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Results for “Medical Order Entry Systems”

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PubMed2004

Evaluation of drug interaction software to identify alerts for transplant medications.

BACKGROUND: The ability of computerized physician order entry (CPOE) systems to identify clinically significant drug interactions is dependent upon the integrity of the drug information populating the software. A CPOE system with incomplete or inaccurate drug information will fail to identify clinically important drug interactions and, therefore, fail to reduce preventable adverse drug events (pADEs). OBJECTIVE: To evaluate, from the prescribers' perspective, the ability of a common drug interaction database to identify clinically important drug interactions involving drugs used in transplantation. METHODS: The clinical significance of drug interactions involving 5 transplant drugs was evaluated by an expert panel to determine whether alerts should be generated for physicians not involved in the transplant at the time of order entry. Drug interactions included in the analysis were generated from the expert panel, a common drug interaction database, and 2 standard drug interaction references. Responses on the clinical significance were used to calculate the sensitivity, specificity, and positive and negative predictive values for each severity setting of a common electronic drug interaction database. RESULTS: Overall, the database failed to identify approximately 70% of interactions considered significant by the expert panel. Of the alerts that were generated, >85% were considered clinically significant. The database was most deficient in identifying interactions resulting from additive toxicity. CONCLUSIONS: To expect a decrease in pADEs caused by drug interactions, the information used to populate CPOE systems must be validated. Establishing consistency and integrity of this information may be a future role for pharmacists.

Databases as Topic↗

PubMed1999

Tracking vaccine compliance in a primary care setting: online history, reminders, order entry, and charting.

In a new primary care setting with three medical disciplines participating, a vaccine history and order entry system was implemented along with other online documentation systems as the primary documentation tools for the clinic. Reminders were generated based upon a set of algorithms consistent with 1998 nationally accepted vaccine guidelines. Vaccine compliance data were analyzed for the entire population cared for in this setting for a 6 month period. Rates of compliance with national recommendations for eight key vaccine groups were calculated based on the online data. Trends in the rates of compliance, interpreted within limitations, showed statistically and clinically significant improvements. The immunization application accomplished several goals: accurate history and patient-specific recommendations, online ordering of vaccines or serum products, online charting of administration that, in turn, automatically maintained the vaccine history.

Adolescent↗

PubMed2004

An intravenous medication safety system: preventing high-risk medication errors at the point of care.

Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months.

Academic Medical Centers↗

PubMedDate not supplied

Evaluations of the prescription order entry system for outpatient clinics by physicians in the 80 university hospitals in Japan.

We investigated the evaluations of the prescription order entry system by the physicians who are the direct users of this system. Questionnaires were sent to 400 staff physicians of 80 medical school affiliated hospitals, out of which 76% responded. Among the respondents, 48 per cent are making use of the computerized outpatient prescription order entry system, and 52 per cent are not. The result shows 78% of the physicians are in favor of the prescription order entry system; the most dissatisfied opinion of the physicians toward the system was that the input took too much time thus reduced the communication with the patient. Physicians who are using the system seemed to favor the system more than the physicians who are not using it.

Attitude to Computers↗

PubMed2004

Implementation and initial evaluation of a Web-based nurse order entry system for multidrug-resistant tuberculosis patients in Peru.

Socios En Salud uses directly observed therapy to treat a majority of the multidrug-resistant tuberculosis in Peru. The nurses play an important role in this community-based model as the patients' primary care givers. Since nurses, rather than physicians, are involved in patients' daily care, we developed a nurse-order entry system to test whether such a system would improve the accuracy and quality of medication data. We compared regimen information from patient electronic medical records, paper charts and pharmacy records. After a two-month training period on the new system, we conducted the trial for 52 days in two of Lima's six geographic treatment areas, and re-reviewed the three sources of medication data. We measured the error rates after the trial period and found there was no significant difference in the control group's (Lima Este), error rate (8.6% vs. 6.9%, P=0.66) after the trial. The intervention group (Lima Callao), however, showed a significant drop in the error rate (17.4% vs. 3.1%, P=0.0074) after the same time interval. Additionally, the nurse expressed satisfaction with the order entry system and its ease of use. The decrease in error rates and user satisfaction regarding the system are promising measures of our order entry system's success.

