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Chapter 1  -  Approaching Clinical Decision Support in Medication Management



 CHAPTER 1 SECTIONS 
  1. Introduction
  2. Overview of CDS Five Rights
  3. Applying CDS to Medication Management
  4. Types of CDS Interventions
  5. How Key Terms Are Used in this Book
  6. Typical State of Medication Management Today
  7. A Vision for Optimal, CDS-Enabled Medication Management
  8. A Peek at the Literature on Medication Use and CDS
  9. Concluding Comments
  10. References

REFERENCES
  1. Institute for Healthcare Improvement.  The Five Rights of Medication Administration; accessed 9/30/2008.
  2. Institute for Safe Medical Practices (ISMP) stresses that if all of the other aspects mentioned are achieved, then the drug will be cost effective.
  3. Tang PC, Young CY. ActiveGuidelines: Integrating Web-based guidelines with computer-based patient records. AMIA Proceedings. 2000; 843-847.
  4. Maviglia SM, Zielstorff RD, Paterno M, et al. Automating complex guidelines for chronic disease: lessons learned. J Am Med Inform Assoc. 2003; 10(2):154-165.
  5. Background on infobuttons and the version of the HL7 standard approved in May 2008 -- Health Level 7. HL7 V3 Infobutton, R1; accessed 9/30/2008.
  6. For example, Wikipedia, accessed 10/1/08, and the Medline Plus Medical Dictionary.
  7. NAHIT releases HIT Definitions; accessed 12/12/2008.
  8. National Coordinating Council for Medication Error Reporting and Prevention; accessed 9/30/2008.
  9. The Institute for Safe Medication Practices. Frequently Asked Questions (FAQ); accessed 9/30/2008.
  10. National Coordinating Council for Medication Error Reporting and Prevention. About Medication Errors; accessed 9/30/2008.
  11. National Coordinating Council for Medication Error Reporting and Prevention. About Medication Errors. Taxonomy of Medication Errors Now Available (see items 30-34); accessed 9/30/2008. See also links to diagrams under NCC MERP Index for Categorizing Medication Errors; accessed 12/12/2008.
  12. USP-ISMP Medication Errors Reporting Program; accessed 12/12/2008.
  13. Standard terminology for laboratory information. See Logical Observation Identifiers Names and Codes (LOINC); accessed 9/30/2008.
  14. A very rich, standardized, multi-lingual clinical healthcare terminology. See Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT); accessed 9/30/2008.
  15. A standard terminology for clinical drugs. See U.S. National Library of Medicine. Unified Medical Language System: RxNorm; accessed 9/30/2008.
  16. Osheroff JA, Teich JM, Middleton B, et al. A roadmap for national action on clinical decision support. J Am Med Inform Assoc. 2007; 14(2):141-145. See also American Medical Informatics Association. CDS Roadmap; accessed 9/30/2008.
  17. The Institute of Medicine has recently developed a detailed roadmap for this. See Institute of Medicine. Knowing What Works in Health Care: A Roadmap for the Nation; accessed 9/30/2008.
  18. The standards development organization HL7 - accessed 10/2/2008 - has a Clinical Decision Support Technical Committee that produces standards for CDS capabilities such as rules and alerts, infobuttons, and order sets; further work is needed to produce a robust suite of widely used standards for the full suite of CDS interventions.
  19. The Health Information Technology Standards Panel (HITSP) - accessed 10/1/2008 - has begun work on this. See, for example, The Medication Management Interoperability Specification; accessed 10/1/2008. This work is supporting the medication management use case. See Health Information Technology. Medication Management Use Case; accessed 10/1/2008. Developed by Office of the National Coordinator for Health IT.
  20. The Certification Commission for Health Information Technology (CCHIT) has begun this work. See, for example, the clinical decision support requirements related to medication management in the latest inpatient and ambulatory certification requirements and test scripts, available at CCHIT; accessed 10/1/2008.
  21. Teich JM, Osheroff JA, Pifer EA, et al. Clinical decision support in electronic prescribing: recommendations and an action plan: report of the joint clinical decision support workgroup. J Am Med Inform Assoc. 2005; 12(4):365-376.
  22. See, for example, Clancy CM, White PJ. Introduction to the JGIM special issue on health information technology. J Gen Intern Med. 2008; 23(4):353-4; accessed 10/1/2008.
  23. See, for example, Focus on Safe e-Prescribing. Journal of the American Medical Informatics Association. 2008; 15(4); accessed 10/1/2008.
  24. Institute of Medicine. Preventing Medication Errors: Quality Chasm Series. Washington, DC: National Academies Press; 2006; accessed 10/1/2008.
  25. Bates DW, Boyle DL, Vander Vliet MB, et al. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995; (10)4:199-205.
  26. Shaughnessy AF, Nickel RO. Prescription-writing patterns and errors in a family medicine residency program. J Fam Pract. 1989; 29(3):290-295.
  27. Gandhi TK, Bartel SB, Shulman LN, et al. Medication safety in the ambulatory chemotherapy setting. Cancer. 2005; 104(11):2477-2483.
  28. Allan EL, Barker KN, Malloy MJ, et al. Dispensing errors and counseling in community practice. Am Pharm. 1995; NS35(12):25-33.
  29. Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc (Wash). 2003; 43(2):191-200.
  30. Classen DC, Pestotnik SL, Evans RS, et al. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997; 277(4):301-306.
  31. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995; 274(1):29-34.
  32. Jha AK, Kuperman GJ, Rittenberg E, et al. Identifying hospital admissions due to adverse drug events using a computer-based monitor. Pharmacoepidemiol Drug Saf. 2001; 10(2):113-119.
  33. Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997; 277(4):307-311; accessed 10/2/2008.
  34. Field TS, Gilman BH, Subramanian S, et al. The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care. 2005; (12):1171-1176; accessed 10/2/2008.
  35. Quotation attributed to William Gibson, Nov 30, 1999; accessed 10/1/2008.
  36. Eslami S, Abu-Hanna A, de Keizer NF. Evaluation of outpatient computerized physician medication order entry systems: a systematic review. J Am Med Inform Assoc. 2007; 14(4):400-6; accessed 10/2/2008.
  37. Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med. 2008; 23(4).
  38. Dexter PR, Perkins SM, Maharry KS, et al. Inpatient computer-based standing orders vs. physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. JAMA. 2004; 292(19):2366-2371.
  39. Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med. 2005; 352(10):969-977.
  40. Teich JM, Merchia PR, Schmiz JL, et al. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000; 160(18):2741-2747.
  41. Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999; 6(4):313-321.
  42. Evans RS, Classen DC, Pestotnik SL, et al. Improving empiric antibiotic selection using computer decision support. Arch Intern Med. 1994; 154(8):878-884.
  43. Chertow GM, Lee J, Kuperman GJ, et al. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001; 286(22):2839-2844.
  44. Linder JA, Ma J, Bates DW, et al. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med. 2007; 167(13):1400-1405.
  45. Gandhi TK, Weingart SN, Seger AC, et al. Outpatient prescribing errors and the impact of computerized prescribing. J Gen Intern Med. 2005; 20(9):837-841.
  46. Nebeker JR, Hoffman JM, Weir CR, et al. High rates of adverse drug events in a highly computerized hospital. Arch Intern Med. 2005; 165(10):1111-1116; accessed 10/2/2008.
  47. Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2007; 14(1):29-40.
  48. Ammenwerth E, Schnell-Inderst P, Machan C, et al. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc. 2008; 15(5):585-600.

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