Page 2 - Clinical Decision Support Systems

EPrescribing, Florida doctors, Medication Databases

Tuesday, June 7, 2011 by David Wilkof

What do all of these have in common? Well for one thing, they are being driven in part by the demands of Meaningful Use requirements. Here is just one example of Meaningful Use effect. Some of the demands are actually in place, and many others roll out over the next few years. EPrescribing in Florida looks like it might be taking an interesting turn as free application provided by the State may be going away, or so I have heard. This recently posted ePrecribing blog described it in greater detail. And a second blog.

As Meaningful Use requirements have dictated more relevant application of medication and drug data within EMR and EHR systems, the awareness of the nuances of these databases has also gone up. Recognition of the following terms is becoming more commonplace: Drug Reference Database; Dosage Range, Dosing in Pediatrics, Drug Interaction List, Pediatric Dosage Calculator, Medicine Interaction. Clinical Decision Support Systems, Drug Content, and more.

Can you rely on your HIS to check your pediatric dosage calculations?

Tuesday, June 7, 2011 by Chris Madjerich

As we attempt to incorporate more technology into medicine through the use of HIS, it brings to light the need for more than just a simple medication list. Health information systems are now being asked to help improve patient outcomes by performing other clinical decision support functions that go beyond a pick list. If we truly want to improve patient outcomes, it is important that our HIS provide relevant clinical guidance especially in a critical population such as pediatrics. Calculating pediatric doses is not always an easy task and having data in your HIS that can perform pediatric dosing calculations can be an invaluable tool in improving patient outcomes.

Lexicomp has a long standing reputation of providing this valuable and often difficult dosing information in the Pediatric Dosage Handbook. For over 20 years, we have been providing neonatal and pediatric dosing based on available literature and current clinical practice. More recently this information has been transformed into Lexi-Data's Pediatric Dosage Range Checking application. This content can be used within an HIS to provide guidance to your clinicians on appropriate dosing for this difficult and vulnerable population.

Dosing in Pediatrics

Monday, June 6, 2011 by Michelle Curren

Matt Bennardo had a great post last week regarding a study which showed the connection between EHRs and their improvement on pediatric care.

With several pediatric calculators on the market, how can one tell which to trust? A reference book can be helpful, yet many other considerations should be taken into account. It is vital to screen drug interactions with the full medicine list of the child along with their maturation. Having all this information readily available with an EMR can vastly work to reduce errors. When dealing with pediatrics, especially neonatal patients, attention to detail and continually updated, unbiased information is best. Lexicomp has all the options to achieve improved safety for patients of any age.

These options include:

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

Can EHRs rely on HIEs or states for functionality?

Sunday, June 5, 2011 by Matt Bennardo

Health information exchanges (or HIEs) have long been the odd duck of the future of healthcare. Their proposed roles have varied from relatively simple (providing a mechanism for exchanging healthcare information among local providers) to complex (actually delivering some clinical decision support systems to their members). Even now there is no consensus on what HIEs should be doing, how they should be funded, and how many there should be.

The truth is that most HIEs are still funded by state and federal grants. These grants are temporary, since it's expected that some viable system of self-support will eventually assert itself. But until there's real evidence that this is happening, it's best to think of the entire HIE model as founded on the shifting sands of government whimsy. As we know all too well, many programs are "ear-marked today, gone tomorrow".

Some states also provide CDS functionality directly -- such as the eprescribing program in Florida. But again, such initiatives exist at the mercy of lawmakers, whose opinions may change without notice. For that reason, all HIS, EMR, and EHR vendors should treat such programs as temporary and not rely on them to provide functionality to their customers.

However, there are also established companies that can provide the same functionality (and have been for years). For drug information to drive clinical decision support, one such vendor is Lexicomp. They also have several partners in the electronic prescribing space that can fill that need with a less capricious solution than government programs. Contact Lexicomp today to learn more about both solutions -- use the phone number or form on this page.