Antitubercular Agents↗

PubMed2003

Provider order entry with integrated decision support: from academia to industry.

OBJECTIVES: To describe the evolution of a provider order entry system with integrated decision support, from a research prototype to full implementation at one academic center, and finally to a commercial product. METHODS: Describe the institutional environment and planning process in which the system originated. Highlight the historical evolution of the provider entry system, and analyze its system architecture and functionality. Describe the requirements for successful design and deployment both within a single health care organization and as part of a commercial product line. RESULTS: Over a period of eight years the system evolved from a research prototype to a fully integrated order entry system in routine use on most inpatient units of a large academic medical center. Around 12,000 orders are entered every day into the computer system; 70% of those are entered directly by the responsible physician. The system embeds best-of-care practice guidelines, and is used to reduce resource utilization by limiting unnecessary testing and suggesting more effective or less costly therapeutic replacements. The system was recently acquired by a large HIS software vendor and is being rapidly implemented at numerous customer sites. CONCLUSIONS: Large-scale development or deployment of complex health information systems requires considerable organizational agreement and resources, as well as close attention to iterative system design that explicitly includes constant feedback from the user community. The transformation of such a system from a single-site success to a widely deployed product requires convergence of resources and needs.

Academic Medical Centers↗

PubMed1975

A highly automated hospital medication system. Five years' experience and evaluation.

Since 1969, medications have been provided to patients at the Johns Hopkins Hospital using a computer system that controls the entire medication process from entry of physician's order to hourly drug distribution. Special envelopes containing patient and dosage information are computer generated for each dose to be administered. These envelopes, containing individually labelled ready-to-administer doses, are delivered to the nursing units hourly. The system provides daily medication profiles, drug administration histories, discharge summaries, and management and billing reports. Medication errors of commission were 4.6 times more frequent on the traditional nursing units compared to the units with the computer system. Registered nurses spend 56% less time performing medication-related activities on the units served by the computer. For 250 beds, total costs are 7% higher using the computer system. For 450 beds, total costs are 14% lower using the computer system.

Costs and Cost Analysis↗

PubMed2004

A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach?

PURPOSE: To analyse the impact of computer-based patient record systems (CBPRS) on medical practice, quality of care, and user and patient satisfaction. DATA SOURCES: Manual and electronic search of the Medline, Cochrane, and Embase databases. STUDY SELECTION: Selected articles were published from 2000 to March 2003. CBPRS was defined as computer software designed to be used by clinicians as a direct aid in clinical decision making. To be included, the systems should have recorded patient characteristics and offered online advice, or information or reminders specific to clinicians during the consultation. DATA EXTRACTION: Keywords used for the search were: electronic record, informatic record, electronic medical record, electronic patient record, patient order entry, computer-based patient system, clinical decision support systems, and evaluation. RESULTS: Twenty-six articles were selected. Use of a CBPRS was perceived favourably by physicians, with studies of satisfaction being mainly positive. A positive impact of CBPRS on preventive care was observed in all three studies where this criterion was examined. The 12 studies evaluating the impact on medical practice and guidelines compliance showed that positive experiences were as frequent as experiences showing no benefit. None of the six studies analysing the impact of CBPRS on patient outcomes reported any benefit. CONCLUSIONS: CBPRS increased user and patient satisfaction, which might lead to significant improvements in medical care practices. However, the studies on the impact of CBPRS on patient outcomes and quality of care were not conclusive. Alternative approaches considering social, cultural, and organizational factors may be needed to evaluate the usefulness of CBPRS.

Consumer Behavior↗

PubMed2003

The potential role of computerisation and information technology in improving prescribing in hospitals.

For physicians, prescribing of drugs is one of the most common actions in daily practice. In the continuum prescribing, dispensing, administration and use of drugs, failures may occur and can lead to patient harm. The use of computerised physician order entry systems is subject to much discussion regarding medication error reduction. This commentary analyses the issues where such systems can contribute to improved care.

Computers↗

PubMed1999

The transition to automated practitioner order entry in a teaching hospital: the VA Puget Sound experience.

