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Sarah K Pontefract, James Hodson, Ann Slee, Sonal Shah, Alan J Girling, Robin Williams, Aziz Sheikh, Jamie J Coleman
BACKGROUND: In this UK study, we investigated the impact of computerised physician order entry (CPOE) and clinical decision support (CDS) implementation on the rate of 78 high-risk prescribing errors amenable to CDS. METHODS: We conducted a preintervention/postintervention study in three acute hospitals in England. A predefined list of prescribing errors was incorporated into an audit tool. At each site, approximately 4000 prescriptions were reviewed both pre-CPOE and 6 months post-CPOE implementation...
March 23, 2018: BMJ Quality & Safety
Cheng-Yi Yang, Yu-Sheng Lo, Ray-Jade Chen, Chien-Tsai Liu
BACKGROUND: A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan...
January 19, 2018: JMIR Medical Informatics
Walter E Haefeli, Hanna M Seidling
Because of its inherent complexity, it is a considerable challenge to tailor drug treatment to a prevalent disease and its subgroups, which are increasingly defined by genomic variability (personalized medicine) and require consideration of context information such as co-morbidity, co-medication, patient preferences, and the specific characteristics of the healthcare sector. Thus, optimum treatment decisions might not be taken intuitively any longer, because decisions must be made both rapidly and increasingly based on analyses of complex relations of numerous variables that exceed the processing performance of a human brain...
March 2018: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
Eileen Yilin Sim, Daryl Jian An Tan, Hairil Rizal Abdullah
BACKGROUND AND GOAL OF STUDY: Over-ordering of routine preoperative investigations is prevalent. Adherence to institutional guidelines differs among physicians. Our institution integrated a Clinical Decision Support (CDS) model into our hospital's Computerized Physician Ordering Entry (CPOE) system to guide physician orders. We investigate if the implementation of CDS into CPOE increases physician adherence to our institutional guidelines. METHODS: A retrospective cohort study in a tertiary academic hospital over 18 months...
December 2017: International Journal of Medical Informatics
R A Jenders
Introduction: Advances in clinical decision support (CDS) continue to evolve to support the goals of clinicians, policymakers, patients and professional organizations to improve clinical practice, patient safety, and the quality of care. Objectives: Identify key thematic areas or foci in research and practice involving clinical decision support during the 2015-2016 time period. Methods: Thematic analysis consistent with a grounded theory approach was applied in a targeted review of journal publications, the proceedings of key scientific conferences as well as activities in standards development organizations in order to identify the key themes underlying work related to CDS...
August 2017: Yearbook of Medical Informatics
Kathrin M Cresswell, Lisa Lee, Hajar Mozaffar, Robin Williams, Aziz Sheikh
OBJECTIVE: To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. STUDY SETTING: Six hospitals in England, United Kingdom. STUDY DESIGN: Qualitative case study. DATA COLLECTION: We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals...
October 2017: Health Services Research
Juan D Chaparro, David C Classen, Melissa Danforth, David C Stockwell, Christopher A Longhurst
Objective: To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. Methods: The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period...
March 1, 2017: Journal of the American Medical Informatics Association: JAMIA
Emmanuel Eschmann, Sascha Karlen, Ludwig Perger, Markus Schneemann, Jürg Blaser
No abstract text is available yet for this article.
2016: Studies in Health Technology and Informatics
Kathrin Cresswell, Hajar Mozaffar, Sonal Shah, Aziz Sheikh
OBJECTIVE: To identify approaches of using stand-alone and more integrated hospital ePrescribing systems to promote and support the appropriate use of antibiotics, and identify gaps in order to inform future efforts in this area. METHODS: A systematic scoping review of the empirical literature from 1997 until 2015, searching the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Trials, International Standard Randomised Controlled Trial Number Registry, Economic Evaluation database and International Prospective Register of Systematic Reviews...
February 2017: International Journal of Pharmacy Practice
George A Gellert, Ricardo Ramirez, S Luke Webster
With the adoption of Computerized Patient Order Entry (CPOE), many physicians - particularly consultants and those who are affiliated with multiple hospital systems - are faced with the challenge of learning to navigate and commit to memory the details of multiple EHRs and CPOE software modules. These physicians may resist CPOE adoption, and their refusal to use CPOE presents a risk to patient safety when paper and electronic orders co-exist, as paper orders generated in an electronic ordering environment can be missed or acted upon after delay, are frequently illegible, and bypass the Clinical Decision Support (CDS) that is part of the evidence-based value of CPOE...
