Assessment of ePrescription quality: an observational study at three mail-order pharmacies

<p>Abstract</p> <p>Background</p> <p>The introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.</p> <p>Methods</p> <p>A direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38–75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.</p> <p>Results</p> <p>Of the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3–2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8–20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.</p> <p>Conclusion</p> <p>The increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.</p

Predicting Computerized Physician Order Entry System Adoption in US Hospitals: Can the Federal Mandate Be Met?

Objectives: The purpose of this study is four-fold. First, the hospitals‘ current level of computerized physician order entry (CPOE) adoption is reported; second, internal and external influence factors‘ roles in determining CPOE adoption rates are described; third, the future diffusion rate of CPOE systems in US hospitals is empirically predicted; finally, the current technology‘s state-of-the-art is assessed. Data source: Secondary data from 3 years of the Leapfrog Group‘s annual survey (2002–2004) of US tertiary-care hospitals. Study design: This study estimates CPOE market penetration rates applying technology diffusion theory and Bass modeling techniques for three future CPOE adoption scenarios—=Optimistic,‘ =Best estimate‘, and =Conservative‘ are empirically derived. Principal findings: Two of the CPOE adoption scenarios have diffusion S-curve that indicates a technology will achieve significant market penetration. Under current conditions, CPOE adoption in urban hospitals will not reach 80% penetration until 2029. Conclusions: The promise of improved quality of care through medication error reductions and significant cost controls prompted the Institute of Medicine to call for universal CPOE adoption by 1999. However, the CPOE products available as of 2006 represent only a =second generation technology‘, characterized by many limitations. Without increased external and internal pressures, such CPOE systems are unlikely to achieve full diffusion in US hospitals in a timely manner. Alternatively, developing a new generation of CPOE technology that is more =user-friendly‘ and easily integrated into hospitals‘ legacy systems may be a more expedient approach to achieving widespread adoption

On Intelligence Augmentation and Visual Analytics to Enhance Clinical Decision Support Systems

Human-in-the-loop intelligence augmentation (IA) methods combined with visual analytics (VA) have the potential to provide additional functional capability and cognitively driven interpretability to Decision Support Systems (DSS) for health risk assessment and patient-clinician shared decision making. This paper presents some key ideas underlying the synthesis of IA with VA (IA/VA) and the challenges in the design, implementation, and use of IA/VA-enabled clinical decision support systems (CDSS) in the practice of medicine through data driven analytical models. An illustrative IA/VA solution provides a visualization of the distribution of health risk, and the impact of various parameters on the assessment, at the population and individual levels. It also allows the clinician to ask “what-if” questions using interactive visualizations that change actionable risk factors of the patient and visually assess their impact. This approach holds promise in enhancing decision support systems design, deployment and use outside the medical sphere as well

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches

Realizing the Value Proposition: A Longitudinal Assessment of Hospitals’ Total Factor Productivity

U.S. hospitals are under continual pressure both to increase productivity and to improve quality through the use of Health Information Technology. This paper analyzes 3,187 US hospitals, using data reported to the American Hospital Association, to assess changes in productivity over a five- year period (2002-2006). The Malmquist Indices derived indicate that Total Factor Productivity (TFP) and Efficiency Change (EFFCH) both increased during that timeframe. The low Technological Change (TC) index indicates that improvements to organizational processes did not contribute substantially to productivity. A secondary analysis examined the use of Computerized Physician Order Entry (CPOE) in relationship to the three indices. TFP trended positively for those hospitals further into the CPOE implementation process

Clinical pharmacology in health care, teaching and research

http://www.ester.ee/record=b4285489*es

Antiepileptic drug utilization : need of sex-specific information and decision support

Antiepileptic drugs are used for the treatment of epilepsy and for other neurological and psychiatric conditions, and therefore is prescribing of antiepileptic drugs a concern for physicians from many disciplines. The age and sex-specific prevalence, as well as the role of sex and gender aspects, vary between the conditions for which antiepileptic drugs are used. The overall aim of this thesis was to gain more understanding of the use of antiepileptic drugs on various diagnoses, focusing on sex/gender differences, and to explore physicians' perceptions of sex and gender in decision making on drug treatment. The first two studies describe the antiepileptic drugs used in epilepsy and other conditions. Clear age and gender differences in the use of specific anti-epileptics were observed. The use of antiepileptic drugs in children and adolescents was mainly limited to epilepsy and the individual antiepileptic drugs prescribed appeared to be in accordance with approved indications and treatment guidelines. However, some antiepileptic drugs were used off-label in children and adolescents. The third study evaluated the effect of a warning issued by the European Medicines Agency in November 2014 on restricted prescribing of valproic acid to girls and women of childbearing potential. The analyzes showed that the warning only affected the prescribing in girls and women with a psychiatric diagnosis. Prescribing to girls and women with epilepsy had decreased long before the warning was issued, which could indicate an increased awareness of the teratogenic risk of valproic acid among neurologists treating women with epilepsy. The fourth study examined how primary care physicians perceive sex/gender and gender equality related to drug prescribing. The results showed that physicians experienced insufficient knowledge of sex/gender differences in drug treatment, although their expressed clinical experience indicated some awareness. The patient's sex was considered during diagnosing while drug prescribing decisions followed the regional recommendation lists because these were believed to be evidence-based and gender-neutral. Overall, physicians wanted more education and knowledge about sex and gender in drug treatment. However, finding reliable information about sex and gender aspects for individual drugs may be difficult. This can be facilitated by the web-based knowledge base Janusmed Sex and Gender, as described in the fifth study. In summary, this thesis demonstrates sex differences in use of certain antiepileptic drugs, which probably reflect the different benefit and risk from these between men and women. Knowledge of how antiepileptic drugs are prescribed and used in women and men with different diagnoses may be useful in discussions on rational drug prescribing and to propose measures to improve prescribing behavior. As shown in this thesis, regulatory measures may be one approach to improve rational prescribing and to highlight the importance of the patient's sex. Another approach may be to get acquainted with sex and gender-related pharmacological information through the knowledge base Janusmed Sex and Gender