We recently installed an automated practitioner order entry system on our busiest inpatient wards and critical care units. The installation followed 20 months preparation in which we created the workstation, network, and host infrastructure, developed requisite policies, recruited personnel to support the system, and installed the software in areas where the pace of order entry was less intense. Since implementing automated order entry, we have experienced problems such as an increase in time required for practitioners to enter orders, workflow changes on inpatient units, difficulties with patient transfers, and others. Our user support system has been heavily used during the transition period. Software tailoring and enhancements designed to address these problems are planned, as is installation of the order entry system in remaining clinical units in our medical centers.

Attitude to Computers↗

PubMed2003

Who's counting now? ROI for patient safety IT initiatives.

The impact and expectation of cost-justifying patient safety IT initiatives using a traditional ROI must evolve to focus beyond the financial benefit. It must encompass overall patient safety, patient satisfaction, and employee and physician satisfaction benefit categories. Computerized physician order entry (CPOE) and bar code medication administration (BCMA) systems are two particular clinical point-of-care products that will play a key role in addressing patient safety objectives. Integrating the two technologies can bring both financial and clinical benefits.

Cost-Benefit Analysis↗

PubMed1994

Status quo and future prospects of the total hospital information system of a Japanese medical college.

Six years have passed since the total hospital information system of Miyazaki Medical College, nicknamed PHOENIX, began its functions for the first time. It started with order entry systems, and has accomplished various systems, leaving one entry system unfinished; the injection order entry system which will be completed in the near future. It was revealed that the waiting period was most reduced at the hospital pharmacy. The waiting period for the visitors was also reduced. Usefulness of the PHOENIX system was greatly advanced by the function of a unique system of personal computer LAN, nicknamed PALM. This personal computer environments consisted of 200 or more Apple Macintosh computers. In this PALM environment, file servers, CD-ROM MEDLINE, clinical information databases, electronic mails (available in LAN and Internet) and sharing of printers are on service 24 hr a day.

Academic Medical Centers↗

PubMed1988

Achieving order entry by physicians in a computerized medical record.

When Community Memorial Hospital selected a computerized Medical Information System (MIS), it was recognized that physician use and acceptance was paramount to success. To achieve this, active participation from the medical-dental staff via an advisory committee, system education and emphasis on physician benefits was sought. Advance preparation included selection of light pen technology, field trips by selected physicians to other hospitals with the same system, and strategic placement and availability of terminals. During implementation, training was scheduled at the convenience of the physician. This training continues to be offered immediately to new physicians as they join the staff. System upgrades and added functions prompt scheduling of demonstrations for interested physicians. Many developmental ideas come from physicians using MIS indicating their interest in maintaining the system. New approaches that will make order entry easier for physicians so that everyone can benefit from their cooperation and participation are continually being looked for.

Computer User Training↗

PubMed1995

Successful implementation of an integrated physician order entry application: a systems perspective.

Direct physician order entry is required for effective implementation of an integrated electronic medical record. This effort involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the findings of a follow-up study that quantified dimensions associated with successful implementation identified in a previous study. Results identified several implementation strategies associated with success. These include an interdisciplinary implementation group, involvement of large numbers of regular staff, early and intensive training and support, and 24 hour available assistance as important to success. In addition, attitudes of physicians and their level of involvement were found to be associated with success.

Attitude of Health Personnel↗

PubMed2000

Effects of computerized physician order entry on prescribing practices.

BACKGROUND: Computerized order entry systems have the potential to prevent errors, to improve quality of care, and to reduce costs by providing feedback and suggestions to the physician as each order is entered. This study assesses the impact of an inpatient computerized physician order entry system on prescribing practices. METHODS: A time series analysis was performed at an urban academic medical center at which all adult inpatient orders are entered through a computerized system. When physicians enter drug orders, the computer displays drug use guidelines, offers relevant alternatives, and suggests appropriate doses and frequencies. RESULT: For medication selection, use of a computerized guideline resulted in a change in use of the recommended drug (nizatidine) from 15.6% of all histamine(2)-blocker orders to 81.3% (P<.001). Implementation of dose selection menus resulted in a decrease in the SD of drug doses by 11% (P<.001). The proportion of doses that exceeded the recommended maximum decreased from 2.1% before order entry to 0.6% afterward (P<.001). Display of a recommended frequency for ondansetron hydrochloride administration resulted in an increase in the use of the approved frequency from 6% of all ondansetron orders to 75% (P<.001). The use of subcutaneous heparin sodium to prevent thrombosis in patients at bed rest increased from 24% to 47% when the computer suggested this option (P<.001). All these changes persisted at 1- and 2-year follow-up analyses. CONCLUSION: Computerized physician order entry is a powerful and effective tool for improving physician prescribing practices.

