Calculating Pediatric Doses

There are a lot of moving parts you will encounter as part of your certification process.  One area that should not create additional complications is with drug databases for clinical decision-making support.    This includes making sure you have the best drug-drug and drug-allergy calculators available.   There are only a few vendors in the marketplace in a position to deliver the high quality drug information your customer needs.

But it's not just about the drug information.  It's about the interface,  service,  assistance and support. Anyone can just send over drug information files.   But it's another story to interact with the vendor...............and feel guilt.   If you are looking to work with a drug data company (including: medicine lists, dosage administration, drug classifications, dosing calculators,  pediatric calculators,  clinical guidelines,  medicine interactions,  and more),  Lexicomp likely will provide the best service,  price and long term confidence.   If you are looking to work with a good ePrescribing company,  I would suggest DoseSpot.  They have a terrific product and are great to work with.

Don't forget to check out these companies at HIMSS conference in Orlando in February.

There is a lot going right about regarding Meaningful Use and EMR developers seeking certification.  More and more certifying bodies are in the marketplace making it easier to get certified.  There are very few suppliers of drug data and even fewer still that are easy to work with.  Lexicomp and Cerner/Multum are just two.  And if you are looking for an easy-to-use, out-of-the-box ePrescribing tool, I would take a look at DoseSpot.  What do all of these companies have in common?  They are easy to work with.

Don't wait to the end of your development process to worry about:  dose range checking,  pediatric dosing, drug calculators, medicine interactions, dosage precautions, clinical guidelines, drug interaction software, duplicate therapy, drug classifications, generic drug names, drug nomenclature and more.  These are critical paths for an EMR build.  But it's not just about the information.  It's about who you select as your partner and who have seamless API's which makes your drop easier.  

You owe it to your product and your customer to make the right choice. 

The meaningful use standards put in place by CMS and ONC in July have everyone talking about what they need to do to get certified -- and what additional criteria might be coming in Stage 2.  But an equally important question is: What's been left out?  Asking (and answering!) that question is how EHR vendors can build systems that stand out in the marketplace and deliver benefits that aren't being provided by a hundred other systems.

Dosage precautions: My vote for the most important missing piece
As far as clinical decisions support goes, meaningful use requirements are surprisingly paltry.  Even an important topic like medicine interactions only gets briefly covered in two areas: drug-drug interactions and drug-allergy interactions.  (The missing pieces of this complex topic could be fodder for a whole other blog post!)

But dosage precautions are just as important as medicine interactions.  We've heard a lot this year about how Dennis Quaid's infant twins ended up in a fight for the lives after being given a dose of the blood thinner heparin that was 1,000 times what should have been administered.  Other children have died from similar mistakes.  And yet, nothing in Stage 1 of meaningful use addresses this.  But it's clear: dose administration and dose calculation -- especially as regards dosing in pediatrics -- are just as important to patient safety as drug interactions.

Patients, doctors, and pharmacists don't decide what's important based on certification guidelines
Fortunately, the absence of dosage precautions in the meaningful use final rule doesn't mean that the healthcare industry is ignoring this.  Clinical guidelines in hospitals and practices govern dose calculation and dose administration on some level -- but mistakes sometimes still happen.  There is definitely an appetite among healthcare professionals (and an increasing number of patients!) for better tools to help with this.

Better dose calculators are one way to respond to this need.  Another way is alerts based on dosage range checking, or even more sophisticated systems that control dose administration with barcodes.  But to drive any of these functions -- especially in pediatric dosage calculations --  your underlying data needs to be much more detailed and rigorous than what is usually available.  FDA guidelines and prescribing information especially are inadequate because there are many circumstances they don't address.

Lexicomp has led the market in dose range checking for decades
Luckily, Lexicomp has exactly the data needed to make sophisticated dosage calculators and alerts a reality.  Their decades of experience makes them the overwhelming choice of pediatrics hospitals across the U.S.  Their data goes far beyond prescribing information published by drug companies, and draws from the expert consensus of the best hospitals in the nation, as well as a rigorous review of published studies on the topic.

The designation of post-gestational age can differ among sources. In Lexi-Comp's pediatric database this is determined from the first day of the last menstrual period until the birth of the baby. Because this is not equivalent to the date of conception there is obviously some degree of variability. Pediatric dosing calculations are frequently based on this parameter. This represents one of the key dosing precautions in premature infants. In addition, clinical guidelines may be based on this age.

Try out the offerings from the Lexi-Comp-Cerner partnership and learn about the integrated clinical decision support systems delivered by two of the most reputable names in the industry.  

If you are a physician,  you should be checking into EMR alternatives the allow for eprescribing.  When the mad scramble to comply starts in a year or two,  you don't want to be in the fray.  Not only that,  there will be incentives for those early adopters.  

Check out Lexi-Comp  or Cerner/Multum as possible providers.

What will hospital information and practice management systems look like in 2014?  Will it be a radical shift,  "encouraged"  by government requirements?   Or will the government have to retrench a bit from their demands because of the difficulties - both financial and developmental -  that smaller hospitals will encounter?   Hard to say,  but there is a great deal at stake - including money,  disruption,  lost time,  turning off patients  etc.

