Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Medical Order Entry Systems”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 739 records · Page 41Linked to original sources
PubMed1995

A general model of drug prescription.

Currently, there is no widely accepted structured representation of drug prescription. Nevertheless, a structured representation is required for entering and storing drug prescriptions avoiding free text in computerized systems, and for drug prescription reviews. Derived from part of the work of the European OPADE project, we describe an object-oriented model of drug prescription which incorporates important concepts such as the phase and triggering event concepts. This model can be used to record all drug prescriptions, including infusions, in a structured way avoiding free text. The phase concept allows the storage of sequentially ordered dosage regimens for a drug within the same prescription. The prescription triggering event concept allows recording of the administration of a drug conditional to dates, symptoms and clinical signs, medical procedures, and everyday life events. This model has been implemented within the OPADE project; the corresponding aspects of the user interface are presented to show how this model can be used in practice. Even if other new attributes may be added to the described objects, the structure of this model is suitable for general use in software which requires the entry, storage and processing of drug prescriptions.

Drug Administration Schedule↗
PubMedDate not supplied

The impact of computerized physician order entry on medication error prevention.

BACKGROUND: Medication errors are common, and while most such errors have little potential for harm they cause substantial extra work in hospitals. A small proportion do have the potential to cause injury, and some cause preventable adverse drug events. OBJECTIVE: To evaluate the impact of computerized physician order entry (POE) with decision support in reducing the number of medication errors. DESIGN: Prospective time series analysis, with four periods. SETTING AND PARTICIPANTS: All patients admitted to three medical units were studied for seven to ten-week periods in four different years. The baseline period was before implementation of POE, and the remaining three were after. Sophistication of POE increased with each successive period. INTERVENTION: Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings. MAIN OUTCOME MEASURE: Medication errors, excluding missed dose errors. RESULTS: During the study, the non-missed-dose medication error rate fell 81 percent, from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period (P < 0.0001). Non-intercepted serious medication errors (those with the potential to cause injury) fell 86 percent from baseline to period 3, the final period (P = 0.0003). Large differences were seen for all main types of medication errors: dose errors, frequency errors, route errors, substitution errors, and allergies. For example, in the baseline period there were ten allergy errors, but only two in the following three periods combined (P < 0.0001). CONCLUSIONS: Computerized POE substantially decreased the rate of non-missed-dose medication errors. A major reduction in errors was achieved with the initial version of the system, and further reductions were found with addition of decision support features.

Clinical Pharmacy Information Systems↗
PubMed2004

Exploratory case method to determine the frequency of redundant orders within manually consolidated order lists.

A computerized provider order entry (CPOE) system can provide an efficient means of retrieving and consolidating order lists from multiple electronic clinical practice standards and protocols. However, the consolidated order list may contain exact duplicate or overlapping orders. Benner's framework for levels of nursing expertise can be used to explicate the variability of the nurse's responses to redundancies in order lists and the potential compromise to patient safety. An exploratory case method was performed to consolidate 74 orders from 11 sources. The consolidated order list contained 35% fewer orders after the redundant orders were removed. Our work has shown that many redundant orders may arise by consolidating order lists from multiple electronic standards. It is imperative that consolidated electronic order lists be manageable by the nurse according to their level of clinical and computer expertise, and that redundant orders are resolved before being displayed to the nurse.

Humans↗
PubMed1992

Emergency care of children in shelters.

Children living in homeless shelters often lack the health care resources usually available to other children. They are often more acutely and chronically ill than domiciled children and frequently use the emergency department (ED) as their point of entry into the health care system. To identify differences in health status, we surveyed sheltered children and domiciled controls during a nine-month period in our ED. One hundred sixty-two families completed a self-administered questionnaire during the study period: 54 homeless and 108 age-matched controls. Mean patient age was 3.4 years, mean maternal age was 27 years in both groups, and average time spent in shelters was 7.8 months. Shelter families had more children, more single mothers, and higher rates of unemployment and uninsurance than did control families. Shelter children showed greater frequencies of immunization delay, lack of TB testing, and lack of a regular health care site and higher rates of medical admissions from the ED. These data show that children in shelters have limited personal, financial, and medical resources and suggest that there are significant disparities in health status. These patients need to be identified when they present to the ED in order to meet subtle, as well as obvious, health needs.

Adolescent↗
PubMed1982

Consulting the computer about acid-base disorders.

