RxInformatics.com

There is a nice article in the November 2009 issue of Hospital Pharmacy on the use of clinical surveillance in pharmacy. I've mentioned these types of systems before here and here.

From the article:

Clinical surveillance tools are atype of clinical decision support system (CDSS), providing pharmacists with patient information that has been filtered according to predefined criteria and is presented at appropriate times to enhance patient care. These tools pull data from 3 sources—admission/discharge/transfer (ADT), laboratory, and pharmacy—and use clinical rules to analyze the data and alert the user of instances that meet the rules’criteria. Though there is some variability in methods across the different vendors’ products, these Webbased applications enerally function by interfacing (HL7) with the hospital’s information systems to securely pull the data to the vendor’s server where the data are analyzed against a set of clinical rules. Some vendors allow the client to build their own rules, some provide a foundational set of rules, and others do not allow user-defined rules. This is an important distinction to make when evaluating the different applications.

For more information try visiting John's Evernote repository for Clinical Decision Support.

Bio-IT World

An motivated pharmacist at the Children's Hospital of Philidelphia worked to create a pediatric knowledgebase. The innovative result provided physicians and pharmacists with pharmacotherapy guidance and adequate electronic health information. The difference here is the close ties to patient data.

Isaac T, Weissman JS, Davis RB; et al. Overrides of medication alerts in ambulatory care. Arch Intern Med. 2009;169(3):305-311. FREE FULL TEXT  [the follow up letters below]

Overrides of Medication Alerts in Ambulatory Care
Stephen N. Rosenberg; Maureen Sullivan; Iver A. Juster; Jeffrey Jacques
Arch Intern Med. 2009; 169:1337.  EXTRACT | FULL TEXT | PDF

I have thought the checking of inappropriate medications with Beers and the lesser known Zhan Criteria was a “no brainer” with CDS in ePrescribing and inpatient CPOE.   All of the drugs in the criteria make no sense to be given to elderly folks and have alternatives that are less likely to cause adverse events.   This article and related editorial gives a needed pause and gut check prior to implementing a wide CDS intervention.  I still think it is the right thing to do, just proceed with caution and understanding.

Agreement Between Drugs-to-Avoid Criteria and Expert Assessments of Problematic Prescribing

http://archinte.ama-assn.org/cgi/content/abstract/169/14/1326?etoc

Clinical Decision Support Systems: State of the Art

http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

and…..

Clinical Practice Improvement and Redesign:  How Change in Workflow Can Be Supported by Clinical Decision Support

http://healthit.ahrq.gov/images/jun09cdsworkflow/09_0054_ef.html

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