EHRs have major impact on improving pediatric care -- with the right data

Friday, May 27, 2011 by Matt Bennardo

All the buzz about Meaningful Use sometimes makes us forget what EHR implementation is really supposed to be about -- improving patient care. But this article from Practice Fusion's blog reminds us that EHR use can reduce errors, save lives, and makes it easier to serve patients better. That's what the real objective is!

The study in the article highlights the benefits of EHR use when pediatric patients are concerned. The researchers were able to link the use of electronic health records and associated clinical decision support systems to a quantifiable decrease in infant mortality -- especially among neonatal patients.

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.

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.

Anesthesiology & Critical Care Drug Information

Wednesday, May 25, 2011 by Ryan Smith

The market for anesthesia information systems is predicted to increase 50% by 2012 and be valued at $4 billion by 2017. According to a new report by iData Research (www.idataresearch.net), the leading global authority in medical device market research, the U.S. anesthesia, respiratory and sleep-management device market will reach approximately $4 billion by 2017, with strong growth being driven by anesthesia information management system (AIMS) sales. This report is accompanied by two companion reports, "Electronic Medical Records" and "Picture Archiving and Communication Systems (PACS)", which forecast rapid adoption of medical information technology due to approaching deadlines set out by the U.S. government's Healthcare Information Technology for Economic and Clinical Health (HITECH) Act.

Lexicomp maintains an Anesthesiology & Critical Care database that presents information on over 2000 medications used in the care of surgical or critically ill patients. This is a must-have drug reference for anesthesiologists, nurse anesthetists, intensivists, and other critical care practitioners.

When utilizing our Web API Solution, Web Services, or XML datasets, this type of information can be accessed from within the workflow. This integration delivers detailed drug and clinical reference information , including anesthesia and critical care concerns, use, dosage, monitoring parameters, and anesthetic drug interactions, where applicable to physicians, pharmacists and nurses, supporting improved decisions at the point-of-care.

E-Prescribing and physician practices...are patients any safer?

Tuesday, May 24, 2011 by Chris Madjerich

The goal of policy makers in requiring the use of e-prescribing is to improve medication safety. Many systems have the ability to screen a new prescription for safety using clinical decision support tools such as drug interaction, drug allergy, duplicate therapy and dosage range checking. A recently published study by the Center for Studying Health System Change (HSC) analyzed the use of e-prescribing in physician practices and the impact on patient care. The study included 24 practices and found that while most e-prescribing systems used had access to patient medication information and clinical decision support tools built-in, only slightly more than half of the physicians reported accessing this information. Several reasons were cited for this low usage including the fact that it is difficult to import medication histories into the patient records and that physicians found little value in reviewing this information when making prescribing decisions.

The results of this study raise some interesting questions. The challenge of incorporating patient specific medication histories from multiple sources certainly is a real barrier and one that is pivotal to making CDS useful. Maybe more alarming is the perception that the alerts and checks that the system can provide are not useful in influencing prescribing decisions. This point can be challenging when e-prescribing systems are not built with reliable and clinically relevant data to power the CDS processes.

Lexicomp provides clinical information that can be used to perform key CDS functions such as drug interaction, drug allergy, duplicate therapy and dosage range screening. This content is derived from our well-established drug reference information that is evidenced-based, peer-reviewed and up-to-date. If you are a clinician working in health care, you most likely have relied on this content to help you make patient care decisions for many years. If CDS is going to accomplish its goal of improving patient care, it is going to require a strong, evidenced based library of clinical information. Something Lexicomp has been doing for over 30 years.

Achieving Meaningful Use with Lexicomp

Monday, May 23, 2011 by Aly Gordon

When integrated into your EMR, Lexicomp's drug reference content and drug interaction data will help you achieve the clinical decision support component of Meaningful Use.

Let’s face it: your customers need to prove Meaningful Use of their certified EMR in order to qualify to receive government incentive money. And if you don’t clearly communicate to users how your system will help them achieve Meaningful Use, you may get left behind.

So rest assured that when you implement Lexicomp's drug data and reference information, your EMR will be one step closer to complying with Meaningful Use! Lexicomp provides:

Data for drug-drug, drug-allergy and drug-disease interaction screening
Data to support duplicate therapy and dose range checking for pediatric and adult patients
Data that allows users to generate patient-specific education handouts

For more information, go to www.lexi.com/meaningful-use.

