Center, University of AmsterdamEmma Children's HospitalMeibergdreef 9AmsterdamNoord HollandNetherlands1105 AZ
| | - Hester Vermeulen
- Amsterdam School of Health Professions, University of Applied Sciences AmsterdamFaculty of NursingAmsterdamNetherlands
- Academic Medical Centre, University of AmsterdamDepartment of SurgeryMeibergdreef 9PO Box 22660AmsterdamNetherlands1100 DD
| | - Bugewa Apampa
- University of SussexSchool of Life SciencesFalmerBrightonUKBN1 9QG
| | - Bernard Fernando
- University of EdinburghCommunity Health Sciences ‐ General PracticeThames Avenue Surgery2 Thames AvenueRainhamKentUKME8 9BW
| | - Maisoon A Ghaleb
- University of HertfordshireDepartment of Pharmacy, School of Life and Medical SciencesCollege Lane CampusHatfieldUKAL10 9AB
| | - Antje Neubert
- University Hospital ErlangenDepartment of PediatricsLoschgestr. 15ErlangenGermany91054
| | - Sudhin Thayyil
- Imperial College LondonAcademic NeonatologyLondonUKWC1N 1EH
| | - Aung Soe
- Medway Maritime HospitalOliver Fisher Neonatal UnitWindmill RoadGillinghamKentUKME7 5NY
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Marcelin A, Perodin C, Baja C, Bright A, Duperval J, Duplan M, Dérilus F, Duda S, Pape J. Developing an Electronic Medical Record for Interlinked Care Services in Haiti. Stud Health Technol Inform 2015; 216:883. [PMID: 26262185 PMCID: PMC4573958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A large clinical care and research organization in Haiti required an electronic medical record system (EMR) to serve the needs of its 30 interlinked clinical programs. After assessing available open source software, the local team designed and implemented a modular proprietary EMR that is improving data quality and patient care. Despite the many benefits of existing open source medical record systems, clinical centers with complex workflow patterns--even those in resource-limited settings--should consider developing sustainable, local systems that fit their care model.
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Affiliation(s)
- A Marcelin
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | - C Perodin
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | - C Baja
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | - A Bright
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | - J Duperval
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | - M Duplan
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | - F Dérilus
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
| | | | - J Pape
- Groupe Haïtien d'Etude du Sarcoma de Kaposi et des Infections Opportunistes (GHESKIO)
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Navas H, Graffi Moltrasio L, Ares F, Strumia G, Dourado E, Alvarez M. Using mobile devices to improve the safety of medication administration processes. Stud Health Technol Inform 2015; 216:903. [PMID: 26262205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Within preventable medical errors, those related to medications are frequent in every stage of the prescribing cycle. Nursing is responsible for maintaining each patients safety and care quality. Moreover, nurses are the last people who can detect an error in medication before its administration. Medication administration is one of the riskiest tasks in nursing. The use of information and communication technologies is related to a decrease in these errors. Including mobile devices related to 2D code reading of patients and medication will decrease the possibility of error when preparing and administering medication by nurses. A cross-platform software (iOS and Android) was developed to ensure the five Rights of the medication administration process (patient, medication, dose, route and schedule). Deployment in November showed 39% use.
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Affiliation(s)
- H Navas
- Sanatorio Finochietto, Buenos Aires, Argentina
| | | | - F Ares
- Develaris, Buenos Aires, Argentina
| | | | - E Dourado
- Sanatorio Finochietto, Buenos Aires, Argentina
| | - M Alvarez
- Sanatorio Finochietto, Buenos Aires, Argentina
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20
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Al Muallem Y, Al Dogether M, Al Assaf R, Al Ateeq A, Househ M. The implementation experiences of a pharmacy automation drug dispensing system in saudi arabia. Stud Health Technol Inform 2015; 208:22-26. [PMID: 25676941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this paper is to investigate the experiences of implementing a pharmacy automation drug dispensing system in Saudi Arabia. Key informant interviews, meeting documents, and experience of the researcher were the data collection sources used in the study. A thematic analysis of the data was conducted. Study results discuss the organizational challenges prior to implementation as well as details of the implementation process. Preliminary results show improvements in the services provided by the pharmaceutical department. Lessons learned are also discussed. The work presented in this paper is preliminary and more research is needed to evaluate the overall impact of the new pharmacy automation system on services provided by the pharmaceutical department.