EMR and EHR developers,  hospitals and group practices have a lot on their plates.  One area that tends to be an afterthought is the integration of drug information into the various systems.   Many of these systems need drug data to generate medicine interactions,  dose administration,  pediatric dose calculations,  therapeutic dosages,  drug classifications and  drug lists.   There are only  few providers of this information.   The key is to select the provider who will provide the greatest support in integrating this data into your system.  One that will help from assisting in clinical guidelines to eprescribing to drug nomenclature.

To convert raw data into a system that will like a drug interaction database for clinical decision support,  means you need to look beyond just the data.  You need to discern who will be the easiest vendor to work with and will hand hold if necessary.  Sometimes going with the biggest provider is the best,  other times,  when customer support is critical to a successful implementation,  it is best look to look long term.

More and more medical practitioners are using eprescribing as a  means for writing prescriptions.  Why?   First,  because it is more efficient.   Second,  government mandates will soon require that eprescribing be used  to maximize reimbursement.  So how many people are using eprescribing?

According to Surescripts, operator of a national e-prescribing network,  more than 200,000 office-based prescribers in the United States now use electronic prescribing technology.  As part of these eprescribing applications,  the practitioner is expecting robust drug information to be included.   Issues of drug interactions,  therapeutic dosages,  drug nomenclature, pediatric dosing charts,  pediatric dose calculations,  medication brand names,  duplicate drug therapy and more,  are all part of the information that practitioners are looking for when they use an eprescribing tool.

Are you developing an EMR or EHR and need to make sure you have a top source of drug information?   There are actually just a few providers of this information,  including Lexi-Comp and Cerner/Multum.  Make sure you don't wait to the end of your development process to decide which provider you are going with.

Lexi-Comp is most likely the newest player in the drug data arena.  Lexi-Comp has established itself as the leading provider of drug reference information for pharmacists, physicians, and nurses and has now taken that same expertise and built the tools required to provide clinical decision support information for EMRs.  As the newest provider of this content, Lexi-Comp has built an intuitive API and an internal team of experts to provide a startup EMR with the content they need to implement drug data or for an existing EMR system to swap out a new or ancillary data source.  Lexi-Comp has successfully been used for certification and is currently being implemented across many EMRs and institutions.

As a leader in pediatric dose range checking, Lexi-Comp has published the Pediatric Dosage Handbook for over 15 years.  This book is recognized as the authority in pediatric drug information.  This content has been implemented into Lexi-Comp's drug data and can provide the backbone to the best pediatric specific information dosing, calculators, etc. for an EMR.

Visit www.lexi.com/businesses to learn more.

It's no surprise that a majority of hospitals aren't ready for the switch to electronic medical records and that the uptake of technology has not been, nor will be, as rapid as the government hopes. 

Although there are billions of dollars available for care facilities to implement new technologies, such as EMRs, clinical decision support systems (CDS), and clinical information systems (CIS), these are often expensive and time consuming up front, requiring implementation and training of already overworked staff.  This process can take from months to years to reach maturity and often does not show significant gains immediately.  Remember, though, the aim is for better standardized patient care and long term efficiencies within the facility.

With all the headaches associated with the implementation of clinical information systems,  take the guesswork out of at least one part of the process and ensure that your EHR vendor is partnered with a reputable drug information provider.  Lexi-Comp provides drug product information that includes drug classifications by brand and generic name, a comprehensive drug interaction database, pediatric dosing calculators, and duplicate therapy checking.

Learn more about Lexi-Comp's drug information.  

One challenge in arriving at the therapeutic dosage for a medication is the need to adjust to levels of organ function. Automated dosage checking converts a string of inputs such as amount, unit, frequency, etc. which can be compared to defined ranges which are based on age, weight, and other parameters. In the absence of specific information (such as creatinine clearance) the system generally defaults to a range which corresponds to normal organ function. Although a pediatric dosage calculator or pediatric dosage chart may be used in the original dose estimation, organ function cannot be assumed to be normal. Automated checking prior to dose administration should prompt the user to evaluate these factors. Ideally, pediatric dose calculations are modified by indicators of organ function. Hepatic function, in particular, is difficult to estimate objectively. Synthetic activity, detoxification, and genetic factors are important parameters to evaluate. Dosage precautions which are embedded into EMR applications (dose range checking, dosing advice) facilitate the appropriate adjustment of dose based on these parameters. Periodic review of medicine lists may permit the identification of therapies which were initiated at unadjusted dosages. Medicine interactions may also be reviewed in light of changes in organ function changes to ensure medication safety.

I recently came across an interesting article on ABC News that argues that accidentally giving children wrong doses of over the counter medicines could be a form of child abuse.

Although this debate will likely not be solved without the involvement of lawyers and much more research on the topic, I couldn't help but wonder if something COULD be done to help prevent the accidental misuse of commonly used medications for children. For one, children have unique needs when it comes to drug dosing. Secondly, in order to properly prescribe appropriate doses of medications to children, pediatric practices must seek to implement EMRs into their practice settings that are pediatric-specific and specialize in providing drug information that meets the unique needs of pediatricians. 

