J Am Med Inform Assoc - A clinical data warehouse-based process for refining medication orders alerts.

Tópicos

{ medic(1828) order(1363) alert(1069) }
{ decis(3086) make(1611) patient(1517) }
{ system(1976) rule(880) can(841) }
{ problem(2511) optim(1539) algorithm(950) }
{ measur(2081) correl(1212) valu(896) }
{ error(1145) method(1030) estim(1020) }
{ algorithm(1844) comput(1787) effici(935) }
{ process(1125) use(805) approach(778) }
{ blood(1257) pressur(1144) flow(957) }
{ model(3480) simul(1196) paramet(876) }
{ data(3008) multipl(1320) sourc(1022) }
{ imag(1947) propos(1133) code(1026) }
{ method(1219) similar(1157) match(930) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ patient(2315) diseas(1263) diabet(1191) }
{ take(945) account(800) differ(722) }
{ studi(2440) review(1878) systemat(933) }
{ motion(1329) object(1292) video(1091) }
{ assess(1506) score(1403) qualiti(1306) }
{ control(1307) perform(991) simul(935) }
{ case(1353) use(1143) diagnosi(1136) }
{ system(1050) medic(1026) inform(1018) }
{ studi(1119) effect(1106) posit(819) }
{ spatial(1525) area(1432) region(1030) }
{ patient(2837) hospit(1953) medic(668) }
{ model(2656) set(1616) predict(1553) }
{ data(2317) use(1299) case(1017) }
{ group(2977) signific(1463) compar(1072) }
{ gene(2352) biolog(1181) express(1162) }
{ first(2504) two(1366) second(1323) }
{ use(2086) technolog(871) perceiv(783) }
{ high(1669) rate(1365) level(1280) }
{ cancer(2502) breast(956) screen(824) }
{ implement(1333) system(1263) develop(1122) }
{ estim(2440) model(1874) function(577) }
{ activ(1452) weight(1219) physic(1104) }
{ model(3404) distribut(989) bayesian(671) }
{ can(774) often(719) complex(702) }
{ data(1737) use(1416) pattern(1282) }
{ inform(2794) health(2639) internet(1427) }
{ imag(1057) registr(996) error(939) }
{ bind(1733) structur(1185) ligand(1036) }
{ sequenc(1873) structur(1644) protein(1328) }
{ featur(3375) classif(2383) classifi(1994) }
{ network(2748) neural(1063) input(814) }
{ treatment(1704) effect(941) patient(846) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ chang(1828) time(1643) increas(1301) }
{ learn(2355) train(1041) set(1003) }
{ concept(1167) ontolog(924) domain(897) }
{ clinic(1479) use(1117) guidelin(835) }
{ extract(1171) text(1153) clinic(932) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ model(2220) cell(1177) simul(1124) }
{ care(1570) inform(1187) nurs(1089) }
{ general(901) number(790) one(736) }
{ method(984) reconstruct(947) comput(926) }
{ search(2224) databas(1162) retriev(909) }
{ featur(1941) imag(1645) propos(1176) }
{ howev(809) still(633) remain(590) }
{ data(3963) clinic(1234) research(1004) }
{ studi(1410) differ(1259) use(1210) }
{ risk(3053) factor(974) diseas(938) }
{ perform(999) metric(946) measur(919) }
{ research(1085) discuss(1038) issu(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ record(1888) medic(1808) patient(1693) }
{ health(3367) inform(1360) care(1135) }
{ monitor(1329) mobil(1314) devic(1160) }
{ ehr(2073) health(1662) electron(1139) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ sampl(1606) size(1419) use(1276) }
{ intervent(3218) particip(2042) group(1664) }
{ activ(1138) subject(705) human(624) }
{ time(1939) patient(1703) rate(768) }
{ patient(1821) servic(1111) care(1106) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ use(976) code(926) identifi(902) }
{ use(1733) differ(960) four(931) }
{ drug(1928) target(777) effect(648) }
{ result(1111) use(1088) new(759) }
{ survey(1388) particip(1329) question(1065) }
{ method(1969) cluster(1462) data(1082) }
{ method(2212) result(1239) propos(1039) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

The objective of this case report is to evaluate the use of a clinical data warehouse coupled with a clinical information system to test and refine alerts for medication orders control before they were fully implemented. A clinical decision rule refinement process was used to assess alerts. The criteria assessed were the frequencies of alerts for initial prescriptions of 10 medications whose dosage levels depend on renal function thresholds. In the first iteration of the process, the frequency of the 'exceeds maximum daily dose' alerts was 7.10% (617/8692), while that of the 'under dose' alerts was 3.14% (273/8692). Indicators were presented to the experts. During the different iterations of the process, 45 (16.07%) decision rules were removed, 105 (37.5%) were changed and 136 new rules were introduced. Extensive retrospective analysis of physicians' medication orders stored in a clinical data warehouse facilitates alert optimization toward the goal of maximizing the safety of the patient and minimizing overridden alerts.