Hospital EMR Security Raises Concerns

Sunday, May 22, 2011 by Matt Snodgrass

As more hospitals are taking up the mantle of electronic medical records, the issue of security continues to plague the industry. Every day, more hospitals are identified as having security gaps - sometimes glaring, sometimes minor - but always of concern to the administrators, IT professionals, clinicians, and patients of those hospitals.

A recent study released by the Office of the Inspector General showed "a lack of general [information technology] security controls during prior audits at Medicare contractors, State Medicaid agencies, and hospitals." 124 out of 151 breeches were considered "high-impact" - resulting in costly losses, injury, or death.

Given all that a hospital EMR implementation team and IT staff has to worry about concerning the safety and security of these systems, the one thing they shouldn't have to concern themselves with is the depth and quality of the drug information of their system.

Many drug information vendors can promise drug-drug interaction checking, drug-allergy interaction checking, and other required clinical decisions support functions. But once the developers get into the guts of the medication lists and supporting tables, will they be pulling their hair out and wasting precious days trying to make sense of awkward data structures?

Lexi-Data, Lexicomp's clinical decision support database contains:

Drug Interaction Data - we'll provide your system data that enables clinicians to screen for drug interactions, including drug-allergy, drug-drug and drug-food

RxNorm Mapping - we promote interoperability through mapping to industry standard RxNorm

Drug Reference Data - integrate drug reference information, such as drug images and black box warnings, into your system

Patient Education Data - we provide patient education information that allows users to generate patient-specific handouts for medications (available in 19 languages), and conditions and procedures (available in English and Spanish)

Dose Range Checking - we provide data that enables clinicians to receive dosing alerts for medications, including limits for pediatric patients

Would your EHR system have prevented this fatal error?

Thursday, May 19, 2011 by Matt Bennardo

Hospitals are complex organizations with many different systems used by different departments, and often not well integrated. All kinds of errors can occur -- human errors, data-entry errors, labeling errors. And unfortunately, sometimes those errors have fatal consequences, such as this case of a premature infant that received a lethal dose of sodium due to a parenteral nutrition compounding error.

In this particular case, the death was reported to have led from incorrect data entry into the compounder, insufficient oversight by the pharmacist, incorrect labeling, and an unfulfilled physician request for investigation into abnormally high sodium levels in the infant. Though neither the EMR nor the CPOE were directly implicated in the error this time, it's always worth thinking about whether your system would have been capable of preventing this mistake -- and if not, what you may need to change.

Needed: Dose range checking -- and then some
In order for any system to have detected this error, some form of dose range checking would need to have been in place. This wasn't a result of an adverse drug event or an improperly prescribed medication, so Meaningful Use interaction and allergy checking are of no use. Only knowledge of the correct dosage for this specific patient would help.

In fact, not even all dose range checking would be helpful. This patient belonged to a special class -- a neonate. So the dose checking would need to be differentiated between adult and pediatric (or, in this case, neonatal). Otherwise, a dose that would be appropriate for an adult but fatal to an infant could easily be prescribed.

IV compatibility also an issue
This case also dealt with a solution administered intravenously. In this particular case, there was no adverse reaction between the ingredients being compounded, but with IV administration that's always a possible danger. Therefore, to be 100% safe, your EHR or HIS would also need to contain information about IV Y-site compatibility.

And of course, all of this would need to be checked and double-checked at every stage of the process by every clinician: the physician entering the order into the CPOE, the pharmacist compounding the solution, and the nurse administering it to the patient. The systems that each clinician uses should be able to check for each of these factors (and more!), and also should be able to provide the clinicians with more "human readable" information in case something doesn't seem right.

With the state of healthcare IT today, most of us are still a long way off from being able to implement a perfectly integrated system that can eliminate this kind of error entirely. But taking a few steps with the systems we have control over can reduce tragic outcomes like this one. One place to start is to contact a clinical and drug information vendor like Lexicomp to find out what information is available to be integrated into your systems -- both transactionally for automatic clinical decision support and as reference material for clinicians to make use of.

