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!
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!
Nothing is final yet, but in all likelihood Meaningful Use Stage 2 won't kick in until 2014. In addition, some of the draft recommendations floating around look a lot like Stage 1 with stricter compliance levels. In other words: much of the work for Stage 2 is going to fall on EPs and hospitals, rather than on EMR vendors. There will likely be some new functionality -- especially around provider-patient communication -- but probably not the crush of requirements we saw in Stage 1.
So what will EMR, EHR, and HIS vendors do with their reprieve? If they're smart, they'll take this opportunity to improve their products in ways that aren't (yet!) required by Meaningful Use but which will give them an advantage in the market. Here's some functionality that EMRs may be using this reprieve to pursue:
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.
EMR vendors that can solve some or all of these issues now will find themselves ahead of the game when the next round of MU guidelines come out. Not only that, but they'll be delivering real value to clinicians that sets them apart from all the other cookie-cutter competitors who are simply "checking boxes" on the Meaningful Use checklist.
But where to start? Lexicomp is a drug and clinical information vendor who can help with all of the items listed above -- and with many more as well. Call or fill out a form today to start learning about how Lexicomp can help you build value for your users, save money and development resources, and meet government requirements for your EMR system.
Pediatric dosing continues to be a major concern among clinicians in almost all practice settings. In fact, those who do not regularly treat children often have the most questions about proper dosing and treatment. One area where EMR, EHR, and HIS systems can meaningfully differentiate themselves is in providing this information.
Physicians, pharmacists and nurses know that children are not simply "little adults". Besides different dosage precautions, children may require different administration or routes -- and for some cases may receive completely different medications. Different patient education leaflets are also needed when treating children.
For these reasons, it's important to partner with a drug information vendor that is well regarded in pediatrics. Lexicomp is the drug reference vendor of choice among U.S. pediatric hospitals, and has specialized in this area for decades. Most clinicians will see children as patients at some point in their work, and they know that this vulnerable population requires special care. Using Lexicomp as a drug vendor can help put their concerns to rest and add value to their EMR, EHR, or HIS system.
EMR vendors are not the only ones rapidly deploying clinical decision support systems to healthcare providers. Dental professionals are demanding that their practice management systems overcome massive development hurdles in order to comply with Meaningful Use standards.
There is a buzz in the dental technology community about Meaningful Use and incorporating more clinical decision support into the practice management system workflow. If you are searching for the best dental specific drug database to integrate into your dental EMR, turn to Lexicomp. There are very few suppliers of drug data within the dental market and even fewer still that are easy to work with. And if you are looking for an easy-to-use, out-of-the-box ePrescribing tool, trust our partner DoseSpot to deliver the solution. What do all of these companies have in common? They are easy to work with and provide you with the ability to get to the market fast!
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 a dental EMR build. But it's not just about the information. It's about who you select as your partner and who has seamless API's which makes your development easier.
You owe it to your product and your customer to make the right choice.
One of the key reasons that clinicians are frustrated with decision support related to drug interaction software is the potential for 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.
Last week I posted an entry that dealt with the reported upcoming changes in Stage II Meaningful Use requirements as it relates to providing the patient drug education leaflets in their native tongues. There has been interest in that posting and its implications, so I am reposting it for those who might have missed it.
My colleague,Matt Bennardo,wrote a wonderful blog posting about the potential upcoming changes in stage two Meaningful Use guidelines as it relates to Patient Education. This could be a very big deal.
Patient education will become more and more important over time, because there is a strong belief that better patient outcomes will result if patients know more about their condition, treatment program, and drug regimen. On the drug side, this could mean dose administration regimen, dosage precautions, drug interactions, drug-allergy interactions, adverse drug events and more.
What EMR vendors (and institutions) need to start thinking about today, are the implications that requirements to supply Patient Education Leaflets, likely will not just mean English.
In his posting, Matt, states: "The workgroups are additionally talking aboutbetter and more relevant patient education. One point of discussion hasbeen providing the materials in "common primary languages" for everymetropolitan statistical area. This would require providers to havepatient education available in any language that is spoken by 5% of thepopulation they serve, or at least 1000 people in the same population --whichever is lower. This is a big deal, and not every informationvendor is in a position to deliver on this!