Resumo Limpo

object case report evalu use clinic data warehous coupl clinic inform system test refin alert medic order control fulli implement clinic decis rule refin process use assess alert criteria assess frequenc alert initi prescript medic whose dosag level depend renal function threshold first iter process frequenc exceed maximum daili dose alert dose alert indic present expert differ iter process decis rule remov chang new rule introduc extens retrospect analysi physician medic order store clinic data warehous facilit alert optim toward goal maxim safeti patient minim overridden alert

Resumos Similares

J Am Med Inform Assoc - Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients. ( 0,901012833867902 )
Int J Med Inform - Evaluation of medication dose alerts in pediatric inpatients. ( 0,897348740636201 )
J Am Med Inform Assoc - Errors associated with outpatient computerized prescribing systems. ( 0,882134002976011 )
J Am Med Inform Assoc - Factors contributing to an increase in duplicate medication order errors after CPOE implementation. ( 0,87754770577476 )
J. Med. Internet Res. - Physician order entry or nurse order entry? Comparison of two implementation strategies for a computerized order entry system aimed at reducing dosing medication errors. ( 0,874567741513524 )
Telemed J E Health - Rural inpatient telepharmacy consultation demonstration for after-hours medication review. ( 0,874096268112876 )
Appl Clin Inform - Response to medication dosing alerts for pediatric inpatients using a computerized provider order entry system. ( 0,867262813610537 )
J Am Med Inform Assoc - Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients. ( 0,865424317575714 )
Comput Methods Programs Biomed - Developing guideline-based decision support systems using prot?g? and jess. ( 0,864422969147208 )
Int J Med Inform - Prescription order risk factors for pediatric dosing alerts. ( 0,863874914988637 )
J Am Med Inform Assoc - Evaluating the accuracy of electronic pediatric drug dosing rules. ( 0,863568390361015 )
J Am Med Inform Assoc - Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system. ( 0,862637396170062 )
Appl Clin Inform - Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System: A systematic approach to decrease alerts. ( 0,862327586287461 )
J Am Med Inform Assoc - Failure to utilize functions of an electronic prescribing system and the subsequent generation of 'technically preventable' computerized alerts. ( 0,861457931041312 )
J Am Med Inform Assoc - Impact of clinical decision support preventing the use of QT-prolonging medications for patients at risk for torsade de pointes. ( 0,861241588487404 )
Appl Clin Inform - Drug interaction alert override rates in the Meaningful Use era: no evidence of progress. ( 0,860127542327863 )
AMIA Annu Symp Proc - Improving Patient Safety through Medical Alert Management: An Automated Decision Tool to Reduce Alert Fatigue. ( 0,855763012584843 )
J Am Med Inform Assoc - Overrides of medication-related clinical decision support alerts in outpatients. ( 0,855700652571169 )
AMIA Annu Symp Proc - Improving patient safety by modifying provider ordering behavior using alerts (CDSS) in CPOE system. ( 0,85533387569436 )
J Am Med Inform Assoc - Understanding and preventing wrong-patient electronic orders: a randomized controlled trial. ( 0,854404077315929 )
Int J Med Inform - The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan. ( 0,854074883854393 )
J Am Med Inform Assoc - Integrating pharmacogenetic information and clinical decision support into the electronic health record. ( 0,853179550518794 )
Comput Methods Programs Biomed - Physicians' responses to computerized drug-drug interaction alerts for outpatients. ( 0,851772712144471 )
Comput Methods Programs Biomed - A smart medication recommendation model for the electronic prescription. ( 0,850834338308358 )
J Am Med Inform Assoc - Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors. ( 0,849574091783539 )
Int J Med Inform - Junior doctors' prescribing work after-hours and the impact of computerized decision support. ( 0,848247026719401 )
J Am Med Inform Assoc - Ambulatory prescribing errors among community-based providers in two states. ( 0,846779249326463 )
J Am Med Inform Assoc - Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard. ( 0,846497115330209 )
J Med Syst - Two RFID-based solutions for secure inpatient medication administration. ( 0,844949836771507 )
Appl Clin Inform - Effect of EHR user interface changes on internal prescription discrepancies. ( 0,844181098973926 )
