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Results for “Reminder Systems”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 361 records · Page 20Linked to original sources
PubMed2005

A trial of automated decision support alerts for contraindicated medications using computerized physician order entry.

BACKGROUND: Automated clinical decision support has shown promise in reducing medication errors; however, clinicians often do not comply with alerts. Because renal insufficiency is a common source of medication errors, the authors studied a trial of alerts designed to reduce inpatient administration of medications contraindicated due to renal insufficiency. METHODS: A minimum safe creatinine clearance was established for each inpatient formulary medication. Alerts recommending cancellation appeared when a medication order was initiated for a patient whose estimated creatinine clearance was less than the minimum safe creatinine clearance for the medication. Administration of medications in patients with creatinine clearances less than the medication's minimum safe clearance were studied for 14 months after, and four months before, alert implementation. In addition, the impact of patient age, gender, degree of renal dysfunction, time of day, and duration of housestaff training on the likelihood of housestaff compliance with the alerts was examined. RESULTS: The likelihood of a patient receiving at least one dose of contraindicated drug after the order was initiated decreased from 89% to 47% (p < 0.0001) after alert implementation. Analysis of the alerts seen by housestaff showed that alert compliance was higher in male patients (57% vs. 38%, p = 0.02), increased with the duration of housestaff training (p = 0.04), and increased in patients with worsening renal function (p = 0.007). CONCLUSION: Alerts were effective in decreasing the ordering and administration of drugs contraindicated due to renal insufficiency. Compliance with the alerts was higher in male patients, increased with the duration of housestaff training, and increased in patients with more severe renal dysfunction.

Contraindications↗
PubMed1997

Effects of age, system experience, and navigation technique on driving with an advanced traveler information system.

This paper explores the effects of age, system experience, and navigation technique on driving, navigation performance, and safety for drivers who used TravTek, an Advanced Traveler Information System. The first two studies investigated various route guidance configurations on the road in a specially equipped instrumented vehicle with an experimenter present. The third was a naturalistic quasi-experimental field study that collected data unobtrusively from more than 1200 TravTek rental car drivers with no in-vehicle experimenter. The results suggest that with increased experience, drivers become familiar with the system and develop strategies for substantially more efficient and safer use. The results also showed that drivers over age 65 had difficulty driving and navigating concurrently. They compensated by driving slowly and more cautiously. Despite this increased caution, older drivers made more safety-related errors than did younger drivers. The results also showed that older drivers benefited substantially from a well-designed ATIS driver interface.

Adult↗
PubMed2005

Development of an electronic health record-based Clinical Trial Alert system to enhance recruitment at the point of care.

Clinical trials are essential to the progress of medical science. Physician participation in trial recruitment is vital, but most do not participate. Few approaches to improve physician participation in trial recruitment have been described or proven successful. Previously described approaches have largely relied on locally developed technology or been designed for use in specialized settings, thereby limiting their generalizability. We describe the design, operation and initial testing of a new Clinical Trial Alert (CTA) system built upon the existing capabilities of a commercial EHR in use across a large academic healthcare system. Given the trend toward implementation of similarly capable EHRs in institutions engaged in clinical research, this approach should be widely applicable and may represent a solution to the common problem of inadequate clinical trial recruitment. Further study of this system is ongoing.

Clinical Trials as Topic↗
PubMed2005

Strategies for reducing nuisance alerts in a dose checking application.

Commercial rule bases can be implemented to identify medication orders that fall outside recommended dosage ranges, but they are likely to produce an excessive number of nuisance and clinically insignificant alerts. Strategies for customizing commercial dosing rules can be implemented to minimize this problem. This paper describes specific strategies implemented in a dose checking application necessary for achieving a clinically acceptable alert rate.

Clinical Pharmacy Information Systems↗
PubMed2005

Drug-age alerting for outpatient geriatric prescriptions: a joint study using interoperable drug standards.

For more than a decade, the Beers criteria have identified specific medications that should generally be avoided in the geriatric population. Studies that have shown high prevalence rates of these potentially inappropriate medications have used disparate methodologies to identify these medications and hence are difficult to replicate and generalize. In an effort to improve prescribing behavior, we are building a drug-age alerting system utilizing standard drug coding systems for use in our Electronic Health Record (EHR) systems.