Decision Support Systems, Clinical↗

PubMed2000

Utilization and effectiveness of a weight-based heparin nomogram at a large academic medical center.

OBJECTIVE: To determine the utilization rate of a weight-based heparin nomogram and to assess the performance of the nomogram outside of experimental conditions. STUDY DESIGN: Prospective cohort analysis. PATIENTS AND METHODS: A total of 747 consecutive patients treated with intravenous heparin therapy for any indication on an internal medicine service were evaluated for the utilization rate of the weight-based nomogram, the time needed to exceed heparin's therapeutic threshold (activated partial thromboplastin time [aPTT] of > 1.5 times the control value), and the time needed to achieve heparin's therapeutic range (aPTT of 1.5 to 2.4 times the control value). Physicians were encouraged to use the weight-based nomogram by using conventional continuing medical education techniques and by configuring the computerized order entry system to give physicians an equally easy and voluntary choice between choosing the weight-based nomogram or ordering heparin in the traditional fashion. RESULTS: The study program had no effect in increasing the utilization rate of the nomogram; this rate remained the same as before the program was initiated (10%). Less time was needed both to exceed the therapeutic threshold and to achieve a therapeutic range with the weight-based nomogram compared with physician-guided dosing (P < .001 and P = .021, respectively). No difference was demonstrated between the weight-based and physician-guided groups in incidence of bleeding complications or in the proportion of patients with one or more supratherapeutic aPTTs. CONCLUSIONS: The weight-based nomogram led to superior intermediate outcomes compared with physician-guided dosing. However, despite efforts intended to modify physician behavior, the utilization rate remained so low that it was ineffective. Further research into the reasons why physicians chose not to use the weight-based nomogram and further research into methods to translate efficacious therapies into effective patient care are indicated.

Academic Medical Centers↗

PubMed2005

Unintended medication discrepancies at the time of hospital admission.

BACKGROUND: Prior studies suggest that unintended medication discrepancies that represent errors are common at the time of hospital admission. These errors are particularly worthy of attention because they are not likely to be detected by computerized physician order entry systems. METHODS: We prospectively studied patients reporting the use of at least 4 regular prescription medications who were admitted to general internal medicine clinical teaching units. The primary outcome was unintended discrepancies (errors) between the physicians' admission medication orders and a comprehensive medication history obtained through interview. We also evaluated the potential seriousness of these discrepancies. All discrepancies were reviewed with the medical team to determine if they were intentional or unintentional. All unintended discrepancies were rated for their potential to cause patient harm. RESULTS: After screening 523 admissions, 151 patients were enrolled based on the inclusion criteria. Eighty-one patients (53.6%; 95% confidence interval, 45.7%-61.6%) had at least 1 unintended discrepancy. The most common error (46.4%) was omission of a regularly used medication. Most (61.4%) of the discrepancies were judged to have no potential to cause serious harm. However, 38.6% of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration. CONCLUSIONS: Medication errors at the time of hospital admission are common, and some have the potential to cause harm. Better methods of ensuring an accurate medication history at the time of hospital admission are needed.

Aged↗

PubMed2003

Toward efficient medication error reduction: error-reducing information management systems.

Hospitals and other health-care providers today are being pressed more than ever to use technologies for reducing medical errors. Particularly, medication errors are likely to increase fast as Americans age. This paper intends to provide a starting point for understanding information technologies and database systems supporting such technologies as Computerized Physician Order Entry (CPOE), Automated Dispensing System (ADS), and Bar Coding System designed to reduce medication errors in hospitals. Although vendors provide the necessary communication software and applications, actions involving governments, technology vendors, pharmaceutical companies, and clinical researchers are needed to put to actual use the applications with a massive potential to significantly reduce medication-related errors.

Drug Prescriptions↗