J Am Med Inform Assoc - A randomized-controlled trial of computerized alerts to reduce unapproved medication abbreviation use. ( 0,843384162817254 )
J Am Med Inform Assoc - A framework for evaluating the appropriateness of clinical decision support alerts and responses. ( 0,842843807919387 )
J Am Med Inform Assoc - Development and use of active clinical decision support for preemptive pharmacogenomics. ( 0,841831038055688 )
J Am Med Inform Assoc - Prevalence of medication administration errors in two medical units with automated prescription and dispensing. ( 0,8416152960917 )
Int J Med Inform - Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. ( 0,840542304303964 )
Med Decis Making - Better medicine by default. ( 0,837274113989041 )
J Am Med Inform Assoc - Don't fuel the fire: decreasing intravenous haloperidol use in high risk patients via a customized electronic alert. ( 0,831905017488744 )
Int J Med Inform - A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation. ( 0,831569689445163 )
Int J Med Inform - What, if all alerts were specific - estimating the potential impact on drug interaction alert burden. ( 0,83075635581441 )
Int J Med Inform - Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists' analysis of medication orders in hospitals. ( 0,828823431613578 )
Perspect Health Inf Manag - Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? ( 0,8273866681157 )
Int J Med Inform - Technology-related medication errors in a tertiary hospital: a 5-year analysis of reported medication incidents. ( 0,825808225798344 )
BMC Med Inform Decis Mak - Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence. ( 0,825046837662699 )
Appl Clin Inform - Duplicate orders: an unintended consequence of computerized provider/physician order entry (CPOE) implementation: analysis and mitigation strategies. ( 0,823805751687514 )
J Am Med Inform Assoc - Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system. ( 0,823367990199819 )
Health Informatics J - Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial. ( 0,819590313685357 )
AMIA Annu Symp Proc - Unexpected effects of unintended consequences: EMR prescription discrepancies and hemorrhage in patients on warfarin. ( 0,818175643586126 )
Perspect Health Inf Manag - Enhance the accuracy of medication histories for the elderly by using an electronic medication checklist. ( 0,815414835297306 )
J Am Med Inform Assoc - Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE). ( 0,813055770683358 )
Artif Intell Med - Evaluation of rule effectiveness and positive predictive value of clinical rules in a Dutch clinical decision support system in daily hospital pharmacy practice. ( 0,812506630481545 )
Int J Med Inform - Impact of a clinical decision support system for high-alert medications on the prevention of prescription errors. ( 0,809667180491764 )
J Am Med Inform Assoc - Classification of medication incidents associated with information technology. ( 0,809175539784147 )
J Am Med Inform Assoc - The influence of computerized decision support on prescribing during ward-rounds: are the decision-makers targeted? ( 0,808581082095252 )
J Am Med Inform Assoc - Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. ( 0,808477546111209 )
J Am Med Inform Assoc - Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation. ( 0,806340227149694 )
Artif Intell Med - Physicians' responses to clinical decision support on an intensive care unit--comparison of four different alerting methods. ( 0,801968482723919 )
BMC Med Inform Decis Mak - Development of a context model to prioritize drug safety alerts in CPOE systems. ( 0,798029949171726 )
J Med Syst - Development of a point-of-care HIV/AIDS medication dosing support system using the Android mobile platform. ( 0,797360036070036 )
AMIA Annu Symp Proc - An analysis and recommendations for multidisciplinary computerized handoff applications in hospitals. ( 0,796879248579674 )
Int J Med Inform - Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients. ( 0,796868872525461 )
J Am Med Inform Assoc - Guided medication dosing for elderly emergency patients using real-time, computerized decision support. ( 0,795847580068912 )
J Am Med Inform Assoc - How to improve the delivery of medication alerts within computerized physician order entry systems: an international Delphi study. ( 0,794063611211215 )
J Am Med Inform Assoc - Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support. ( 0,789272985871238 )
J Am Med Inform Assoc - The safety of electronic prescribing: manifestations, mechanisms, and rates of system-related errors associated with two commercial systems in hospitals. ( 0,788224471293117 )