A computer program was developed at Beth Israel Hospital in Boston to offer consultation to health care personnel treating patients with electrolyte and acid-base disorders, as the diagnosis of these disorders involves consideration of numerous factors and performance of tedious calculations. In order to obtain the necessary diagnostic information, the computer conducts a dialogue between itself and the person seeking its advice. The program then allows the computer to generate an evaluation note, which lists the diagnostic possibilities, explains the pathophysiology, recommends treatment, and provides references to the medical literature. The entire transaction, from data entry to printing, takes about 4 minutes. The computer program also compensates for entry of inconsistent data and for lack of data. Our experience with the program has revealed that it has favorably influenced patient care in a number of cases and has helped our staff better understand the pathophysiology and treatment of electrolyte and acid-base disorders.

Acid-Base Imbalance↗
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↗
PubMed2000

Does a physician's ability to accurately assess the likelihood of pulmonary embolism increase with training?

PURPOSE: Pulmonary embolism (PE), an elusive diagnosis, is detected by a diagnostic work-up that is often guided by the physician's level of clinical suspicion. The ability to accurately assess PE risk on solely clinical grounds may increase with the physician's level of training. This study documented the ability of house staff practicing in an academic teaching hospital to accurately assess the clinical likelihood of PE in patients. METHOD: During a seven-month period, all 245 patients with suspected acute PE who had had lung scans ordered via a computerized order-entry system were enrolled in the study. When ordering the lung scans, all physicians (interns, residents, and attending physicians) were required to also enter their levels of clinical suspicion on a scale of 0 to 100. The physicians' levels of clinical suspicion were correlated with the final determinations of PE, and receiver operating characteristic (ROC) curves were calculated for patients' and physicians' subgroups. RESULTS: Attending physicians were most able to diagnose PE; residents were moderately able to make the diagnosis, and interns were least able to diagnose PE. The area under the ROC curve for a correct identification of patients with PE was greatest for attending physicians (0.839), intermediate for residents (0.601), and least for interns (0.594). CONCLUSION: The ability to correctly assess a patient's likelihood of PE increases with a physician's level of training, suggesting that more senior physicians should be involved in the diagnostic work-up of patients with suspected acute PE. More instruction may help medical students, interns, and residents navigate clinical scenarios in which the diagnosis is uncertain or in which sequential tests must be performed to reach the correct diagnosis.

Acute Disease↗
PubMed2006

The implementation of an anesthesia information management system.

BACKGROUND AND OBJECTIVE: Anaesthesia information management systems, though still not used widely, will inevitably replace handwritten records and may eventually serve as a core for the development of computerized decision support. We investigated staff expectations and the accuracy of data entry in a recently implemented commercially available anaesthesia information management system. METHODS: A structured questionnaire was administered to the staff before and 1 week and 3 months after implementation in order to assess their opinion. The quality of manual data entry, and of automatic data record was evaluated by looking for missing data and the prevalence of artefacts. RESULTS: Despite initial fears the users quickly accepted the system. Both automatic and manual data entry were found to be accurate and reliable while the prevalence of artefacts was relatively low. CONCLUSIONS: A commercially available anaesthesia information management system can be easily implemented and used instead of paper charts.

Adult↗
PubMed2000

Comparison of two knowledge bases on the detection of drug-drug interactions.

This paper describes a drug ordering decision support system that helps with the prevention of adverse drug events by detecting drug-drug interactions in drug orders. The architecture of the system was devised in order to facilitate its use attached to physician order entry systems. The described model focuses in issues related to knowledge base maintenance and integration with external systems. Finally, a retrospective study was performed. Two knowledge bases, developed by different academic centers, were used to detect drug-drug interactions in a dataset with 37,237 drug prescriptions. The study concludes that the proposed knowledge base architecture enables content from other knowledge sources to be easily transferred and adapted to its structure. The study also suggests a method that can be used on the evaluation and refinement of the content of drug knowledge bases.

Artificial Intelligence↗
PubMed2007

Integrating incident reporting into an electronic patient record system.

Developments in information technology offer new opportunities to design electronic patient record systems (EPR) which integrate a broad range of functions such as clinical decision support, order entry, or electronic alerts. It has been recently suggested that EPR could support new applications for disease surveillance and patient safety. We describe the integration of a voluntary incident reporting system into an EPR used in operating theatres, to allow the reporting of accidents and preventable complications. We assessed system's reliability and users' acceptance. During the 4-years observation period (2002-2006), 48,983 interventional procedures were performed. Clinicians documented 85.1% of procedures on the incident reporting form. Agreement between chart review and electronically reported incidents was 80.6%. The integration of an incident reporting system into an EPR is reliable and well supported by health care professionals.

