Clinical Decision Support Systems

Are you developing EMRs and practice management systems where speed to market is critical?   One of the modules of such systems is the inclusion of drug information.    Since this is neither the expertise of your developers nor your content people,  it is important to identify the preferred drug information provider early in the process.   Four criteria are critical in making this decision.   First, quality of information.  Second,  flexibility of design and APIs.   Third, simplicity of data structure.   Fourth, and very important, customer support during the development period and after release.    More and more EMRs are now using Lexicomp drug information as part of their offering.  And there is a reason for that.

Lexi-Data is the foundation of Lexicomp's clinical decision support architecture is quickly becoming the standard for when companies need an up-to-date comprehensive drug database.  This product provides patient specific alerts and referential content to support sound treatment decisions in areas such as drug interaction checking (drug-drug and drug-food), drug allergy checking, therapeutic duplication checking, RxNorm Mappings, supports Surescripts Certification,  Drug Classifications, dose range checking (adult and pediatric), Patient Education, Pediatric and neonatal drug interactions and more. 

1. Meaningful Use support: Including drug-drug and drug-allergy interaction checking
2. Superior customer service: Every customer receives personal service, no matter the size
3. Advanced filtering options: A unique system of complex filters allows users to target Black Boxed Warnings to particular users and circumstances
4. Trusted content and name: Thousands of physicians, pharmacists, nurses, dentists, and other clinicians buy information direct from Lexicomp because they trust it
5. Full support for eprescribing: Customers have used Leicomp's clinical decision support to create their own e-prescribing modules for EMRs and EHRs

• Compatible with required standards like RxNorm
• Supports drug-drug and drug-allergy interaction checking
• All data necessary for ePrescribing and CPOE
• Additional functionality like dose range checking

• Easy-to-use APIs and web services -- you choose which you want
• Superior one-on-one customer service
• Most intuitive data structure and fastest implementation

• Black Box Warning filters to alleviate clinician alert fatigue
• Patient education available in 19 languages

One of the most common comments I hear from users of Electronic Medical Records (EMR) systems is associated with “alert fatigue” from unwelcome drug interaction notifications. Many users tell me that they are flooded with unavoidable but unnecessary alerts that interrupt their workflow, decrease productivity, and make the important alerts harder to see. Clinicians find themselves clicking through the alerts as quickly as possible which defeats the purpose of clinical decision support. 

In today's fast-paced healthcare industry, electronic health record (EHR) and other healthcare information system vendors need smart, current drug data that will enable their systems to drive patient safety and improve healthcare -- without generating a flood of annoying alerts that will only be ignored. Lexicomp has recently included new functionality that can alert users with the appropriate Black Box Warning where appropriate in the current workflow. 

In the most simple terms, an FDA Black Box Warning is the strongest warning that the US Food and Drug Administration (FDA) puts on a drug. It means that you should pay close attention to the drug's usage because there are some potentially extremely harmful or dangerous threats to your health that the already FDA approved drugs could pose.

The other side of the coin, however, is that an FDA Black Box Warning means that despite the FDA's knowledge of these harmful, serious and sometimes deadly side effects that they are still leaving the FDA approved drug on the market for you to be able to take and potentially experience these harmful side effects. In theory, these FDA Black Box Warnings are designed for both the doctor who is prescribing the drug to be aware of the problems and for you as the consumer to be more aware.

The warning is placed in a prominent 'black box' on the package insert of an FDA approved drug so that people and their doctors can be more aware of it, but few doctors ever see the pill bottles and the vast majority of consumers realistically aren't going to go through the amazingly large amount of technical and medically detailed information on a package insert. This can lead to doctors note being aware of a serious alert which can have serious consequences. With Lexicomp’s inclusions of Black Box Warnings within their medication database, the warnings can be provided to the physician during the prescription process where they are most needed.

There have been thousands of articles written discussing why EMR adoption rates have been so low and why physicians especially have been resistant to moving into the electronic age.  Little return on the initial investment, lack of efficiency in the system and no improvements in patient outcomes have been listed as reasons for reduced adoption rates.

One key element to the lack of efficiency and little improvement in patient care is due to the number of alerts that are generated when trying to use these systems.  As a pharmacist, I enter in hundreds of medication orders in a shift and it is rare that I do so without receiving an alert from my HIS telling me about a drug interaction or duplicate therapy.  These alerts although technically accurate, often involve medicine interactions that are so minor or irrelevant to hospital medicine.  

If an HIS truly wants to improve patient care and become an indispensable part of medicine, it must provide clinical decision support that can accurately and appropriately give clinicians therapeutic alerts that are relevant and can help improve patient care.  That is the goal of Lexi-Data.  For more information about Lexi-Data, check out www.lexi.com.

Matt Bennardo had a great blog post last week where he wrote about the positive benefits of Meaningful Use on the development of EHRs and their impact on patient safety.  He cites a study by Practice Fusion,  where it has been shown that EHR's are having a real impact on the decrease in infant mortality.  This is great news!

As Matt wrote, "Of course, to get these kinds of results, the information in the EHR needs to be accurate, timely, complete, actionable, and specific to the patient. With respect to pediatric and neonatal patients, that last point is especially important. An EHR that is only set up to perform dose range checking and interaction checking on adults won't be nearly as helpful when it comes to children."

All pediatric dosage calculators are not created equally.   As Matt goes on to say, "But luckily there are drug information vendors like Lexicomp that understand there is a vast world of difference between adults and children -- and often between older children and neonates. Lexicomp's drug information is trusted by dozens of EHR vendors to guide clinicians in prescribing, fulfilling, and administering drugs to patients of all types -- including children.

Lexicomp provides both "machine readable" transactional information (geared towards specific populations) for use in clinical decision support, as well as "human readable" reference materials for clinicians and patients. Even Lexicomp's patient education leaflets are written with either adult or pediatric patients in mind.

If you are developing an EMR or looking to improve an EHR or HIS system, I would suggest reaching out to Lexicomp for some suggestions.

• anesthesia and critical care concerns, use, dosage, and monitoring parameters
• anesthetic drug interactions

• Pediatric Dosage Calculations in both transactional information for the clinical decision support systems and reference materials designed for clinicians.
• Pediatric focused patient education materials