Appl Clin Inform - Medication safety improves after implementation of positive patient identification. ( 0,786194085560389 )
Appl Clin Inform - A trial of inpatient indication based prescribing during computerized order entry with medications commonly used off-label. ( 0,785632841797238 )
Appl Clin Inform - Analysis of electronic medication orders with large overdoses: opportunities for mitigating dosing errors. ( 0,78523364806833 )
AMIA Annu Symp Proc - Factors Contributing to CPOE Opiate Allergy Alert Overrides. ( 0,785035353819344 )
J Am Med Inform Assoc - 'Too much, too late': mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing. ( 0,784909834326032 )
AMIA Annu Symp Proc - I meant that med for Baylee not Bailey!: a mixed method study to identify incidence and risk factors for CPOE patient misidentification. ( 0,782778607017272 )
AMIA Annu Symp Proc - Evaluating the effectiveness of clinical alerts: a signal detection approach. ( 0,782753028759759 )
J Am Med Inform Assoc - Prescribers' expectations and barriers to electronic prescribing of controlled substances. ( 0,780326855844546 )
Methods Inf Med - From adverse drug event detection to prevention. A novel clinical decision support framework for medication safety. ( 0,780246716391581 )
Med Decis Making - Electronic notifications about drug substitutes can change physician prescription habits: a cross-sectional observational study. ( 0,777837338558323 )
Int J Med Inform - Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan. ( 0,777498218167234 )
Appl Clin Inform - AMDIS Case Conference: Intrusive Medication Safety Alerts. ( 0,7770838929825 )
Int J Med Inform - Impact of electronic order management on the timeliness of antibiotic administration in critical care patients. ( 0,776652307926564 )
J Am Med Inform Assoc - Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. ( 0,77304214483979 )
AMIA Annu Symp Proc - Reducing free-text communication orders placed by providers using association rule mining. ( 0,772604422128861 )
AMIA Annu Symp Proc - Effectiveness of bar coded medication alerts for elevated potassium. ( 0,768213080769779 )
J Am Med Inform Assoc - Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance. ( 0,767109891112902 )
Int J Med Inform - An RFID solution for enhancing inpatient medication safety with real-time verifiable grouping-proof. ( 0,760925831712282 )
Appl Clin Inform - Electronic medical record prompts for lab orders in patients initiating statins. ( 0,760378545815459 )
Appl Clin Inform - Reducing risk with clinical decision support: a study of closed malpractice claims. ( 0,759278714628157 )
Health Informatics J - Statistical classification of drug incidents due to look-alike sound-alike mix-ups. ( 0,758495981309466 )
Int J Med Inform - Comparing the working time between Bar-Code Medication Administration system and traditional medication administration system: an observational study. ( 0,757980276126766 )
AMIA Annu Symp Proc - Ontological approach for safe and effective polypharmacy prescription. ( 0,756989873647359 )
J. Med. Internet Res. - Ethical principles for physician rating sites. ( 0,751810267731479 )
Int J Med Inform - Coded entry versus free-text and alert overrides: what you get depends on how you ask. ( 0,750462409322829 )
Int J Med Inform - Evaluation of the pilot program on the real-time drug utilization review system in South Korea. ( 0,748603062327803 )
AMIA Annu Symp Proc - Reducing wrong patient selection errors: exploring the design space of user interface techniques. ( 0,748517194246024 )
AMIA Annu Symp Proc - Analyzing U.S. prescription lists with RxNorm and the ATC/DDD Index. ( 0,747808257827865 )
Int J Med Inform - Understanding handling of drug safety alerts: a simulation study. ( 0,747149711960847 )
BMC Med Inform Decis Mak - Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model. ( 0,746301333492375 )
Artif Intell Med - Safety and usability evaluation of a web-based insulin self-titration system for patients with type 2 diabetes mellitus. ( 0,743749767719565 )
J Am Med Inform Assoc - Impact of clinical decision support on receipt of antibiotic prescriptions for acute bronchitis and upper respiratory tract infection. ( 0,740896246180124 )
BMC Med Inform Decis Mak - Variability of the impact of adverse events on physicians' decision making. ( 0,73916253307257 )
J Am Med Inform Assoc - Paving the COWpath: data-driven design of pediatric order sets. ( 0,735571704921304 )
J Telemed Telecare - Feasibility and accuracy of medication checks via Internet video. ( 0,735463567087008 )
BMC Med Inform Decis Mak - Evaluation of a drug-drug interaction: fax alert intervention program. ( 0,735391409342252 )