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PubMed2001

What's so special about medications: a pharmacist's observations from the POE study.

Observations from a multi-site observational study of physician order entry (POE) confirm that implementing POE is problematic, and suggest that implementing medication order entry is particularly difficult. A pharmacist participating in the study group sought to answer the question: What makes medications different? Analysis of themes specific to medication POE in this study's large data set was undertaken using a grounded theory approach. Emerging themes in the data are explored and include: (1) order complexity and the consequences of error; (2) impacts on professional roles; (3) prescribing needs in different settings; and (4) technology impact on medication administration. Awareness of potential roadblocks and lessons learned from previous implementation attempts should help organizations considering medication POE to optimize their own strategies.

Hospital Information Systems↗
PubMed2001

Patient safety in guideline-based decision support for hypertension management: ATHENA DSS.

The Institute of Medicine recently issued a landmark report on medical error.1 In the penumbra of this report, every aspect of health care is subject to new scrutiny regarding patient safety. Informatics technology can support patient safety by correcting problems inherent in older technology; however, new information technology can also contribute to new sources of error. We report here a categorization of possible errors that may arise in deploying a system designed to give guideline-based advice on prescribing drugs, an approach to anticipating these errors in an automated guideline system, and design features to minimize errors and thereby maximize patient safety. Our guideline implementation system, based on the EON architecture, provides a framework for a knowledge base that is sufficiently comprehensive to incorporate safety information, and that is easily reviewed and updated by clinician-experts.

Artificial Intelligence↗
PubMed2001

Physician Order Entry impact on drug turn-around times.

This paper describes a study of the impact of Physician Order Entry (POE) on pharmacy order turn-around times. The study looked at two surgical services, Neurosurgery and Transplant, of a large Midwestern academic medical center. Pharmacy orders were followed in these units from the time a physician wrote an order to the time the patient received the medication. The first part of the study tracked pharmacy orders for a two-month period before the implementation of POE and the second part of the study tracked pharmacy orders for a two-month period after POE had been implemented. The pre- and post-POE pharmacy turn-around times were compared. It was expected that the data would show a substantial decrease in pharmacy order turn-around times. Our study did, in fact, show a significant reduction in this turn-around-time.

Clinical Pharmacy Information Systems↗
PubMed2002

The better medication management system. Implications for Australian general practice.

BACKGROUND: The Better Medication Management System (BMMS) is a national initiative to use information technology to bring together the fragmented medication record systems currently used in Australian health care. OBJECTIVE: This article provides a brief outline of the BMMS and some of its implications for Australia's general practitioners and their patients. DISCUSSION: The BMMS has the potential to assist in achieving significantly better health outcomes by providing current information to assist prescribing and dispensing decisions and by promoting more informed medication management partnerships between consumers and their doctors and pharmacists.

Australia↗
PubMed2002

[Prescribing and dispensing drugs in Denmark. Frequency of and intervention against errors in documentation and dispensing of drugs].

Foreign studies mainly describe errors in medicine prescriptions in context with adverse drug events unlike most Danish studies and projects, which focus on documentation. Current methods of prescribing medicines in Denmark only partially follow the guidelines given by the National Board of Health. About two thirds of the prescriptions are unambiguous. Errors of potential clinical significance are estimated to occur in 4.5% of prescriptions. Transcription errors occur mainly from patients' records to the medication forms and are found in 23% to 83% of transcribed prescriptions. Several departments have intervened by using only one prescription form, a paper or electronic version, which reduced the number of ambiguous prescriptions and eliminated transcription errors. Dispensing errors are common and demonstrate the importance of further quality improvement.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Epidemiology of gout: is the incidence rising?

OBJECTIVE: To determine whether the incidence of gout is higher in 1995-1996 compared to 1977-1978. METHODS: Using the Rochester Epidemiology Project computerized medical record system, all potential cases of acute gout in the city of Rochester, Minnesota during the time intervals of 1977-1978 and 1995-1996 were identified. The complete medical records of all potential cases were screened and all who fulfilled the 1977 American College of Rheumatology proposed criteria for gout were included as incidence cases. Demographic data, body mass index, clinical presentation, and associated comorbid conditions were abstracted. The overall and age-gender adjusted incidence rates from the 2 cohorts were calculated and compared. RESULTS: A total of 39 new cases of acute gout were identified during the 2 year interval 1977-1978 representing an age and sex-adjusted annual incidence rate of 45.0/100,000 (95% CI: 30.7, 59.3). For the interval 1995-1996, 81 cases were diagnosed, representing an annual incidence rate of 62.3/100,000 (95% CI: 48.4, 76.2). There was a greater than 2-fold increase in the rate of primary gout (i.e., no history of diuretic exposure) in the recent compared to the older time periods (p = 0.002). The incidence of secondary, diuretic related gout did not increase over time (p = 0.140). CONCLUSION: Our results indicate that the incidence of primary gout has increased significantly over the past 20 years. While this increase might be a result of improved ascertainment of atypical gout, it may also be related to other, as yet unidentified, risk factors.

