Clinical Information Systems

• 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

 
Alert fatigue is related to the barrage of messages provided clinical decision support systems which can overwhelm a provider and cause them to ignore messages. The alerts, while found to be helpful in some cases, can result in a type of "fatigue" whereby the provider, after receiving too many alerts, begins to ignore and/or override the alerts. Receiving too many alerts can result in slowing the provider down rendering the alert useless.

One of the key reasons that clinicians are frustrated with decision support related to drug interaction software is the potential for this alert fatigue. Clinicans do not want to be messaged regarding dosage precautions related to an interaction which has already been recognized and addressed. It is particularly important in the era of electronic prescribing to engineer systems which can present the appropriate information to the appropriate person. Systems need to recognize whether an individual has previously addressed the issue, rather than simply blindly alerting to the presence of two medications within the medicine list. A collaborative effort between drug database providers and application vendors is needed, and discussions to improve the quality of alerts, while decreasing the quantity, are moving forward. These will greatly improve satisfaction with these tools. 

Not all clinical information is structured the same!
The more detail that your medication and clinical information vendor provides about crucial alerts, the easier it is for you to implement customization for your users. If every alert looks the same (which is true of what many vendors provide!), then that means that your users will have to go through them all one by one, setting their preferences on warnings and dosage precautions by hand. Then they have to keep their settings up to date as new alerts are added. That's not user friendly design!

By contrast, Lexicomp's implementation of Black Box Warnings (also called Black Boxed Warnings) gives a great deal of flexibility to developers to allow for multi-dimensional customization. Each warning contains information about which clinician the alert is intended for, how severe the alert is, and whether the alert applies only to patients with specific conditions (e.g., pregnancy).

Win customer loyalty by automating alert customization! 
This way, you can automate much of the customization without having to ask for input from every individual user. You can simply have the system hide alerts intended for nurses from pharmacists, and vice-versa. Likewise, you can make your system intelligent enough to hide alerts related to pregnancy from male patients. This is the kind of smart implementation that users are looking for to help them aviod alert fatigue and become more efficient and effective clinicians. Talk to Lexicomp today to learn more!
 

Among the Eligible Professionals who are going for federal incentive payments for Meaningful Use, podiatrists rank high among early adopters. iWatch news recently published an article (http://www.iwatchnews.org/2011/10/12/6941/podiatrists-have-their-foot-door), describing this observation.

Does your EHR meet the certification requirements established by ONC? Lexicomp can help by providing your system key clinical decision support data required for certification.  As an integrated component of your EHR, our transactional drug data and reference information support the following Stage 1 meaningful use and certification criteria from ONC's Final Rule.

Lexi-Data is the foundation of Lexicomp's clinical decision support architecture. This solution provides clinical decision 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, Drug Classifications, dose range checking (adult and pediatric) and more.

When developing an EHR system, when is the right time to evaluate a drug interaction database? Because there are only a handful of vendors in the market, it makes sense to evaluate their respective offerings several times. Certainly, before you make the final decision to go with any particular vendor, you should talk once more to the other data providers to ensure nothing has changed.

A lot can change in a few months
One vendor that has added a lot of enhancements to their medication and clinical information is Lexicomp. Evaluating their solution today versus a year ago would show many differences in capabilities.

Some of the new enhancements include:

• New web services calls that allow for implementation of Meaningful Use Stage 1 requirements without an installed database
• New Black Box Warnings information that helps alleviate alert fatigue
• Expanded patient education leaflets in multiple languages

In an industry like this where things can change quickly but in which product development can sometimes span years, it's important to check in with possible vendors more than once! If you haven't talked to Lexicomp recently, click the links on this page to set up a conversation with them now.

With all the focus on improving patient care with electronic medical records, it's strange that most medication and clinical data vendors don't allow developers to meaningfully use Black Box Warnings. But one vendor, Lexicomp, is leading the way with detailed, customizable warnings that add value across the continuum of care.

What are Black Box Warnings and how do they help?
Black Box Warnings (also called Black Boxed Warnings) are the FDA's highest class of medication warning -- it indicates a precaution of the highest concern to patients or clinicians. They get their name from the distinctive black box that surrounds the warning on the packaged information that comes with drugs.

