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Medication-related clinical decision support in computerized provider order entry systems: a review. 2007

Gilad J Kuperman, and Anne Bobb, and Thomas H Payne, and Anthony J Avery, and Tejal K Gandhi, and Gerard Burns, and David C Classen, and David W Bates
Quality Informatics, NewYork-Presbyterian Hospital, 525 E. 68 Street, Box 298, New York, NY 10021, USA. gkuperman@nyp.org

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals. Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

UI MeSH Term Description Entries
D008508 Medication Errors Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage. Drug Use Error,Errors, Medication,High-Alert Drug Error,High-Alert Medication Error,LASA Medication Errors,Look-Alike Drug Name Errors,Look-Alike Sound-Alike Drug Errors,Look-Alike Sound-Alike Drug Substitution Errors,Look-Alike Sound-Alike Medication Errors,Lookalike Drug Name Errors,Lookalike Soundalike Drug Errors,Lookalike Soundalike Drug Substitution Errors,Lookalike Soundalike Medication Errors,Drug Error, High-Alert,Drug Use Errors,Error, Drug Use,Error, LASA Medication,Error, Medication,High Alert Drug Error,High Alert Medication Error,High-Alert Drug Errors,High-Alert Medication Errors,LASA Medication Error,Look Alike Drug Name Errors,Look Alike Sound Alike Drug Errors,Look Alike Sound Alike Drug Substitution Errors,Look Alike Sound Alike Medication Errors,Medication Error,Medication Error, High-Alert,Medication Error, LASA,Medication Errors, High-Alert,Medication Errors, LASA
D008510 Medication Systems, Hospital Overall systems, traditional or automated, to provide medication to patients in hospitals. Elements of the system are: handling the physician's order, transcription of the order by nurse and/or pharmacist, filling the medication order, transfer to the nursing unit, and administration to the patient. Hospital Drug Distribution Systems,Hospital Medication System,Hospital Medication Systems,Medication System, Hospital,Drug Distribution System, Hospital,Drug Distribution Systems, Hospital,Hospital Unit Dose Drug Distribution System,Hospital Unit Dose Drug Distribution Systems,System Hospital Medication,Systems, Medication Hospital,Hospital Medication, System,Hospital Medications, System,Hospital System, Medication,Hospital Systems, Medication,Medication Hospital System,Medication Hospital Systems,Medication, System Hospital,Medications, System Hospital,System Hospital Medications,System, Hospital Medication,System, Medication Hospital,Systems, Hospital Medication
D004360 Drug Therapy, Computer-Assisted Adjunctive computer programs in providing drug treatment to patients. Computer-Assisted Drug Therapy,Protocol Drug Therapy, Computer-Assisted,Therapy, Computer-Assisted Drug,Computer Assisted Drug Therapy,Computer-Assisted Drug Therapies,Drug Therapies, Computer-Assisted,Drug Therapy, Computer Assisted,Protocol Drug Therapy, Computer Assisted,Therapies, Computer-Assisted Drug,Therapy, Computer Assisted Drug
D004364 Pharmaceutical Preparations Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. Drug,Drugs,Pharmaceutical,Pharmaceutical Preparation,Pharmaceutical Product,Pharmaceutic Preparations,Pharmaceutical Products,Pharmaceuticals,Preparations, Pharmaceutical,Preparation, Pharmaceutical,Preparations, Pharmaceutic,Product, Pharmaceutical,Products, Pharmaceutical
D005569 Formularies as Topic Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPEIA in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000075202 Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Contraindications, Physical Agent,Medical Contraindications,Agent Contraindication, Physical,Agent Contraindications, Physical,Contraindication,Contraindication, Medical,Contraindication, Physical Agent,Contraindications, Medical,Medical Contraindication,Physical Agent Contraindication,Physical Agent Contraindications
D050316 Medical Order Entry Systems Information systems, usually computer-assisted, that enable providers to initiate medical procedures, prescribe medications, etc. These systems support medical decision-making and error-reduction during patient care. CPOE,Order Entry Systems, Medical,Alert Systems, Medication,Computerized Physician Order Entry,Computerized Physician Order Entry System,Computerized Provider Order Entry,Computerized Provider Order Entry System,Medication Alert Systems,Alert System, Medication,Medication Alert System,System, Medication Alert
D020000 Decision Support Systems, Clinical Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care. Clinical Decision Support System,Clinical Decision Support Systems,Clinical Decision Support,Decision Support, Clinical,Clinical Decision Supports,Decision Supports, Clinical,Support, Clinical Decision,Supports, Clinical Decision

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