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Affiliation(s)
- Yahya Al Muallem
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Majed Al Dogether
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Rakan Al Assaf
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Asma Al Ateeq
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Mowafa Househ
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
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21
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Price M, Weber JH, Davies I, Bellwood P. Lead User Design: Medication Management in Electronic Medical Records. Stud Health Technol Inform 2015; 216:237-241. [PMID: 26262046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Improvements in medication management may lead to a reduction of preventable errors. Usability and user experience issues are common and related to achieving benefits of Electronic Medical Records (EMRs). This paper reports on a novel study that combines the lead user method with a safety engineering review to discover an innovative design for the medication management module in EMRs in primary care. Eight lead users were recruited that represented prescribers and clinical pharmacists with expertise in EMR design, evidence-based medicine, medication safety and medication research. Eight separate medication management module designs were prototyped and validated, one with each lead user. A parallel safety review of medicaiton management was completed. The findings were synthesized into a single common set of goals, activities and one interactive, visual prototype. The lead user method with safety review proved to be an effective way to elicit diverse user goals and synthesize them into a common design. The resulting design ideas focus on meeting the goals of quality, efficiency, safety, reducing the cognitive load on the user, and improving communication wih the patient and the care team. Design ideas are being adapted to an existing EMR product, providing areas for further work.
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Affiliation(s)
- Morgan Price
- Dept. of Computer Science, University of Victoria, Victoria, British Columbia, BC, Canada
| | - Jens H Weber
- Dept. of Computer Science, University of Victoria, Victoria, British Columbia, BC, Canada
| | - Iryna Davies
- Dept. of Family Practice, University of British Columbia, Vancouver, British Columbia, BC, Canada
| | - Paule Bellwood
- Dept. of Family Practice, University of British Columbia, Vancouver, British Columbia, BC, Canada
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Al Muallem Y, Al Dogether M, Al Assaf R, Al Ateeq A, Househ M. A pharmacy inventory management system in saudi arabia: a case study. Stud Health Technol Inform 2015; 208:17-21. [PMID: 25676940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this paper is to report on the preliminary findings of the implementation process of a pharmacy inventory management system at a local Saudi hospital. Meeting documents, key informant interviews, and experience of the researcher were part of the data collection sources used in the study. A thematic analysis of the data was conducted. Preliminary findings show that the implementation process of the pharmacy inventory management system needs the involvement and support of senior management and experienced technical expertise. Future research will focus on investigating the impacts of the pharmacy inventory management system on workflow and medication errors.
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Affiliation(s)
- Yahya Al Muallem
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Majed Al Dogether
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Rakan Al Assaf
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Asma Al Ateeq
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Mowafa Househ
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard - Health Affairs (MNG-HA), Riyadh, Saudi Arabia
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Ehrler F, Baumann P, Lovis C. How to represent the decision process in a medication plan: the case of the Swiss cohort of inflammatory bowel diseases. Stud Health Technol Inform 2015; 210:724-728. [PMID: 25991248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Inflammatory bowel diseases (IBD) belong to healthcare problems impacting the quality of life and inducing important costs for the healthcare system. There is still no magical cure against this kind of diseases, but many promising therapies are under investigation. In order to study the efficiency and side effects of the existing drugs and to evaluate new ones, large numbers of patients are followed in long term cohort studies. The particular constraints associated to the follow up of patients with IBD require the implementation of adapted and efficient tools. On the one hand, clinicians must be able to perform daily changes to the patient treatment in order to adapt it for its best efficiency and react to side effects. On the other hand, the tool must provide long term view on the data to allow large scale analyses regarding the efficiency of the investigated treatment. There are few solutions allowing a clear visualization of the treatment plan of the patients in the long term that indicates clearly the changes and the adverse events. In this work, we propose a new integrated tool that offers a clear temporal view over the patients' treatment.