2016: Applied Clinical Informatics
Hajar Mozaffar, Kathrin M Cresswell, Lisa Lee, Robin Williams, Aziz Sheikh
BACKGROUND: Implementation delays are common in health information technology (HIT) projects. In this paper, we sought to explore the reasons for delays in implementing major hospital-based HIT, through studying computerized physician order entry (CPOE) and clinical decision support (CDS) systems for prescribing and to develop a provisional taxonomy of causes of implementation delays. METHODS: We undertook a series of longitudinal, qualitative case studies to investigate the implementation and adoption of CPOE and CDS systems for prescribing in hospitals in the U...
February 24, 2016: BMC Medical Informatics and Decision Making
Xue Wu, Changxu Wu, Kan Zhang, Dong Wei
BACKGROUND: Computerized physician order entry (CPOE) system with embedded clinical decision support (CDS) can significantly reduce certain types of prescription error. However, prescription errors still occur. Various factors such as the numeric inputting methods in human computer interaction (HCI) produce different error rates and types, but has received relatively little attention. OBJECTIVE: This study aimed to examine the effects of numeric inputting methods and urgency levels on numeric inputting errors of prescription, as well as categorize the types of errors...
April 2016: International Journal of Medical Informatics
Kathrin M Cresswell, Lisa Lee, Ann Slee, Jamie Coleman, David W Bates, Aziz Sheikh
OBJECTIVES: We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. SETTING: Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. PARTICIPANTS: Nine participants, representing 6 key vendors operating in the UK, attended...
October 26, 2015: BMJ Open
Hajar Mozaffar, Robin Williams, Kathrin Cresswell, Zoe Morrison, David W Bates, Aziz Sheikh
OBJECTIVE: To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals. METHODS: Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England...
March 2016: Journal of the American Medical Informatics Association: JAMIA
Deborah Ariosto
CONTEXT: Increasing regulatory incentives to computerize provider order entry (CPOE) and connect stores of unvalidated allergy information with the electronic health record (EHR) has created a perfect storm to overwhelm clinicians with high volumes of low or no value drug allergy alerts. Data sources include the patient and family, non-clinical staff, nurses, physicians and medical record sources. There has been little written on how to collect hypersensitivity information suited for drug allergy alerting...
2014: AMIA ... Annual Symposium Proceedings
Pieter J Helmons, Carrie R Coates, Jos G W Kosterink, Charles E Daniels
PURPOSE: Study results demonstrating the effectiveness of order-entry clinical decision support (CDS) alerts as a tool for enforcing therapeutic interchange are presented. METHODS: A retrospective observational study was conducted at an academic medical center to evaluate formulary nonadherence before and after implementation of a fully electronic medical record with computerized prescriber order-entry (CPOE) technology configured to display therapeutic interchange alerts immediately on entry of orders for nonformulary agents...
March 1, 2015: American Journal of Health-system Pharmacy: AJHP
Patrick Emanuel Beeler, David Westfall Bates, Balthasar Luzius Hug
Clinical decision support (CDS) systems link patient data with an electronic knowledge base in order to improve decision-making and computerised physician order entry (CPOE) is a requirement to set up electronic CDS. The medical informatics literature suggests categorising CDS tools into medication dosing support, order facilitators, point-of-care alerts and reminders, relevant information display, expert systems and workflow support. To date, CDS has particularly been recognised for improving processes. CDS successfully fostered prevention of deep-vein thrombosis, improved adherence to guidelines, increased the use of vaccinations, and decreased the rate of serious medication errors...
2014: Swiss Medical Weekly
Gabriel S Zuckerberg, Andrew V Scott, Jack O Wasey, Elizabeth C Wick, Timothy M Pawlik, Paul M Ness, Nishant D Patel, Linda M S Resar, Steven M Frank
BACKGROUND: Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. STUDY DESIGN AND METHODS: We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center...
July 2015: Transfusion
Andrew K Moriarity, Chad Klochko, Matthew O'Brien, Safwan Halabi
PURPOSE: To examine the effect of integrating point-of-care clinical decision support (CDS) using the ACR Appropriateness Criteria (AC) into an inpatient computerized provider order entry (CPOE) system for advanced imaging requests. METHODS: Over 12 months, inpatient CPOE requests for nuclear medicine, CT, and MRI were processed by CDS to generate an AC score using provider-selected data from pull-down menus. During the second 6-month period, AC scores were displayed to ordering providers, and acknowledgement was required to finalize a request...
April 2015: Journal of the American College of Radiology: JACR
A R Shriner, E C Webber
BACKGROUND: Many resident physicians have experienced transitioning from traditional paper documentation and ordering to an electronic process during their training. OBJECTIVE: We sought to investigate the attitudes and perceptions of residents related to implementation of computer provider order entry (CPOE) and clinical decision support (CDS). METHODS: Pediatric residents completed web-based surveys prior to CPOE implementation and at 6 months and 12 months after implementation...
2014: Applied Clinical Informatics
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