The secret to a better EMR product and faster deployment? Listen to IT!

Tuesday, May 17, 2011 by Matt Bennardo

With hundreds of EMR vendors rushing to enter the market these days and with limited time left in the government Meaningful Use incentives, speed to market is top of everyone's mind. Electronic health records and electronic prescribing are part of the near future of healthcare, and the first arrivals with the best products will likely win the race.

At Lexicomp, we have helped many EMRs implement clinical decision support systems and prepare for (and then pass!) ONC-ATB certification. Several of our satisfied customers have come to us after working with other drug information vendors and finding their databases difficult to work with and their customer service unresponsive.

Sometimes "How" is as important as "What"
Many drug information vendors can promise drug-drug interaction checking, drug-allergy interaction checking, and other required clinical decisions support functions. But once the developers get into the guts of the medication lists and supporting tables, will they be pulling their hair out and wasting precious days trying to make sense of awkward data structures?

That's why the secret to a fast deployment and better product often requires listening to the IT department. If they don't like what they see, then it's time to look for a new solution. At Lexicomp, we also have many customers who included numerous drug information vendors in their up-front analysis. This allowed them to save time by not going down the wrong path to begin with -- their IT department was able to review sample files ahead of time and make a recommendation that resulted in greater speed to market.

When choosing a drug information provider, listen to the people on your staff who will need to work with the data every day! If you ignore their suggestions, then don't be surprised when development is slow and functionality lags behind.

Not all drug reference databases are created equal

Saturday, May 14, 2011 by Mark Dachille

When reviewing a drug reference database provider, there are a number of factors to consider other than what functionality their product includes. While there are a number of vendors that provide clinical decision support like drug interaction, drug-allergy interaction, duplicate therapy, dose range checking, patient education leaflets, and other components of meaningful use, their quality of data may not be the same.

It is one thing to be able to check off a box that your EMR or ePrescribing application contains these features, but it is a different story when clinicians actually start to use your product. Implementation of one dataset maybe less expensive over another up front, but the cost of providing data that is deemed inaccurate or not valuable by your end users is extremely high as it can lead to alert fatigue and a distrust of your system.

Checking into the background of your drug reference database provider, the current customers using their content, and the past reputation of the vendor up front can prove invaluable down the road and lead to your users being happy and becoming champions of your product.

Re-evaluating EMR design in a changing market

Tuesday, May 10, 2011 by Matt Bennardo

In the past few years, new developments on many fronts have created innovation and changes among EMR vendors. Regulations like Meaningful Use have caused particular features and functions to gain sudden prominence. New technologies have given us buzzwords like "software as a service" (SaaS) and "the cloud" -- along with new ways to deliver information. New business models have some EMR companies giving away their product to users. And new hardware like tablets and smartphones are suggesting new ways that clinicians can interact with their EMR systems.

As EMR vendors plan to release new products or new versions of software to take advantage of some of these new opportunities (or to comply with government mandates), it's also the perfect time to evaluate the drug information that forms the basis of any EMRs clinical decision support.

When many EMRs were first designed several years ago, there weren't many choices for drug information. Now there are new vendors in the market with competitive offerings, like Lexicomp. Many new EMRs are finding it to their advantage to sign up with Lexicomp for their drug reference and clinical decision support information. If you've been using the same drug information vendor for years because you thought you had no other choice, it's time to find out why!

Looking for drug information to include in your EMR, EHR or HIS system?

Friday, May 6, 2011 by David Wilkof

Several weeks ago I wrote a blog posting that included a list of drug information considerations for EMR vendors that were launching new products or looking to improve their current products. As I wrote:

More and more EMR vendors and hospital EHR/HIS systems are attempting to improve their drug information to further enhance clinical decision support. Below are just a few areas where having the right medicine data can make all the difference in the world.