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Affiliation(s)
- Frederic Ehrler
- University Hospitals of Geneva, Division of Medical Information Sciences, Geneva, Switzerland
| | - Philippe Baumann
- University Hospitals of Geneva, Division of Medical Information Sciences, Geneva, Switzerland
| | - Christian Lovis
- University Hospitals of Geneva, Division of Medical Information Sciences, Geneva, Switzerland
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24
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Cha E, Golden SH, Finkelstein J. Unanticipated consequences of hospital-based insulin management order sets. Stud Health Technol Inform 2015; 216:939. [PMID: 26262241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recent studies demonstrated risks to patient safety associated with implementation of electronic applications for medication management in ambulatory care. This study was aimed at demonstrating similar phenomenon in a hospital setting. After introduction of computerized order set targeting hypoglycemia, the frequency of hypoglycemia significantly decreased from 1/1/07 to 12/31/08. In contrast, the frequency of hyperglycemia increased at the same time from 1/1/07 to 12/31/07. Only after subsequent introduction of a hospital-wide standardized insulin order set including hyperglycemia policies frequency of hyperglycemic episodes declined. Hypo/hyperglycemia is associated with adverse clinical outcomes in the inpatient setting. Retroactive analysis showed that if hypoglycemic and hyperglycemic policies were introduced simultaneously, unexpected increase in frequency of hyperglycemic episodes could have been avoided. These data are informative in identifying unanticipated consequences of an insulin management order sets focused entirely on hypoglycemia. A balanced approach in implementing insulin management guidelines concurrently addressing both hypoglycemia and hyperglycemia policies is warranted.
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Affiliation(s)
- Eunme Cha
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Phillips W. Ethical controversies about proper health informatics practices. Mo Med 2015; 112:53-57. [PMID: 25812276 PMCID: PMC6170081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pinto Pizzo VR, Gonçalves PB, Goncalves Barbosa LM, Mantovani Faustino de Carvalho DC, Ortiz de Camargo M, Onofre de Lira C. The Impact of Implementing a New Computerized Physician Order Entry (CPOE) System on Pharmaceutical Interventions in a Tertiary Brazilian Hospital. Stud Health Technol Inform 2015; 216:940. [PMID: 26262242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We analyzed trends in pharmaceutical interventions during the implementation of a new computerized physician order entry (CPOE) process in a tertiary hospital in Brazil. The new process utilized an eletronic interface that was designed in-house and an automatic order extension program. The new process reduced the number of order transcriptions and mitigated other potential CPOE-related errors [1].
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Delamarre D, Bouzille G, Dalleau K, Courtel D, Cuggia M. Semantic integration of medication data into the EHOP Clinical Data Warehouse. Stud Health Technol Inform 2015; 210:702-706. [PMID: 25991243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Reusing medication data is crucial for many medical research domains. Semantic integration of such data in clinical data warehouse (CDW) is quite challenging. Our objective was to develop a reliable and scalable method for integrating prescription data into EHOP (a French CDW). METHOD PN13/PHAST was used as the semantic interoperability standard during the ETL process, and to store the prescriptions as documents in the CDW. Theriaque was used as a drug knowledge database (DKDB), to annotate the prescription dataset with the finest granularity, and to provide semantic capabilities to the EHOP query workbench. RESULTS the system was evaluated on a clinical data set. Depending on the use case, the precision ranged from 52% to 100%, Recall was always 100%. CONCLUSION interoperability standards and DKDB, document approach, and the finest granularity approach are the key factors for successful drug data integration in CDW.
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Affiliation(s)
| | | | - Kevin Dalleau
- Université de Rennes 1, LTSI, Rennes, F-35000, France
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Morquin D, Ologeanu-Taddei R, Koumar Y, Bourret R, Reynes J. Implementing a tele-expertise system to optimise the antibiotic use and stewardship: The case of the Montpellier University Hospital (France). Stud Health Technol Inform 2015; 210:296-300. [PMID: 25991153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper has two aims: 1) to describe the tele-expertise system implemented in the Montpellier University Hospital (France) in order to optimize antimicrobial use 2) to analyze the prescribers' adherence to this system. For the second purpose, an observational prospective study was conducted for 12 months. Data were collected from counselling advices, which were notified in the electronic medical records. 1386 tele-expertise actions were performed. Among them, 87% were made without clinical evaluation at the bedside. The prescribers' adherence rate to a diagnosis was 79%. For the therapeutic requests, 87% of answers were fully followed. The results outline how the tele-expertise system enables both infectious disease specialists and prescribers to make better decisions in particular cases.