He goes on to say:
Lexicomp can help bridge the gap Luckily, some vendors are. Lexicomp has long had patient education materials in many languages. At last count, they could provide up to 19 different languages commonly spoken in the United States and Canada. This is just one example of how a forward-thinking drug information vendor was able to anticipate and meet advanced requirements before they were even formulated. So when evaluating vendor partnerships for your EMR or HIS system, it's not enough to find one who can check off boxes. Instead, you need to find a vendor with the same commitment to improving patient care that ONC and CMS are seeking."
Please take note now, early in the integration of your drug module into your EMR system.
My colleague,Matt Bennardo,wrote a wonderful blog posting about the potential upcoming changes in stage two Meaningful Use guidelines as it relates to Patient Education. This could be a very big deal.
Patient education will become more and more important over time, because there is a strong belief that better patient outcomes will result if patients know more about their condition, treatment program, and drug regimen. On the drug side, this could mean dose administration regimen, dosage precautions, drug interactions, drug-allergy interactions, adverse drug events and more.
What EMR vendors (and institutions) need to start thinking about today, are the implications that requirements to supply Patient Education Leaflets, likely will not just mean English.
In his posting, Matt, states: "The workgroups are additionally talking aboutbetter and more relevant patient education. One point of discussion hasbeen providing the materials in "common primary languages" for everymetropolitan statistical area. This would require providers to havepatient education available in any language that is spoken by 5% of thepopulation they serve, or at least 1000 people in the same population --whichever is lower. This is a big deal, and not every informationvendor is in a position to deliver on this!
He goes on to say:
Lexicomp can help bridge the gap Luckily, some vendors are. Lexicomp has long had patient education materials in many languages. At last count, they could provide up to 19 different languages commonly spoken in the United States and Canada. This is just one example of how a forward-thinking drug information vendor was able to anticipate and meet advanced requirements before they were even formulated. So when evaluating vendor partnerships for your EMR or HIS system, it's not enough to find one who can check off boxes. Instead, you need to find a vendor with the same commitment to improving patient care that ONC and CMS are seeking."
Please take note now, early in the integration of your drug module into your EMR system.
Stage 1 of Meaningful Use has been criticized by some as simply encouraging EMR vendors, hospitals, and physicians to "check off boxes" in order to be eligible for government incentives. These critics look at Stage 1 and ask how the hodge-podge of "requirements" (many of which are still very optional) will really lead to better patient outcomes. By all accounts, CMS and ONC intend to use Stage 2 and Stage 3 to correct that perception.
Patient education -- just one small example One simple example of this is in patient education leaflets that are mentioned in Stage 1. These pamphlets are intended to give important information to patients to help them better manage their own health and be more informed when they visit healthcare providers. Some of the most commonly distributed patient education materials are those related to prescription drugs, and they include information on dosage precautions and administration, potential adverse drug events, allergy symptoms and so on.
It's not even required to supply patient education materials to qualify for Stage 1 -- instead, it's an optional item in a menu set. Even if providers do choose the patient education menu option, the bar is very low. Providers need only supply patient-specific materials to 10% of patients. It's easy to see how critics may find fault with this.
But beefed up requirements are on the way! Workgroups have been hashing out details of what will be required in Stage 2, and their proposed requirements are expected later this summer. Patient education is one area they've been discussing. Published minutes and transcripts from the workgroup meetings reveal that patient education will now be required for everybody, and that the percentage of patients who receive it will be drastically increased -- up to 80%. The Stage 1 requirement was clearly just to develop the functionality. Stage 2 is where the rubber meets the road.
But that's not all yet! The workgroups are additionally talking about better and more relevant patient education. One point of discussion has been providing the materials in "common primary languages" for every metropolitan statistical area. This would require providers to have patient education available in any language that is spoken by 5% of the population they serve, or at least 1000 people in the same population -- whichever is lower. This is a big deal, and not every information vendor is in a position to deliver on this!