Adrenal Cortex Hormones↗
PubMed2002

Electronic signature for medical documents--integration and evaluation of a public key infrastructure in hospitals.

OBJECTIVES: Our objectives were to determine the user-oriented and legal requirements for a Public Key Infrastructure (PKI) for electronic signatures for medical documents, and to translate these requirements into a general model for a signature system. A prototype of this model was then implemented and evaluated in clinical routine use. METHODS: Analyses of documents, processes, interviews, observations, and of the available literature supplied the foundations for the development of the signature system model. Eight participants of the Department of Dermatology of the Heidelberg University Medical Center evaluated the implemented prototype from December 2000 to January 2001, during the course of an intervention study. By means of questionnaires, interviews, observations and database analyses, the usefulness and user acceptance of the electronic signature and its integration into electronic discharge letters were established. RESULTS: Since the major part of medical documents generated in a hospital are signature-relevant, they will require electronic signatures in the future. A PKI must meet the multitude of responsibilities and security needs required in a hospital. Also, the signature functionality must be integrated directly into the workflow surrounding document creation. A developed signature model, fulfilling user-oriented and legal requirements, was implemented using hard and software components that conform to the German Signature Law. It was integrated into the existing hospital information system of the Heidelberg University Medical Center. At the end of the intervention study, the average acceptance scores achieved were mean = 3.90; SD = 0.42 on a scale of 1 (very negative attitude) to 5 (very positive attitude) for the electronic signature procedure. Acceptance of the integration into computer-supported discharge letter writing reached mean = 3.91; SD = 0.47. On average, the discharge letters were completed 7.18 days earlier. CONCLUSION: The electronic signature is indispensable for the further development of electronic patient records. Application-independent hard and software components, in accordance with the signature law, must be integrated into electronic patient records, and provided to certification services using standardized interfaces. Signature-oriented workflow and document management components are essential for user acceptance in routine clinical use.

Authorship↗
PubMed2002

Characteristics and override rates of order checks in a practitioner order entry system.

Order checks are important error prevention tools when used in conjunction with practitioner order entry systems. We studied characteristics of order checks generated in a sample of consecutively entered orders during a 4 week period in an electronic medical record at VA Puget Sound. We found that in the 42,641 orders where an order check could potentially be generated, 11% generated at least one order check and many generated more than one order check. The rates at which the ordering practitioner overrode 'Critical drug interaction' and 'Allergy-drug interaction' alerts in this sample were 88% and 69% respectively. This was in part due to the presence of alerts for interactions between systemic and topical medications and for alerts generated during medication renewals. Refinement in order check logic could lead to lower override rates and increase practitioner acceptance and effectiveness of order checks.

Clinical Pharmacy Information Systems↗
PubMed2002

Leveraging on information technology to enhance patient care: a doctor's perspective of implementation in a Singapore academic hospital.

Information technology (IT) can improve the safety of patient care by minimising prescribing errors and organising patient-specific information from diverse databases. Apart from legibility, prescribing safety is enhanced as online access to databases carrying patient drug history, scientific drug information and guideline reference, and patient-specific information is available to the physician. Such specific information includes discharge summaries, surgical procedure summaries, laboratory data and investigation reports. In addition, decision support and prompts can be built in to catch errant orders. For such system implementations to work, the IT backbone must be fast, reliable and simple to use. End-user involvement and ownership of all aspects of development are key to a usable system. However, the hospital leadership must also have the will to mandate and support these development efforts. With such support, the design and implementation team can then map out a strategy where the greatest impact is achieved in both safety and enhanced information flow. The system should not be considered a finished work, but a continual work in progress. The National University Hospital's continuously updated Computerised Patient Support System (CPSS) is an example of an IT system designed to manage information and facilitate prescribing. It is a client-server based, one-point ordering and information access portal for doctors that has widespread adoption for drug prescription at outpatient and discharge medication usage areas. This system has built in safety prompts and rudimentary decision support. It has also become the choice means of accessing patient-related databases that impact on diagnoses and management.

Attitude of Health Personnel↗
PubMed2002

[Electronic medical records in somatic hospitals--availability and clinical use].

BACKGROUND: Despite the fact that 53 out of 72 Norwegian hospitals (as of January 2001) have introduced electronic medical records systems (EMR), very few evaluation or comparisons between such systems have been published. MATERIAL AND METHODS: We developed a questionnaire for physicians with items on computer literacy, use of electronic medical records and user satisfaction that was sent in January 2001 to 314 hospital physicians. 227 physicians responded (72%). Details about local system implementation were collected through telephone interviews with key IT personnel in each hospital. RESULTS: EMR functions were available for a total of 15 out of 23 tasks listed in our questionnaire. The majority of physicians used EMR for between two and seven tasks that mainly covered reading patient data, though respondents scored highly on computer literacy (72.2/100). INTERPRETATION: There is a substantial discrepancy between the reported use of EMR systems and the functions available in the systems. The causes are not known, but lack of computer literacy is a less probable cause.

Attitude to Computers↗