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Affiliation(s)
- D Morquin
- Montpellier Management Research Center, University of Montpellier, France
| | - R Ologeanu-Taddei
- Montpellier Management Research Center, University of Montpellier, France
| | - Y Koumar
- Infectious and Tropical Diseases Department, Gui de Chauliac, Montpellier University Hospital, France
| | - R Bourret
- Research Division, Montpellier University Hospital, France
| | - J Reynes
- Infectious and Tropical Diseases Department, Gui de Chauliac, Montpellier University Hospital, France
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Takeda T, Mihara N, Nakagawa R, Manabe S, Shimai Y, Teramoto K, Matsumura Y. A template-based computerized instruction entry system helps the comunication between doctors and nurses. Stud Health Technol Inform 2015; 210:271-275. [PMID: 25991148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In a hospital, doctors and nurses shares roles in treating admitted patients. Communication between them is necessary and communication errors become the problem in medical safety. In Japan, verbal instruction is prohibited and doctors write their instruction on paper instruction slips. However, because it is difficult to ascertain revision history and the active instructions on instruction slips, human errors can occur. We developed template-based computerized instruction entry system to reduce ward workloads and contribute to medical safety. Templates enable us to input the instructions easily and standardize the descriptions of instructions. By standardizing and combine the instruction into one template for one instruction item, the systems could prevent instructions overlap. We created sets of templates (e.g., admission set, preoperative set), so that doctors could enter their instructions easily. Instructions entered via any of the sets can be subdivided into separate items by the system before being submitted, and can also be changed on a per-item basis. The instructions were displayed as calendar form. Calendar form represents the instruction shift and current active instructions. We prepared 382 standardized instruction templates. In our system, 66% of instructions were entered via templates, and 34% were entered as free-text comments. Our system prevents communication errors between medical staff.
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Affiliation(s)
- Toshihiro Takeda
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Naoki Mihara
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | | | - Shiro Manabe
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Yoshie Shimai
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Kei Teramoto
- Department of Medical Informatics, Osaka University Graduate School of Medicine
| | - Yasushi Matsumura
- Department of Medical Informatics, Osaka University Graduate School of Medicine
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Prakash G. Devising outlier-based alerts for medication orders. Stud Health Technol Inform 2015; 210:359-363. [PMID: 25991166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drugs are chemical substances, which can, on consumption and under certain conditions, be toxic and cause Adverse Drug Reactions (ADRs) in patients. This paper puts forth the proposition of generating a systemic alert to a clinician, at the time of placing a medication order for a patient, when the number of ADRs associated with the selected medication is significantly different from the number of ADRs associated with other drugs approved for the same therapeutic area.
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Syed-Abdul S, Nguyen A, Huang F, Jian WS, Iqbal U, Yang V, Hsu MH, Li YC. A smart medication recommendation model for the electronic prescription. Comput Methods Programs Biomed 2014; 117:218-224. [PMID: 25092226 DOI: 10.1016/j.cmpb.2014.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The report from the Institute of Medicine, To Err Is Human: Building a Safer Health System in 1999 drew a special attention towards preventable medical errors and patient safety. The American Reinvestment and Recovery Act of 2009 and federal criteria of 'Meaningful use' stage 1 mandated e-prescribing to be used by eligible providers in order to access Medicaid and Medicare incentive payments. Inappropriate prescribing has been identified as a preventable cause of at least 20% of drug-related adverse events. A few studies reported system-related errors and have offered targeted recommendations on improving and enhancing e-prescribing system. OBJECTIVE This study aims to enhance efficiency of the e-prescribing system by shortening the medication list, reducing the risk of inappropriate selection of medication, as well as in reducing the prescribing time of physicians. METHOD 103.48 million prescriptions from Taiwan's national health insurance claim data were used to compute Diagnosis-Medication association. Furthermore, 100,000 prescriptions were randomly selected to develop a smart medication recommendation model by using association rules of data mining. RESULTS AND CONCLUSION The important contribution of this model is to introduce a new concept called Mean Prescription Rank (MPR) of prescriptions and Coverage Rate (CR) of prescriptions. A proactive medication list (PML) was computed using MPR and CR. With this model the medication drop-down menu is significantly shortened, thereby reducing medication selection errors and prescription times. The physicians will still select relevant medications even in the case of inappropriate (unintentional) selection.