Luckily there’s Lexi-Comp.

When integrated into an EMR or various other healthcare applications, Lexi-Data – Lexi-Comp’s comprehensive drug database – provides pediatricians the clinical decision support they need to enhance pediatric care. In addition to providing drug interaction software checking, drug-allergy checking and dose range checking, Lexi-Comp can provide pediatric-specific drug data and pediatric dosage calculators that enable EMRs to meet the special needs of pediatric practices. In the end, pediatricians will be better equipped to improve patient care and help decrease the occurrence of accidental “child abuse.”

EHR vendors play a critical role in creating higher quality, safer, more effective health care systems.  Whether it's through ePrescribing, drug interaction screening or dose range checking, EHR systems offer clinical decision support to enhance therapy decisions.  Recently, the final rules were published by the Department of Health and Human Services defining meaningful use of EHR and the EHR incentive program.  Health care providers now have additional funding to support the meaningful use of EHR as well as guidelines that can help implementation in a way that improves patient care.  Benefits of meaningful use of EHR include:

• Know more about patients - Information in the EHR such as patient medication lists can be used to coordinate and improve the quality of patient care.
• Make better decisions - With more information and clinical guidelines available for clinical decision support, healthcare professionals will have the information they need regarding treatments and conditions.  Information ranging from pediatric dose calculations to duplicate therapy alerts help clinicians make better decisions.
• Save money - EHR adoption requires an initial investment of time and money but clinicians who have implemented EHR systems have reported significant time savings, workflow efficiencies as well as receiving government incentives.
  

If you are in need of drug data and drug product information to support your clinical support system (ie EHR, EMR,  HIS, etc),  you need to ask the right questions.  There are only a few medicine list providers and the drug data they provide is somewhat similar in broad strokes (although some stand out in certain areas:  Lexi-Comp is by far the best provider of pediatric dosage information and pediatric calculators).

Given that this is likely to be a long term relationship, you must look at the less obvious and the intangibles.  Will they lock in your price over a longer term contract?  Do they provide affordable APIs to tie into your system,  if that is your preference?   Will they be flexible in working to solve your problems and the problems of other partners that you might be working with?  Will they work to solve some of the growing complex issues dealing with drug classification, interoperability,  and drug nomenclature?

Things are getting a little crazy out there with all of the scrambling around certification requirements and speed to certification.   Recently,  some vendors have opted not to develop their own eprescribing module in the short term for fear that it might get hung up in a protracted approval process.  Instead, they have elected to go with nimble and responsive eprescribing vendors such as DoseSpot.   My advice is to make sure you are comfortable with your partner.  If they are not flexible to work with now,  think of how it will be down the road.

Well, the term, "Meaningful Use" certainly has become a mantra in the healthcare information community in the last six months.  Just check out the last few blog postings by my colleagues on blog.lexi.com and you'll see what I mean.   It's a mad scramble,  especially among medium to smaller hospitals.  It's like a scrum in rugby.  Groups of people moving in tandem together trying to move the ball forward, with some of them coming out bloody and scratched.

A few of the Meaningful Use areas that don't have to be that difficult to implement deal with drug databases for clinical information systems and various ePrescribing systems.  Much work has already been done in the ePrescribing arena.  Why reinvent the wheel?  For example,  companies like DoseSpot  have developed flexible and customer friendly packages.  ePrescribing is a major component of Meaningful Use so make sure you pick the right vendor.

Integrating drug information databases are a bit more complicated and take more time, but don't make it any more complicated than you need.  There are only three or four well-known vendors who can provide the necessary information,  with Lexi-Comp and Cerner/Multum providing strong options.  You want to look for a vendor that is easy to work with,  has easy-to-use APIs,  is cooperative in developing interoperability structures,  and who provides great value.

All of the vendors should have basic information like  dose administration, drug nomenclature,  pediatric dose calculations,  medication brand names,  drug classifications, drug interaction databases,  therapeutic dosages,  and more.  But the providers are not all the same in their service,  ease of integration, and likelihood for ultimate success.

If you are currently looking for drug database supplier to provide data for your EHR,  EMR, HIS or other practice management system,  it's an important decision.  And now that ePrescribing is a critical component in all of the new systems under development,  the importance of working with  top quality drug interaction software and data companies takes on an even more important role. 

So what's important in making your selection?   Certainly price is.  There is no reason to overpay and leave money on someone else's table.  Negotiating an agreement where your price is locked in, should also be an important part of your data acquisition strategy.  There are very few drug database companies, and only one or two would likely give you the option of locking into long term pricing without escalation clauses.  Think about it before you sign.

But even more important is to find a vendor who you can work closely with, whose IT staff is flexible and cooperative, and who has the easiest to use and most developed APIs.   Think about whether the vendor has the preferred and pre-eminent pediatric dose calculations and pediatric dosing charts.  EHR vendors are now starting to see that those organizations who used to dominate the industry may no longer be their best choices.  The health information industry is changing rapidly.  Find someone flexible and cooperative, who has the best information available.