Adult↗
PubMed2001

[Development of an inspection-supporting system using drug images for unit dose packages].

When inspecting unit-dose packaged drugs, there would be some possibility of inspection errors and ultimately dispensing errors due to pharmacist's incorrect memory of drug identification. Therefore, this study was aimed to establish a computer-aided system for inspecting drugs of unit dose packages more accurately and efficiently. First, we analyzed the identifiability of 5846 tablets and capsules using drug codes, in order to define an identification problem for unit dose-packaged drugs. It was shown that as much as 36% of the drugs do not have any codes, 4.0% of the code-marked drugs have identical codes with others, and that 9.7% of the drugs with codes on both sides of the surface share the same code with other drugs. Thus, it was clearly shown that in many cases it is impossible to identify pharmaceuticals exactly using drug codes only. On the other hand, it was indicated that approximately 80% of the drugs which were not identified with drug codes only, could be identified when additional information on drugs' color, size, form, and splitting line was provided. Therefore, in this study, we designed an inspection-supporting system to present promptly all the information necessary for the drug identification by displaying real drug images as linked with prescribing information on the monitor. Retrieval of prescription data from the order entry host was automatically performed by entering patient's ID number or by selecting a patient from the name list of patients at the inspection terminal computer. Moreover, the system was equipped with abilities to automatically check drug interactions and duplicate prescriptions, to provide various information of prescribed drugs and to monitor patients' drug history. We used the developed system and evaluated that it is a useful tool for accurate and efficient inspection of unit dose-packaged drugs. In addition, the quality of drug inspection increased by utilizing system functions such as checking drug interactions and providing drug information.

Clinical Pharmacy Information Systems↗
PubMed2004

Evaluation of SNOMED coverage of Veterans Health Administration terms.

Veterans Health Administration (VHA) is now evaluating use of SNOMED-CT. This paper reports the first phase of this evaluation, which examines the coverage of SNOMED-CT for problem list entries. Clinician expressions in VA problem lists are quite diverse compared to the content of the current VA terminology Lexicon. We selected a random set of 5054 narratives that were previously "unresolved" against the Lexicon. These narratives were mapped to SNOMED-CT using two automated tools. Experts reviewed a subset of the tools' matched, partly matched, and un-matched narratives. The automated tools produced exact or partial matches for over 90% of the 5054 unresolved narratives. SNOMED-CT has promise as a coding system for clinical problems. In subsequent studies, VA will examine the coverage of SNOMED for other clinical domains, such as drugs, allergies, and physician orders.

Forms and Records Control↗
PubMed2003

Does failure breed success: narrative analysis of stories about computerized provider order entry.

OBJECTIVE: To assess the definitions of success and failure as defined by the participants of the Menucha Consensus Conference on Computerized Provider Order Entry (CPOE). DESIGN: Thirteen experts from various fields participated in Menucha Consensus Conference. Though they belonged to different fields, all of them had some kind of experience in CPOE implementation. MEASUREMENTS: The stories of these experts were analyzed using a constant comparison method and partially ordered display. RESULTS: Each participant told a success and a failure story. Definitions of success and failure, as well as variables contributing to the success and failure of CPOE implementations, were extracted from the transcripts. CONCLUSION: Analysis reveals that what is considered a failure is context dependent and that it often is an antecedent to success.

Decision Support Systems, Clinical↗
PubMed2002

A web-based central diagnostic data repository.

A central repository for diagnostic information about individual patients was created as a service to diagnostic laboratories participating in the Compentence Network for Acute and Chronic Leukemias in order to support health care delivery to patients suffering from leukemia. During the diagnostic phase several specialised laboratories perform different assays on samples from the same patient. The use of these assays in the diagnostic process and during the treatment phase may be improved in terms of both rapid delivery and cost if any one laboratory is aware of preliminary or final results from the assay carried out in other laboratories. In order to support a more efficient communication of these results, a central diagnostic data repository (CDDR) was created and web-based user interface was developed. Currently, the CDDR maintains documents in the form of portable document format (PDF) files. Several other formats are accepted and converted automatically upon entry. Patient identification is accomplished by pseudonym rather than proper name and the data is held on the CDDR for a limited time interval to accommodate the stringent privacy regulations in Germany. The principle operation of a CDDR may also be applied to the diagnostic or therapeutic process of other diseases.

Acute Disease↗
PubMed2001

Medical informatics--the state of the art in the Hospital Authority.