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Affiliation(s)
- Shabbir Syed-Abdul
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Alex Nguyen
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Frank Huang
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Wen-Shan Jian
- Taipei Medical University, School of Health Care Administration, Taiwan.
| | - Usman Iqbal
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Vivian Yang
- College of Medical Science and Technology, Institute of Biomedical Informatics, Taiwan.
| | - Min-Huei Hsu
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
| | - Yu-Chuan Li
- Taipei Medical University, College of Medical Science and Technology, Graduate Institute of Biomedical Informatics, Taiwan.
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Perspectives in Health Information Management. Fall 2014 introduction. Perspect Health Inf Manag 2014; 11:1a. [PMID: 25593567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Charles K, Cannon M, Hall R, Coustasse A. Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? Perspect Health Inf Manag 2014; 11:1b. [PMID: 25593568 PMCID: PMC4272436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change.
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Affiliation(s)
- Krista Charles
- Krista Charles, MS, is an alumni of the Healthcare Program of the College of Business at Marshall University, Graduate College, in South Charleston, West Virginia
| | - Margaret Cannon
- Margaret Cannon, MS, is an alumni of the Healthcare Program of the College of Business at Marshall University, Graduate College, in South Charleston, West Virginia
| | - Robert Hall
- Robert Hall, MS, is an alumni of the Healthcare Program of the College of Business at Marshall University, Graduate College, in South Charleston, West Virginia
| | - Alberto Coustasse
- Alberto Coustasse, DrPH, MD, MBA MPH, is an associate professor of the Healthcare Program of the College of Business at Marshall University, Graduate College, in South Charleston, West Virginia
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Fischer JR. The impact of health care technology on medication safety. S D Med 2014; 67:279-280. [PMID: 25076683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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35
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Bernstein K. Reporting of drug allergies for use in a national decision support system. Stud Health Technol Inform 2014; 205:68-72. [PMID: 25160147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In Denmark, there are plans for establishing a national decision support system, providing on-line support for physicians during drug prescribing. This includes establishment of a national database containing information about each patient's drug allergies. Allergy information already exists in medication modules in hospital systems and primary care systems and thus constitutes a potential source for the national allergy database. This paper reports an analysis of local data structure, content and registration policies with the aim to re-use existing allergy data. The result of the analysis is that due to lack of harmonisation most existing cannot be re-used in the national database. The paper propose a common dataset for allergy data where national and international standards were considered.
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Affiliation(s)
- Knut Bernstein
- MEDIQ - Medical Informatics and Quality Management, Copenhagen, Denmark
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Kivekäs E, Luukkonen I, Mykkänen J, Saranto K. Improving the coordination of patients' medication management: a regional Finnish development project. Stud Health Technol Inform 2014; 201:175-180. [PMID: 24943541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this paper, we present an overview of activities and results from a regional development project in Finland. The aim in this project was to analyze how healthcare providers produce and receive information on a patient's medication, and to identify opportunities to improve the quality, effectiveness, availability and collaboration of social and healthcare services in relation to medication information. The project focused on the most important points in patients' medication management such as home care and care transitions. In a regional development project, data was gathered by interviews and a multi professional workshop. The study revealed that medication information reached only some professionals and lay caregivers despite electronic patient record (EPR) systems and tools. Differences in work processes related to medication reconciliation and information management were discussed in the group meeting and were regarded as a considerable risk for patient safety.
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Affiliation(s)
- Eija Kivekäs
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Irmeli Luukkonen
- School of Computing, HIS R&D, University of Eastern Finland, Kuopio, Finland
| | - Juha Mykkänen
- School of Computing, HIS R&D, University of Eastern Finland, Kuopio, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Sedki K, Duclos C, Lamy JB. A Preference-based framework for medical decision making. Stud Health Technol Inform 2014; 205:63-67. [PMID: 25160146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical decision making, such as choosing which drugs to prescribe, requires to consider mandatory constraints, e.g. absolute contraindications, but also preferences that may not be satisfiable, e.g. guideline recommendations or patient preferences. The major problem is that these preferences are complex, numerous and come from various sources. The considered criteria are often conflicting and the number of decisions is too large to be explicitly handled. In this paper, we propose a framework for encoding medical preferences using a new connective, called ordered disjunction symbolized by ~×. Intuitively, the preference "Diuretic~×Betablocker means: "Prescribe a Diuretic if possible, but if this is not possible, then prescribe a Betablocker". We give an inference method for reasoning about the preferences and we show how this framework can be applied to a part of a guideline for hypertension.