Aged↗
PubMed2005

Partitioning knowledge bases between advanced notification and clinical decision support systems.

Due to the varying rates of change of ephemeral administrative and enduring clinical knowledge in decision support systems (DSSs), the functional partition of knowledge base (KB) components can lead to more efficient and cost-effective system implementation and maintenance. Our prototype loosely couples a clinical event monitor developed by Columbia University Medical Center (CUMC) with a secure notification service proxy developed by IBM Research to form a novel and complex clinical event communication service.

Computer Security↗
PubMed2005

Physician perceptions of an Electronic Health Record-based Clinical Trial Alert system: a survey of study participants.

Physicians play a vital role in the clinical trial recruitment process, but most do not participate. We developed a new Clinical Trial Alert (CTA) system and studied its effect on a cohort of physicians across a health system. Following this study, we surveyed our physician subjects. Their responses offer insights into the CTA's utility, their attitudes toward trial recruitment, and suggest areas for CTA refinement.

Attitude of Health Personnel↗
PubMed2005

Improving override rates for computerized prescribing alerts in ambulatory care.

Computerized drug prescribing alerts can improve patient safety, but are often overridden because of poor specificity and alert overload. We developed a selective knowledge base of only clinically significant drug alerts and designated only critical-high severity alerts to be interruptive to clinician workflow (a tiered approach). Using this approach, we were able to achieve a 67% clinician accept rate for ambulatory computerized prescribing alerts.

Ambulatory Care Information Systems↗
PubMed1998

Development of a clinical event monitor for use with the Veterans Affairs Computerized Patient Record System and other data sources.

We are developing an event monitor to operate with the Veterans Affairs Computerized Patient Record System (CPRS). The event monitor is designed to receive messages when important patient events such as posting of new results, patient movement, and orders occur. Our design separates the event monitor from CPRS itself, using communication via a network connection to receive HL7 messages, to access other data needed to run rules, and to communicate with providers by message display, electronic mail and other mechanisms. Results from operation of the event monitor using patient data in our test account show that a wide variety of data can be accessed by the event monitor with acceptable response times.

Computer Communication Networks↗
PubMed1998

Optimal use of communication channels in clinical event monitoring.

We argue that the optimal use of communication channels in clinical event monitors is an important design consideration for these systems. We review the state-of-the-art in selection of communication channels, including our current approach--allowing users to choose the communication channel by which the event monitor sends each notification. We describe a new approach that we are in the process of developing. In this new approach, we view event monitoring as the decision of whether and how to send new patient data to a clinician and apply the principle of maximum expected utility to this decision problem. Our initial experience with this approach suggests that notifying clinicians of normal patient data may be of high utility. We also found that methods for explanation in uncertain reasoning may be necessary in this approach.

Communication↗
PubMed2005

Medical guidelines presentation and comparing with Electronic Health Record.

Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model.

Czech Republic↗
PubMedDate not supplied

The guideline interchange format: a model for representing guidelines.

OBJECTIVE: To allow exchange of clinical practice guidelines among institutions and computer-based applications. DESIGN: The GuideLine Interchange Format (GLIF) specification consists of GLIF model and the GLIF syntax. The GLIF model is an object-oriented representation that consists of a set of classes for guideline entities, attributes for those classes, and data types for the attribute values. The GLIF syntax specifies the format of the test file that contains the encoding. METHODS: Researchers from the InterMed Collaboratory at Columbia University, Harvard University (Brigham and Women's Hospital and Massachusetts General Hospital), and Stanford University analyzed four existing guideline systems to derive a set of requirements for guideline representation. The GLIF specification is a consensus representation developed through a brainstorming process. Four clinical guidelines were encoded in GLIF to assess its expressivity and to study the variability that occurs when two people from different sites encode the same guideline. RESULTS: The encoders reported that GLIF was adequately expressive. A comparison of the encodings revealed substantial variability. CONCLUSION: GLIF was sufficient to model the guidelines for the four conditions that were examined. GLIF needs improvement in standard representation of medical concepts, criterion logic, temporal information, and uncertainty.

Decision Making, Computer-Assisted↗