Since its inception in 1990, the Hospital Authority (HA) has strongly supported the development and implementation of information systems both to improve the delivery of care and to make better information available to managers. This paper summarizes the progress to date and discusses current and future developments. Following the first two phases of the HA information technology strategy the basic infrastructural elements were laid in place. These included the foundation administrative and financial systems and databases; establishment of a wide area network linking all hospitals and clinics together; laboratory, radiology and pharmacy systems with access to results in the ward. A major push into clinical systems began in 1994 with the clinical management system (CMS), which established a clinical workstation for use in both ward and ambulatory settings. The CMS is now running at all major hospitals, and provides single logon access to almost all the electronically collected clinical data in the HA. The next phase of development is focussed on further support for clinical activities in the CMS. Key elements include the longitudinal electronic patient record (ePR), clinical order entry, generic support for clinical reports, broadening the scope to include allied health and the rehabilitative phase, clinical decision support, an improved clinical documentation framework, sharing of clinical information with other health care providers and a comprehensive data repository for analysis and reporting purposes.

China↗
PubMed2000

Pharmacy database for tracking drug costs and utilization.

A pharmacy database for tracking drug costs and physician prescribing trends is described. Accuracy problems plagued data systems used to make drug-use-policy decisions at a tertiary care teaching hospital because of structural deficiencies within the systems and their nonclinical orientation. To resolve these problems, a programmer analyst, a clinical supervisor, and a clinical pharmacist developed a hierarchical database of drug costs. The database was designed to be valid for tracking drug costs according to patterns of clinical use. Internal controls were created that could identify and correct cost-tabulation errors arising within the ordering, order-entry, and billing processes. The database was able to tabulate drug costs according to the clinical service on which the patient was being treated at the time so that reports could compare aggregate prescribing trends from one time period to another for the same service. Similarly, the database could track and report drug use by disease or financial classification. Flagging elements were introduced to the database for cancer chemotherapy and antimicrobial drug products to enable reporting by these categories and by therapeutic subcategories within the antimicrobial category. Routine monthly reports were distributed to end users. Development of a database for tracking drug costs and utilization allowed a teaching hospital to derive the cost of medications from billing-charge information and to report data to health care professionals on the basis of important factors like clinical services.

Academic Medical Centers↗
PubMed2004

Requirements of tools and techniques to support the entry of structured nursing data.

The benefits of structured data are widely accepted within the nursing informatics community. However, despite the existence of structured data in the form of well-established nursing terminologies, computer-based nursing record systems are yet to achieve widespread adoption and few of the potential benefits have yet to be realized. In this paper we argue the need for tools and techniques to support the entry of structured nursing data into computer-based systems. In the absence of a generally accepted solution, we build on preliminary work carried out at the 2002 Nursing Terminology Summit and analyze the results of other studies in order to identify a preliminary set of requirements or desiderata for such tools and techniques. These requirements are centered on: how structured data is presented to users for selection; how to mediate between a variety of conceptual structures--terminologies, information models, user interface models and models of the clinical process; and how to reduce the considerable modeling burden through reuse of modeling constructs. Further applied research is needed with the ultimate goal of developing a general solution that will benefit nurses, other professionals and ultimately their patients.

Data Collection↗
PubMed2004

Remote order entry and video verification: reducing after-hours medication errors in a rural hospital.

BACKGROUND: Hendry Regional Medical Center, a 66-bed facility, has 8.5 hours of pharmacy staffing daily. Review of two years of medication errors indicated that 34% of all medication errors involved selection of the wrong drug from stock after pharmacy hours. PROCESS CHANGES: During 2003 many changes were implemented in the medication management process to enhance medication safety. For example, a limited-access area of the pharmacy was established for night entry by the nursing supervisor. The hospital then implemented services with a newly licensed remote order-entry service. These steps decreased the rate of errors involving wrong drug selection to 15%. Subsequently, a medication error involving selection of the wrong drug at night prompted another look at the process. IMPLEMENTING THE VIDEO VERIFICATION PROCESS: The hospital began using a webcam to create a digital image of the medication selected for removal from the pharmacy stock by the nursing supervisor. This image is transmitted via e-mail. In six months, only one (recent) error resulting from selection of the wrong medication after normal pharmacy hours occurred; the medication selection process simply was not followed. DISCUSSION: Results of medication error reporting indicated that using Webcam/e-mail image transmission and video verification by a pharmacist further improved patient safety in the medication selection process.

After-Hours Care↗