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Affiliation(s)
- K Sedki
- LIMICS (INSERM UMRS 1142), Université Paris 13, Sorbonne Paris Cité, 93017 Bobigny, France UPMC Université Paris 6, Sorbonne Universités, Paris
| | - C Duclos
- LIMICS (INSERM UMRS 1142), Université Paris 13, Sorbonne Paris Cité, 93017 Bobigny, France UPMC Université Paris 6, Sorbonne Universités, Paris
| | - J B Lamy
- LIMICS (INSERM UMRS 1142), Université Paris 13, Sorbonne Paris Cité, 93017 Bobigny, France UPMC Université Paris 6, Sorbonne Universités, Paris
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Luukkonen I, Mykkänen J, Kivekäs E, Saranto K. Structuring medication related activities for information management. Stud Health Technol Inform 2014; 205:637-641. [PMID: 25160264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medication treatment and the related information management are central parts of a patient's health care. As a cross-organizational and cooperative process, medication information management is a complex domain for development activities. We studied medication activities and related information management in a regional project in order to produce a shared broad picture of its processes and to understand the main issues and the needs for improvement. In this paper we provide a summary of the findings in a structured form, based on a six-dimensioned framework for design and analysis of activities and processes.
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Affiliation(s)
- Irmeli Luukkonen
- University of Eastern Finland, School of Computing, Healthcare Information Systems Research and Development, Kuopio, Finland
| | - Juha Mykkänen
- University of Eastern Finland, School of Computing, Healthcare Information Systems Research and Development, Kuopio, Finland
| | - Eija Kivekäs
- University of Eastern Finland, Department of Health and Social Management, Kuopio, Finland
| | - Kaija Saranto
- University of Eastern Finland, Department of Health and Social Management, Kuopio, Finland
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Luukkonen I, Mykkänen J, Kivekäs E, Saranto K. Medication information management: capturing multiprofessional perspective. Stud Health Technol Inform 2014; 205:642-646. [PMID: 25160265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medication information management (MIM) is a crucial activity for good quality of medication, but unfortunately not without problems. In order to improve medication information management the core activity of medication as a cooperative activity is to be studied as a whole, and the multiprofessional viewpoint for the improvement needs must be captured. In this paper we present our approach to gain such shared understanding, based on our regional development project experiences in Northern Savonia, Finland. The central features of the approach include thematic interviews supported by activity-driven models and a workshop with professionally mixed groups. Participants agreed strongly on the usefulness of the approach.
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Affiliation(s)
- Irmeli Luukkonen
- University of Eastern Finland, School of Computing, Healthcare Information Systems Research and Development, Kuopio, Finland
| | - Juha Mykkänen
- University of Eastern Finland, School of Computing, Healthcare Information Systems Research and Development, Kuopio, Finland
| | - Eija Kivekäs
- University of Eastern Finland, Department of Health and Social Management, Kuopio, Finland
| | - Kaija Saranto
- University of Eastern Finland, Department of Health and Social Management, Kuopio, Finland
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Lupşe OS, Stoicu-Tivadar L. Pediatrics prescriptions with ontologies and treatment suggestions. Stud Health Technol Inform 2014; 205:403-407. [PMID: 25160215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Diagnosis and treatment for children healthcare are very sensitive activities. The present work presents an ontology based model for a future information system to support these activities. The input data contains children health status, and drug characteristics. During clinical practice a database with what specialists mark as successful treatments is created. This database is gradually growing bigger and is built by physicians based on their good results related to a treatment for a certain health condition. The new ontology system proposed in this paper is supporting the e-prescription process. The relations are managed using the open source application Protégé and for suggesting treatments, using the database with successful treatments, we developed a special module that offers to physicians a selection from which they can chose the best treatment for their current case.