Lexicomp can help bridge the gap Luckily, some vendors are. Lexicomp has long had patient education materials in many languages. At last count, they could provide up to 19 different languages commonly spoken in the United States and Canada. This is just one example of how a forward-thinking drug information vendor was able to anticipate and meet advanced requirements before they were even formulated. So when evaluating vendor partnerships for your EMR or HIS system, it's not enough to find one who can check off boxes. Instead, you need to find a vendor with the same commitment to improving patient care that ONC and CMS are seeking.
Adverse drug events may be dose-related or idiosyncratic. Dose related events can be avoided by observing dosage precautions such as adjustment for age, organ impairment, or concurrent drug therapy (drug interactions). However, even at a therapeutic dosage, some events may occur which are unpredictable, such as allergic reactions.
In the electronic prescribing era, drug allergy can be the subject of over-alerting, as some records of allergy represent intolerance (such as an upset stomach) as opposed to a true immunologic event. Inaccurate representation of allergy may lead to selection of an alternative (and potentially less efficacious) therapy.
It is important to document the nature of a reaction which has been reported by a patient, and to analyze this information with respect to potential for recurrence and cross-reactivity among agents. Until records are capable of differentiating reactions of concern from those which are less severe the ability to screen for drug allergy will continue to be less than optimal.
Several institutions, as well as drug data vendors, have constructed dose range checking content. In many cases, the institutions have learned that this can be a difficult process to complete and maintain. Reliance on a drug reference book such as the Pediatric Dosage Handbook to create these data technically is outside of the terms of use, and leaves open the issue of maintenance and timely modification as new information appears in the literature.
Without a valid model to identify, acquire, evaluate, and publish. Dosage precautions which are not actively supported by this type of surveillance typically fall out of date rather rapidly. Pediatric dose calculations can be limited, and therapeutic dosages which are supported in the literature may be identified as outside the range. This type of over-alerting is a source of frustration. Lexicomp has worked with its partners to transform the content of the Handbook into a database with associated APIs to execute dose range checking for pediatrics. In addition, these data are actively modified in conjunction with the normal process of maintaining this publication. In this way, the user can integrate dose range checking simply, with the assurance that the data are continuously updated and expanded.
America is a great country. I wouldn't be surprised if there were more EMRs (and related systems) in development in the United States than the rest of the world combined. Cultural and marketplace paroxysms create stress and discomfort, and at the same time result in major breakthroughs and great new products. That is what is going on this country, day by day. The great scramble is on. There is much pressure to do things quickly and get to the market rapidly before the doors begin closing. One thing the developing EMR company should not worry about is their selection for a provider of drug and medicine information.
There are only a few suppliers available. The EMR companies should decide based on which company will be the easiest to work with to facilitate the data integration, with appropriate support, APIs, and quality data. Check into Multum (part of Cerner) and Lexicomp.
These companies are experienced and respected in providing dosage precautions, pediatric dosing information, drug interaction software, clinical guidelines, Meaningful Use information, therapeutic dosages, drug-drug interaction, drug-allergy interaction and more. Make sure you make the right choice. You have other more important things to worry about.
According to iHealthBeat, "a coalition of 25 interested consumer groups said that ONC should resist pressure from health care providers to scale back requirements (Health Data Management, 2/28).
The consumer groups and unions expressed support for several issues, including:
Transitioning all "optional" criteria in Stage 1 to "required" criteria in Stage 2;
Advancing key criteria that have an impact on quality and safety, such as electronic prescribing and medication reconciliation;
Improving collection of advance directives (CMIO, 2/28); and
Providing patients with online access to their health data, as well as secure messaging capabilities."
It is unclear how much will be required if government dollars dry up. But regardless, medical institutions and vendors need to keep pushing forward. It will be too difficult to turn the spigot on and off. This theme kept coming through at HIMSS.
Specifically in the areas of EHRs, EMRs, HIS', ePrescribing and more, they need to keep moving forward in their efforts to include drug-drug interaction, drug-allergy interaction, therapeutic dosages, medicine interactions, dosage administration, dosage precautions, medication brand names and generic names, pediatric dosage calculations, and eprescribing. Regardless of what the specific requirements will look like 12 months from now, there is no doubt that these changes will improve patient outcomes. Whether you go to Lexicomp or to Multum, find a vendor that will be your solution partner to help you through minefields. APIs are rarely just plug and play. Having the right partner will make a big difference.