Not all Black Box Warnings are alike. Some are relevant at the time a drug is prescribed, others at the time the prescription is filled, and others when the drug is administered or stored. For this reason, different warnings are most likely to apply to different clinicians (or even the patient) along the continuum of care. Similarly, some warnings are only applicable to patients with special conditions (e.g., pregnancy), and some are considered by clinicians to be "obvious" warnings (e.g., only oncologists may prescribe cancer treatment regimens).

Yet, the information included in these warnings is very important -- so long as they are delivered at the right time to the right people. They can help save lives, reduce liability, and reduce the cost of care.

How do you get Black Box Warnings into your EMR system?
Until recently, there was no good way to get this information in an EMR, EHR, or HIS system. Some drug information vendors offer an indicator on their drug monographs that simply states "YES" or "NO" whether the drug has an associated Black Box Warning. It's still up to every clinician in the continuum of care -- the prescribing doctor, the fulfilling pharmacist, the administering nurse -- to look up those warnings in the drug's packaged inserts to see if they apply to them. This is an unnecessary extra step that could potentially lead to crucial missed information!

Lexicomp offers a better way. With Lexicomp, detailed information is provided about each Black Box Warning. In addition to the full text of the warning and additional context written by Lexicomp's staff of in-house experts, the warnings are all classified to make it easy to customize which ones appear for which clinicians. You can reduce alert fatigue by ensuring that only relevant warnings appear for particular clinicians or patients. Not only will your EMR be improving patient safety, but it will be making life easier for all of your users as well!

Alert fatigue has been the big bogeyman of EMR implementation for many users, developers, and vendors. Although clinicians agree that it's important to see alerts, they disagree on how many and even which ones. Many vendors have found that a crucial step in alleviating alert fatigue is to allow clinicians to customize their own alerts to some extent. But can your drug information vendor even support that?

Not all clinical information is structured the same!
The more detail that your medication and clinical information vendor provides about crucial alerts, the easier it is for you to implement customization for your users. If every alert looks the same (which is true of what many vendors provide!), then that means that your users will have to go through them all one by one, setting their preferences on warnings and dosage precautions by hand. Then they have to keep their settings up to date as new alerts are added. That's not user friendly design!

By contrast, Lexicomp's implementation of Black Box Warnings (also called Black Boxed Warnings) gives a great deal of flexibility to developers to allow for multi-dimensional customization. Each warning contains information about which clinician the alert is intended for, how severe the alert is, and whether the alert applies only to patients with specific conditions (e.g., pregnancy).

Win customer loyalty by automating alert customization! 
This way, you can automate much of the customization without having to ask for input from every individual user. You can simply have the system hide alerts intended for nurses from pharmacists, and vice-versa. Likewise, you can make your system intelligent enough to hide alerts related to pregnancy from male patients. This is the kind of smart implementation that users are looking for to help them aviod alert fatigue and become more efficient and effective clinicians. Talk to Lexicomp today to learn more!

• Implementing dose range checking: From a clinical point of view, this is one of the big gaps in what we've seen so far in the first two stages of Meaningful Use. Many of the news stories we read about adverse drug events aren't about interactions or allergies at all -- they're about mistakes in dosing. This is especially true with pediatric dosing, which can be extremely complicated. If dosage precautions were more widely implemented, patient safety would be positively affected.
• Addressing alert fatigue: Many EMR systems are likely to live or die based on this issue alone. Whoever can figure it out will have an undeniable benefit over the competition. As with many Meaningful Use issues, it starts with drug information vendors -- does yours provide the detail needed to make alerts intelligent?
• Improving patient education: The new recommendations for Stage 2 Meaningful Use are all about provider-patient communication. And transcripts of workgroups show that CMS and ONC are very interested in improving not just the method of communication, but the quality of information that flows through it. It seems likely that this will eventually include things like specific patient education materials for pediatric and adult patients, delivered in the language they primarily speak.

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.

• Our Web API solution empowers integration of all Lexicomp content. Consistent API programming calls save time and allow clinicians to launch from their internal applications into our clinical databases, utilizing whatever delivery platform they choose.

• Our Web Services platform is written for compatibility with Microsoft® .NET™ and Java™ programs. XML data can be obtained via standardized calls and is then processed and returned in real-time. Your application will retrieve and parse the content into your display, making complete customization a reality.

• If live Internet calls are not preferred, XML datasets are available for download from an FTP site and incorporated directly into the database.

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