Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · May 2014
Comparative StudyEstimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records.
Errors in community medication histories increase the risk of adverse events. The objectives of this study were to estimate the extent to which access to community-based pharmacy records provided more information about prescription drug use than conventional medication histories. ⋯ Pharmacy records identified a substantial number of medications that were not in the ED chart. There is potential for greater safety and efficiency with automated access to pharmacy records.
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J Am Med Inform Assoc · May 2014
Using a medical simulation center as an electronic health record usability laboratory.
Usability testing is increasingly being recognized as a way to increase the usability and safety of health information technology (HIT). Medical simulation centers can serve as testing environments for HIT usability studies. We integrated the quality assurance version of our emergency department (ED) electronic health record (EHR) into our medical simulation center and piloted a clinical care scenario in which emergency medicine resident physicians evaluated a simulated ED patient and documented electronically using the ED EHR. ⋯ Similarly, working with information systems teams was important for integration of the EHR. Electronic tools are needed to facilitate entry of fictitious clinical results while the simulation scenario is unfolding. EHRs can be successfully integrated into existing simulation centers, which may provide realistic environments for usability testing, training, and evaluation of human-computer interactions.
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J Am Med Inform Assoc · May 2014
Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.
The specificity of medication-related alerts must be improved to overcome the pernicious effects of alert fatigue. A systematic comparison of new drug orders to historical orders could improve alert specificity and relevance. Using historical order data from a computerized provider order entry system, we alerted physicians to atypical orders during the prescribing of five medications: calcium, clopidogrel, heparin, magnesium, and potassium. ⋯ Fifty of the 68 atypical order alerts were over-ridden (74%). However, the over-ride rate is misleading because 28 of the atypical medication orders (41%) were changed. Atypical order alerts were relatively few, identified problems with frequencies as well as doses, and had a higher specificity than dose check alerts.
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J Am Med Inform Assoc · May 2014
Overrides of medication-related clinical decision support alerts in outpatients.
Electronic prescribing is increasingly used, in part because of government incentives for its use. Many of its benefits come from clinical decision support (CDS), but often too many alerts are displayed, resulting in alert fatigue. ⋯ About half of CDS alerts were overridden by providers and about half of the overrides were classified as appropriate, but the likelihood of overriding an alert varied widely by alert type. Refinement of these alerts has the potential to improve the relevance of alerts and reduce alert fatigue.
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J Am Med Inform Assoc · May 2014
Content and functional specifications for a standards-based multidisciplinary rounding tool to maintain continuity across acute and critical care.
Maintaining continuity of care (CoC) in the inpatient setting is dependent on aligning goals and tasks with the plan of care (POC) during multidisciplinary rounds (MDRs). A number of locally developed rounding tools exist, yet there is a lack of standard content and functional specifications for electronic tools to support MDRs within and across settings. ⋯ We recommend an initial list of 11 universal CDEs for continuity in MDRs across settings and 27 CDEs that can be configured to meet setting-specific needs.