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Affiliation(s)
- Oana-Sorina Lupşe
- Faculty of Automatics and Computers, University "Politehnica" Timişoara, Romania
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41
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Kuo MC, Chang P. A total design and implementation of an intelligent mobile chemotherapy medication administration. Stud Health Technol Inform 2014; 201:441-446. [PMID: 24943579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The chemotherapy medication administration is a process involved many stakeholders and efforts. Therefore, the information support system cannot be well designed if the entire process was not carefully examined and reengineered first. We, from a 805-teaching medical center, did a process reengineering and involved physicians, pharmacists and IT engineers to work together to design a mobile support solution. System was implemented in March to July, 2013. A 6" android handheld device with 1D BCR was used as the main hardware. 18 nurses were invited to evaluate their perceived acceptance of system based on Technology Acceptance Model for Mobile Service Model. Time saved was also calculated to measure the effectiveness of system. The results showed positive support from nurses. The estimated time saved every year was about 288 nursing days. We believe our mobile chemotherapy medication administration support system is successful in terms of acceptance and real impacts.
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Affiliation(s)
| | - Polun Chang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan/ROC
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Elsaid K, Truong T, Monckeberg M, McCarthy H, Butera J, Collins C. Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. Int J Qual Health Care 2013; 25:656-63. [PMID: 24132956 DOI: 10.1093/intqhc/mzt067] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the impact of electronic standardized chemotherapy templates on incidence and types of prescribing errors. DESIGN A quasi-experimental interrupted time series with segmented regression. SETTING A 700-bed multidisciplinary tertiary care hospital with an ambulatory cancer center. PARTICIPANTS A multidisciplinary team including oncology physicians, nurses, pharmacists and information technologists. INTERVENTION(S) Standardized, regimen-specific, chemotherapy prescribing forms were developed and implemented over a 32-month period. MAIN OUTCOME MEASURE(S) Trend of monthly prevented prescribing errors per 1000 chemotherapy doses during the pre-implementation phase (30 months), immediate change in the error rate from pre-implementation to implementation and trend of errors during the implementation phase. Errors were analyzed according to their types: errors in communication or transcription, errors in dosing calculation and errors in regimen frequency or treatment duration. Relative risk (RR) of errors in the post-implementation phase (28 months) compared with the pre-implementation phase was computed with 95% confidence interval (CI). RESULTS Baseline monthly error rate was stable with 16.7 prevented errors per 1000 chemotherapy doses. A 30% reduction in prescribing errors was observed with initiating the intervention. With implementation, a negative change in the slope of prescribing errors was observed (coefficient = -0.338; 95% CI: -0.612 to -0.064). The estimated RR of transcription errors was 0.74; 95% CI (0.59-0.92). The estimated RR of dosing calculation errors was 0.06; 95% CI (0.03-0.10). The estimated RR of chemotherapy frequency/duration errors was 0.51; 95% CI (0.42-0.62). CONCLUSIONS Implementing standardized chemotherapy-prescribing templates significantly reduced all types of prescribing errors and improved chemotherapy safety.
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Affiliation(s)
- K Elsaid
- Department of Pharmaceutical Sciences, MCPHS University, 179 Longwood Ave, Boston, MA 02115, USA.
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Kilburn FL, Bailey P, Price D. Sepsis: recognizing the next event. Nursing 2013; 43:14-16. [PMID: 24045815 DOI: 10.1097/01.nurse.0000434320.25397.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Freda L Kilburn
- At St. Claire Regional Medical Center in Morehead, Ky., Freda L. Kilburn is a nursing practice consultant, Phelan Bailey is an assistant manager in the ED, and David Price is an ED charge nurse
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Brady K, Shariff A. Virtual medical scribes: making electronic medical records work for you. J Med Pract Manage 2013; 29:133-136. [PMID: 24228379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is increasing buzz around the term "medical scribe" in healthcare today. Medical scribes help meet the growing electronic medical record (EMR) data entry challenge healthcare providers face. Medical scribes reduce providers' paperwork burden, increase a medical practice's net margins, and reduce stress levels for doctors and their staff. They do this by charting patient encounters in real-time during patient examinations, thus reducing significantly the data entry workload that EMRs place on providers. Medical scribes can work onsite or offsite from a HIPAA-secure location, the latter being known as "virtual medical scribes." This article explores the uses and benefits of scribes to give you the background to employ them effectively in your clinic or hospital.
