Developing and implementing clinical decision support for use in a computerized prescriber-order-entry system. 2010

Bruce W Chaffee, and Christopher R Zimmerman
Department of Pharmacy Services, College of Pharmacy, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5008, USA. bwc@med.umich.edu

OBJECTIVE The development and implementation of clinical decision support (CDS) in a computerized prescriber-order-entry (CPOE) system in a large, tertiary care, academic health care system are described. CONCLUSIONS CDS is generally considered to be a key factor in promoting successful system adoption, patient safety, and positive patient outcomes for CPOE implementation. The impact of CDS depends on the methods used by the institution to implement CPOE using both passive and active system design features. At the University of Michigan Health System, interdisciplinary project teams were assembled to plan, build, and implement the CDS component of CPOE using several underlying fundamental principles to ensure the usability and safety of the system, including standardization of system configuration, workflow design, and prioritization of the number and types of interruptive alerts that would be deployed. Passive CDS rules were established for nomenclature, links to information, relevant results, and order sets. Active CDS rules were developed for noninterruptive alerts (patient list alert flags and form-called medical logic modules) and interruptive alerts, including alerts for allergies, dose checks, drug-drug interactions, drug-food interactions, and drug-disease interactions. The institution provided sufficient staffing and institutional governance to implement and sustain CDS. CONCLUSIONS Through an interdisciplinary collaboration, an academic health care system planned, designed, and implemented institution-specific, CPOE-integrated CDS to improve clinical efficiency and facilitate the compliance with regulatory policies and guidelines.

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
D011785 Quality Assurance, Health Care Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Assessment, Health Care,Health Care Quality Assessment,Health Care Quality Assurance,Healthcare Quality Assessment,Healthcare Quality Assurance,Quality Assessment, Healthcare,Quality Assurance, Healthcare,Assessment, Healthcare Quality,Assessments, Healthcare Quality,Assurance, Healthcare Quality,Assurances, Healthcare Quality,Healthcare Quality Assessments,Healthcare Quality Assurances,Quality Assessments, Healthcare,Quality Assurances, Healthcare
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000046 Academic Medical Centers Medical complexes consisting of medical school, hospitals, clinics, libraries, administrative facilities, etc. Medical Centers, Academic,Medical Centers, University,University Medical Centers,Academic Medical Center,Center, Academic Medical,Center, University Medical,Centers, Academic Medical,Centers, University Medical,Medical Center, Academic,Medical Center, University,University Medical Center
D016730 Program Development The process of formulating, improving, and expanding educational, managerial, or service-oriented work plans (excluding computer program development). Program Descriptions,Description, Program,Descriptions, Program,Development, Program,Program Description
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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