Drug Interaction Lists
Adverse Drug Event Alerts
Patient Education Pamphlets in 19 Languages
RxNorm Mapping
Pediatric Dosage Calculations
Drug Allergy Interactions
Clinical Guidelines
Drug Interaction Software
Drug - Drug Interactions
Drug - Allergy interactions

There are very few drug information providers in the marketplace that have both quality data and a top notch, customer-oriented support staff. Cerner/Multum and Lexicomp top the list. Lexicomp offers a unique blend of top quality information coupled with the finest internal support anywhere. Your IT guys will love you for going with Lexicomp -- a long-term partner in your road to success.

The Landscape of Healthcare Information Technology is Rapidly Changing

Thursday, May 5, 2011 by David White

The landscape of Healthcare Information Technology is rapidly changing leaving many EMR vendors searching for answers about how to develop their systems. It also has caused confusion among clinicians as to what actually defines meaningful use of those systems.

For those seeking clarity as to the direction of healthcare, a recent report by the Department of Health and Human Services defines the National Strategy for Quality Improvement in Healthcare. It is interesting to note that Lexicomp content can help achieve the number one goal outlined in this report - safer care by reducing the number of serious adverse drug events.

Lexicomp's transactional drug data and reference information supports various components of Stage 1 meaningful use and certification criteria from ONC's Final Rule, specifically the implementation of electronic clinical decision support rules (drug-to-drug and drug allergy contraindication checking) based on the data elements included in: problem list, medication list, demographics and laboratory test results.

Lexi-Data, Lexicomp's clinical decision support database, will help you meet several aspects of clinical decision support required for certification. Here's how:

Drug Interaction Data - we'll provide your system data that enables clinicians to screen for drug interactions, including drug-allergy, drug-drug and drug-food

RxNorm Mapping - we promote interoperability through mapping to industry standard RxNorm

Drug Reference Data - integrate drug reference information, such as drug images and black box warnings, into your system

Dose Range Checking - we provide data that enables clinicians to receive dosing alerts for medications, including limits for pediatric patients

Lexi-Data is designed for easy implementation. Our intuitive database design will help you seamlessly integrate complex drug databases into your system.

How do you like the Meaningful Use sausage so far?

Saturday, April 30, 2011 by Matt Bennardo

Congress is often compared to a sausage factory, and its laws to sausages. Anyone who sits down to read federal regulations on almost any topic would be sure to agree. Rarely do you come across a regulation that looks like a piece of steak -- simple, unadorned, and exactly what it appears to be at first glance. No, federal regulations are much more like sausages -- a mish-mash of ingredients of unidentifiable origin, all encased in an opaque shell that makes it impossible to tell if their label is accurate until you take a bite.

Now consider the sausage called "Meaningful Use". Clinicians, patients, and EHR vendors are just now getting their first nibbles of that sausage, and ONC and CMS are watching their faces closely to see how they react. In fact, it's public knowledge that the Meaningful Use sausage recipe is subject to change -- that's what Stage 2 and Stage 3 are all about.

It's a safe bet that not everybody is going to like this sausage. And ONC and CMS are going to respond to complaints in one way: by trying to stuff more regulations into the sausage casing in an attempt to make everybody happy.

What will the next Meaningful Use sausage recipe look like?
Nobody knows, of course. But the safe bet is that there will be more of everything. There will be more (and more complex) clinical decision support. Drug-drug and drug-allergy checking may be joined by drug-food, drug-age, drug-disease, or drug-lab checking. Dose range checking can be expected at some point -- and then the logical step there is customized dose range checking for pediatrics and adults and others with special needs.

There are already conversations taking place about delivering patient education materials in common primary languages. According to the Office of Civil Rights, those are languages that are spoken by more than 5% of a population or more than 1000 people in a population, whichever is lower. Does your EHR system have any customers in New York or Los Angeles or Chicago? Imagine how many common primary languages you'll need to support.

How will your data vendor support you when the sausage recipe changes?
It's impossible to say which of these criteria will appear in Stage 2, which in Stage 3, and which in future regulations that aren't even planned yet. (What -- did you think that Stage 3 would be the end of it?) So it's crucial to have a drug information partner with high quality information who is able to support a wide range of clinical decision support needs and who is ahead of the curve in clinical information and patient education. Moreover, you need a partner who gives you superior customer service. It's a tall order and not easy to fill -- but Lexicomp is all of these things.