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Kelly LS, Caulder CR, Bookstaver PB. Timely formulary management for preventing errors related to antiretroviral drugs. Am J Health Syst Pharm 2013; 70:1014-5. [PMID: 23719874 DOI: 10.2146/ajhp130078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Pharmacotherapy alerting system reduces order-verification errors. Health Devices 2013; 42:201. [PMID: 23901436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Hoonakker PLT, Carayon P, Walker JM, Brown RL, Cartmill RS. The effects of Computerized Provider Order Entry implementation on communication in Intensive Care Units. Int J Med Inform 2013; 82:e107-17. [PMID: 23298435 PMCID: PMC3624062 DOI: 10.1016/j.ijmedinf.2012.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 11/26/2022]
Abstract
The literature shows that communication in health care is one of the most important factors associated with quality of care and patients safety. Especially in Intensive Care Units (ICUs) communication is of importance, due to the characteristics of the setting. However, relatively little is known about the different aspects of communication in health care and how Computerized Provider Order Entry (CPOE) implementation may impact communication, and consequently, quality of care. In this study we adapted an existing questionnaire developed by Shortell et al. to examine the impact of CPOE implementation on communication in a repeated cross-sectional design (6 months before implementation, 3 months after implementation and one-year after implementation). Results show overall that CPOE did not have a negative effect on communication, especially in the long term.
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Affiliation(s)
- Peter L T Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI, USA.
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48
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Bouamrane MM, Mair FS. A study of information management in the patient surgical pathway in NHSScotland. Stud Health Technol Inform 2013; 192:557-61. [PMID: 23920617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We conducted a study of information management processes across the patient surgical pathway in NHSScotland. While the majority of general practitioners (GPs) consider electronic medical records systems as an essential and integral part of their work during the patient consultation, many were not fully satisfied with the functionalities of these systems. A majority of GPs considered that the national eReferral system streamlined referral processes. Almost all GPs reported marked variability in the quality of discharge information. Preoperative processes vary significantly across Scotland, with most services using paper-based systems. Insufficient use is made of information provided through the patient electronic referral leading to a considerable duplication of tasks already performed in primary care. Three health-boards have implemented electronic preoperative information systems. These have transformed clinical practices and facilitated communication and information-sharing among the multi-disciplinary team and within the health-boards. Substantial progress has been made towards improving information transfer and sharing within the surgical pathway in recent years. However, there remains scope for further improvements at the interface between services.
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Uto Y, Iwaanakuchi T, Muranaga F, Kumamoto I. Development of the electronic patient record system based on problem oriented system. Stud Health Technol Inform 2013; 192:1036. [PMID: 23920810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In Japan, POS (problem oriented system) is recommended in the clinical guideline. Therefore, the records are mainly made by SOAP. We developed a system mainly with a function which enabled our staff members of all kinds of professions including doctors to enter the patients' clinical information as an identical record, regardless if they were outpatients or inpatients, and to observe the contents chronologically. This electric patient record system is called "e-kanja recording system". On this system, all staff members in the medical team can now share the same information. Moreover, the contents can be reviewed by colleagues; the quality of records has been improved as it is evaluated by the others.
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Affiliation(s)
- Yumiko Uto
- Department of Medical Informatics, Graduate School of Medical and Dental Sciences, Kagoshima University
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Househ M, Ahmad A, Alshaikh A, Alsuweed F. Patient safety perspectives: the impact of CPOE on nursing workflow. Stud Health Technol Inform 2013; 183:367-371. [PMID: 23388315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this review is to explore the impact of Computerized Physician Order Entry (CPOE) systems on patient safety from a nursing perspective. The paper discusses the importance of safety culture within nursing, nursing perceptions of CPOE, and the impact of CPOE on nursing workflow. The findings indicate that the implementation of CPOE negatively impacts nursing workflow when CPOE systems are inadequately designed. Future work is necessary to explore the impact of CPOE on nursing workflow and the direct impact on patient safety.
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Affiliation(s)
- Mowafa Househ
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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