Haven't heard of Brantley Whittington, CEO of the EHR firm Extormity? Then perhaps you've been living under an HIT rock for the past several months. Not to worry, he's made a big splash at HIMSS11 this year and the legend will only continue to grow.
Early Tuesday, at HIMSS11 Extormity, whose tagline is "Expensive, Exasperating, and Exhausting", announced the launch of their newest solution, Manacle: the Shackled Patient Portal. Said Whittington, "If you like tethered portals, you're going to love being shackled."
According to a press release regarding their data security protocols, "Extormity is now storing patient records in the last place anyone would think to look – old 8-track tapes," Whittington explained. "Every night, we download medical data from our servers onto recycled REO Speedwagon, Styx and Chuck Mangione 8-tracks, and we store them in a rusted Trans-Am with T-tops parked in our back parking lot."
Extormity is obviously a fake entity, but they make light of some of the very real pains felt by providers: prohibitive EMR costs, systems that alter workflow, and general turmoil.
In light of all the pains faced by providers trying to implement an EMR or EHR system, isn't it nice to know that there's a REAL company out there offering a REAL product that performs as designed: smoothly, efficiently, and easily? Lexicomp's content integrates seamlessly into various systems offering medicine lists, dosage precautions, pediatric dosage calculations, drug classifications, drug interaction lists, and more.
Take a few minutes to learn more, we promise it will be worth your while. If not, perhaps Manacle is the tool you're seeking after all.
Drug databases often have application programing interface tools that can alert a user to maximum or minimum dosages on a given medication. What can be even more valuable is the functionality to provide medication dosage precautions at the time of order entry and or the time of medication administration. There is much debate as to whether electronic medical records or drug database APIs should provide dosing ranges or actual expert dosing.
While expert dosing may be a desired tool, one must be cautious in evaluating the system behind such a tool as it will only be as accurate and sophisticated as its logic allows. Criteria that should be considered for either expert dosing or dose range checking includes renal and hepatic functionality of the patient, as well as the typical height, weight, age and sometimes sex.
Alerts that may result from the dose range checking of an order may contain more that the typical therapeutic dosage information, but may also contain some actionable medication dosage precautions. Does the drug require lab testing previous to administration or during it's use? Would the drug be better absorbed if the patient takes it with meals? Planning to include this type of information during the build of the EMR, and subsequently baking it into the maintenance process of adding new drugs, is essential.
A report posted January 21, 2011 by iHealthBeat states, "Nearly 90% of U.S. hospitals will need to install or upgrade their electronic health record systems during the next three years to comply with the federal government's meaningful use requirements." Hospitals have the option to purchase a "ready made" from a vendor or to make their own. No matter what the case, be sure your drug information complies with meaningful use. While you are at, you might as well go above the requirements.
There are several components to look for drug information: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 APIs which makes your drop easier.
Meeting with these vendors in person may help in picking the right partner. The HIMSS 2011 show in Orlando, Florida February 21 - 23 will showcase many of these partners, Lexicomp included!
Last Monday I posted that there was opportunity for a piece of the growing EHR marketplace with 4,000 companies jumping to start the registration process. Another sign of growth has been reported today by HealthData Management. According to a recent posting, "U.S. market for inpatient and outpatient electronic health records software was nearly $1.98 billion in 2009 and will steadily increase to $3.8 billion in 2015" as found in a new report by the research firm IDC Health Insights, Framingham, Mass.
These numbers can be further broken down in Ambulatory and Inpatient EHR electronic records software spending. Ambulatory EHR Spending by all types of providers totaled $633.5 million in 2009, rising in 2015 to $1.41 billion. Inpatient EHR Spending was $1.34 billion in 2009, rising in 2015 to about $2.4 billion.
With all this money being spent and more to come, it's not too late to get your software on the certification track with trusted drug data. Don't wait until 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 APIs which makes your job easier.
You owe it to your product and your customer to make the right choice.
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.
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.
Haven't heard of Brantley Whittington, CEO of the EHR firm Extormity? Then perhaps you've been living under an HIT rock for the past several months. Not to worry, he's made a big splash at HIMSS11 this year and the legend will only continue to grow.
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