Looking for easy implementation? We've got you covered.

Friday, April 29, 2011 by Michelle Curren

What is holding you back from easy implementation? Perhaps you have a laundry list of items or perhaps money is constraint. Either way, look to Lexicomp for an intuitive database design that will help you seamlessly integrate complex drug databases into your system.

Other items that Lexicomp can help check off your list:

Allows for specific clinical decision support functions, including drug-drug and drug-allergy interaction checking
Has consumer-facing patient education materials
Is compliant with the RxNorm
Include comprehensive reference information for the US including drug generic name, drug brand name, drug classifications, and eventually clinical dosage guidelines for calculating pediatric and adult doses

So look around the market, investigate, but remember that Lexicomp can serve all your needs!

Catch-21: Helping specialists achieve Meaningful Use

Friday, April 29, 2011 by Matt Bennardo

Let me walk through the Meaningful Use conundrum faced by specialists and the EHR vendors who serve them, and then see if this sounds familiar...

Item #1: In the earliest days of Meaningful Use, many specialists believed that they'd never be able to qualify for pay-outs even if they adopted certified EHR technology, simply because so many of the measures didn't apply to them.

Item #2: Likewise, many specialists prefer to buy EHR systems that are customized specifically for the special needs of their practices. Why would an oncologist want to use the same system as a general practitioner?

Item #3: Eventually, specialists learned that they could qualify for Meaningful Use incentives by opting out of measurements that didn't apply to them. However, the EHR system they used still had to be able to fulfill all the requirements -- even the ones that don't apply to their specialty.

Put these three items together, and you get an interesting conundrum for developers of EHR systems for specialists. How do you build a system that could serve the needs of a general practitioner, while ensuring that it is still customized for the specialist it's intended for? And this conundrum gets even knottier when you start to look at specialties that have limited need for clinical decision support, e-prescribing or related topics. Because there's a cost in providing these things -- to deliver effective clinical decision support, you must partner with a vendor who has the data to back it up. But why would you want to spend money on something your customers are never (or rarely) going to use?

It's almost a catch-22. (That's why I cleverly called it a catch-21 in my headline.) What saves this from being a full-blown catch-22 is the existence of drug information vendors who are willing to work with you in this unique situation. Lexicomp is one such vendor that is willing to partner with EHR vendors developing systems for specialists with unique needs for data that may get minimal use. They understand the issues and will work to find an equitable solution to best serve the clinicians and patients.

The Best Drug Information for EMRs, EHRs and other Patient Record Systems

Thursday, April 28, 2011 by David Wilkof

More and more EMR vendors and hospital EHR/HIS systems are attempting to improve their drug information to further enhance clinical decision support. Below are just a few areas where having the right medicine data can make all the difference in the world.

Drug Interaction Lists
Adverse Drug Event Alerts
Patient Education Pamphlets in 19 Languages
RxNorm Mapping
Pediatric Dosage Calculations
Drug Allergy Interactions
Clinical Guidelines
Drug Interaction Software
Drug - Drug Interactions
Drug - Allergy interactions

Lexicomp is a unique blend of top quality information coupled with the finest internal support anywhere. Your IT guys will love you for going with Lexicomp -- a long-term partner in your road to success.

Choosing the Best Clinical Decision Support Database

Thursday, April 14, 2011 by David White

Lexicomp's transactional drug data and reference information supports various components of Stage 1 meaningful use and certification criteria from ONC's Final Rule, specifically the implementation of electronic clinical decision support rules (drug-to-drug and drug allergy contraindication checking) based on the data elements included in: problem list, medication list, demographics and laboratory test results.

RxNorm Mapping - we promote interoperability through mapping to industry standard RxNorm

Drug Reference Data - integrate drug reference information, such as drug images and black box warnings, into your system

Dose Range Checking - we provide data that enables clinicians to receive dosing alerts for medications, including limits for pediatric patients

Lexi-Data is designed for easy implementation. Our intuitive database design will help you seamlessly integrate complex drug databases into your system.