Using clinical decision support to maintain medication and problem lists A pilot study to yield higher patient safety

To investigate whether clinical decision support that automates the matching of ordered drugs to problems (clinical diagnoses) on the problem list can enhance the maintenance of both medication and problem lists in the electronic medical record, we designed a clinical decision support system to match ordered drugs on the medication list and ongoing problems on the problem list. We evaluated the capability and performance of this clinical decision support system in medication-problem matching using physician expert chart audits to match ordered drugs to ongoing clinical problems. A clinical decision support system was shown to be useful in improving medication-problem matches in 140 randomly selected audited patient encounters in three inpatient units. Enhanced maintenance of both the medication and problem lists can permit the exploitation of advanced decision support strategies that yield higher patient safety.

[1]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005, JAMA.

[2]  M J Lincoln,et al.  A computer-generated reminder system improves physician compliance with diabetes preventive care guidelines. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[3]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[4]  Gina Rollins.  The prompt, the alert, and the legal record: documenting clinical decision support systems. , 2005, Journal of AHIMA.

[5]  Frank Sullivan,et al.  Has general practitioner computing made a difference to patient care? A systematic review of published reports , 1995, BMJ.

[6]  Daniel B Hier,et al.  Assessing physician comprehension of and attitudes toward problem list documentation. , 2008, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[7]  D W Simborg,et al.  Information Factors Affecting Problem Follow-Up in Ambulatory Care , 1976, Medical care.

[8]  Richard N. Shiffman,et al.  Review: Computer-based Guideline Implementation Systems: A Systematic Review of Functionality and Effectiveness , 1999, J. Am. Medical Informatics Assoc..

[9]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[10]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[11]  D. Mant,et al.  Use of computerised general practice data for population surveillance: comparative study of influenza data. , 1991, BMJ.

[12]  Mitchell J. Barnett,et al.  Assessing the accuracy of computerized medication histories. , 2004, The American journal of managed care.

[13]  C. Marano,et al.  To err is human. Building a safer health system , 2005 .

[14]  T J Handler,et al.  Leveraging Information Technology Towards Enhancing Patient Care and a Culture of Safety in the U.S. , 2003, Methods of Information in Medicine.

[15]  William R. Rooney.  Maintaining a medication list in the chart. , 2003, Family practice management.

[16]  R. Sorelle.  Reducing the rate of medical errors in the United States. , 2000, Circulation.

[17]  M. Deming,et al.  Management of childhood illness at health facilities in Benin: problems and their causes. , 2001, American journal of public health.

[18]  P. Aspden.  Patient Safety: Achieving a New Standard for Care , 2004 .

[19]  David Sarne,et al.  Computerized physician order entry of medications and clinical decision support can improve problem list documentation compliance , 2010, Int. J. Medical Informatics.

[20]  W. Fassett.  Patient Safety and Quality Improvement Act of 2005 , 2006, The Annals of pharmacotherapy.

[21]  Richard N. Shiffman,et al.  Model Formulation: A Design Model for Computer-based Guideline Implementation Based on Information Management Services , 1999, J. Am. Medical Informatics Assoc..

[22]  G Hripcsak,et al.  Natural language processing and its future in medicine. , 1999, Academic medicine : journal of the Association of American Medical Colleges.

[23]  Daniel M. Hartung,et al.  Clinical implications of an accurate problem list on heart failure treatment , 2005, Journal of General Internal Medicine.

[24]  R. Haynes,et al.  Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research , 1994, Annals of Internal Medicine.

[25]  B Starfield,et al.  Concordance Between Medical Records and Observations Regarding Information on Coordination of Care , 1979, Medical care.

[26]  B. Grasso,et al.  Reducing errors in discharge medication lists by using personal digital assistants. , 2002, Psychiatric services.

[27]  Daniel B. Hier,et al.  Adapting User Interface to Expedite Physician Order Entry: A Frontline to Ensure Patient Safety , 2006, 2006 IEEE International Conference on Systems, Man and Cybernetics.

[28]  Fumio Harashima,et al.  IEEE International Conference on Systems, Man, and Cybernetics , 2000 .