RxInformatics.com

The verdict is in. The quality of health information in Wikipedia is inadequate as a sole source for pharmacists [1], medical students [2], dentists [3], and patients [4]. However, it is good enough for use by nursing students [5]…well, sort of.

Determinations about adequacy are based on studies which evaluated the freely editable, online encyclopedia based on characteristics such as reliability, scope, and accuracy. A clear consensus has emerged from that body of literature collectively rendering a decision that Wikipedia is not a suitable resource for high level consultation or citation. The use (and citation in particular) of Wikipedia by healthcare students and professionals seems to irk practitioners and educators moreso when there are high quality alternatives, suggesting the perception that citing Wikipedia in those cases simply reflects a lack of awareness and laziness. To be fair, Wikipedia founder Jimmy Wales has been unwavering in his stance that no encyclopedia should be used as a reference source for college level work or above.

I recently gave a presentation at the Nova Southeastern University 21^st Annual Contemporary Pharmacy Issues program. The slide deck for the presentation can be viewed below.

@kevinclauson

Every pharmacist that has worked in an acute care environment is familiar with documenting interventions. Information from captured interventions is often assigned a dollar value and used by pharmacy and hospital administration to justify pharmacy services or additional pharmacist FTEs.

Interventions captured can range from secondary issues like illegible handwriting and incomplete orders, to pharmacokinetic consults, renal dosage adjustment and prevention of adverse drug events caused by allergies, drug-drug interactions, disease-drug interactions, etc.

Several methods have been used over the years to capture pharmacist initiated interventions, and no two have been the same. I've worked at several facilities over the years, and the systems used have included a paper method, a Microsoft Access database, a PDA system built with Pendragon Forms for the Palm Pilot, a third party software system and of course the pharmacy information system (PhIS) itself. Each had advantages as well as disadvantages. The two things they had in common were that they cumbersome and lacked standardization.

Part One - The Medication Domain

As we enter the second decade of the 21st century, we have been given a mandate to evolve our simplistic, episodic and transient patient records into the robust, longitudinal, and precise paragons of technology that has been promised in board meetings, speeches and science fiction movies. This can be accomplished. Like all good architecture, achieving this objective will require an evolution over time that starts with stable foundational concepts that support the goal. There are a number of domains of clinical terminology: problems, procedures, laboratory tests, nursing orders, etc. One of the most pervasive and complicated of these is medications.

The purpose of this series on medication concepts for engineers is to provide a overview of the moving parts of medications, how they exist in terminologies today, how they are used in systems today and how they could be used in the future to the betterment of healthcare IT.

Medication concepts are used throughout applications in healthcare information technology in various ways. They are used to order medications, record allergies, track inventory, manage purchase pricing, identify insurance coverage, transmit prescriptions, trigger alerts and workflow rules, and the list goes on. It should not be a surprise that the ways that medications are represented in the various standard, proprietary and homegrown terminologies have become quite complicated over the years.

How is the Medication Domain Different?

The medication domain is different from other clinical domains in a few ways.

General functional variability and the resulting ‘Fuzziness'

Last year I developed a course titled “Consumer Health Informatics & Web 2.0 in Healthcare”.  It was an excellent learning experience for me and hopefully beneficial for the students as well.  The course was offered last semester in our College of Osteopathic Medicine – Biomedical Informatics Program.  I plan to offer a similar course next semester in our College of Pharmacy tailored for those students and capitalizing on the lessons learned from the previous version.

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.