Dose Administration

EHRs can alleviate alert fatigue with new filtering options

Tuesday, October 11, 2011 by Matt Bennardo

As EHRs and EMRs become more widespread and more integrated into the daily activities of clinicians, concern over alert fatigue gows. This is one of the biggest issue facing developers today. The ideal EHR or EMR will provide the right alerts for the right clinicians, but won't overwhelm them.

Lexicomp is one drug data provider that is taking steps to address this issue. They have added multi-dimensional filtering to a set of Black Box Warning alerts. These filters allow EHR vendors to filter alerts by intended clinician, severity of the warning, and special conditions related to the alert.

For instance, an alert that applies only to pregnant women at the time of medication dose administration wouldn't display for pharmacists preparing the prescription or for male patients receiving the drug. When only relevant alerts are shown to clinicians, they come to value them more. The detail that Lexicomp includes in the alerts allows for smarter targeting. EHRs and EMRs can finally set themselves apart from the competition by helping clinicians solve a problem that is extremely important to them.

Clinicians look for pediatric dosing guidance from EMRs

Monday, September 19, 2011 by Matt Bennardo

Dosing in Pediatrics 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.

Is your Pharmaceutical Outcomes and Policy’ department looking for a drug database?

Tuesday, June 28, 2011 by David Wilkof

Many universities and institutions are now expressing an interest in a standardized drug database. They are in search of a high quality, dependable database that helps their academic department build a reliable model to determine pharmaceutical outcomes. Lexicomp is often the preferred choice.

Whether the researcher is in need of a drug reference database for clinical decision support, for dosage administration, patient education material, drug classifications (brand or generic), adverse drug events, drug-drug interaction, drug-allergy interaction, more and more academics are coming to Lexicomp to secure their drug database information. Check out this page for more information.

Patient Education Leaflets, Meaningful Use and translations in multiple languages -- a Reprise

Thursday, May 26, 2011 by David Wilkof

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 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!

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.

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

Patient Education Leaflets, Meaningful Use and translations in multiple languages

Thursday, May 19, 2011 by David Wilkof

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.

APIs can make the difference in EHR readiness

Monday, March 7, 2011 by Matt Bennardo

A recent blog post by an EHR IT specialist outlines 20 different roles that a company developing EHR, EMR or HIS software must fill. The list is a sobering reminder of the vast array of tasks that EHR vendors must address before their product is ready for primetime use among healthcare providers.

Some of the roles on the list are general IT needs, like useability experts and database administrators. But others are unique to healthcare IT, like the ominous reference to "HL7 and healthcare data integration conformance engineers". That's the kind of specialized role that is both crucial to EHR development and subject to the greatest competitive pressures. What are the odds of finding an IT professional who can just glide into that role?

With many IT departments under-manned due to intense competition for talent and with so many "must-have" skill sets jockeying for those limited resources, many EHR vendors are making strategic decisions about where their tech staff should be spending its time. One way to free up resources is to partner with a drug information vendor that offers robust APIs which can speed the development of clinical decision support systems. Lexicomp is one such company that offers thorough API support for functionality like drug-drug interaction checking, drug-allergy interaction checking, duplicate therapy, and a myriad of reference look-ups. It's one quick way to get a jumpstart on much of the functionality required by HITECH "Meaningful Use" regulations.

Likewise, many EHR vendors are also adding on pre-certified ePrescribing or CPOE modules, rather than developing their own right now. These are "stand-alone" modules that already have SureScripts certification, and which can be integrated quickly into any EHR platform. DoseSpot is a good example of a company which can offer this.

Both of these options can ease the IT crunch and get your EHR market-ready sooner. Without these options, many EHR vendors may find themselves at the back of the pack when it comes time to sign up customers or qualify users for incentive dollars.

Consumer groups want healthcare providers to push forward on Meaningful Use

Wednesday, March 2, 2011 by David Wilkof

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.

HIMSS -- Interoperability, Meaningful Use, HL7, Medication Databases and More

Tuesday, February 22, 2011 by David Wilkof

I am in Orlando at HIMSS. It is a huge show with many lectures, many exhibitors and 30,000 people. It takes 8 minutes to walk from one end of the hall to the other. The main special exhibit for the show is centered around interoperability. There is progress being made in this area, but one area that remains difficult, and will prove more difficult and elusive over time, is to provide interoperability regarding drug database information, drug-drug interactions, drug-allergy interactions, dose administration, therapeutic dosages. This will become a major win when it is finally accomplished.

Medication Dosage Precautions

Friday, February 18, 2011 by Bonnie Briggs

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.

Better Choices in Drug Information Databases At HIMSS - A Good Place to Start

Wednesday, February 2, 2011 by David Wilkof

My colleague, Matt Bennardo, recently wrote a blog about discovering alternatives to the traditional providers of drug information data for EMRs and EHRs. He suggested that HIMSS this year will offer some choices to customers who are desperately looking beyond their few limited choices of the past.

Lexicomp showed last year at HIMSS and started getting the attention of many EMR companies. Throughout the course of 2010 this translated into many new customers and strong partnership relationships.

As Matt wrote:

"More EMRs are calling Lexi-Data their “preferred choice” every month
Many of our customers have told us that they’ve made the switch because they found Lexi-Data delivered:

Better quality information with faster updates and fewer mistakes
A more clinically relevant focus that their end users valued
Easier implementation and more powerful functionality
Superior customer service
Unique content not available elsewhere, like Lexicomp’s industry-leading Pediatric Dose Range Checking

Lexicomp will be exhibiting at HIMSS 2011 in Orlando, Florida, from February 21 - 23. Stop by for a visit at Booth #6653 and learn more about the choices you have in drug information databases!"

So if you are looking for dosage administration, drug brand and generic names, therapeutic dosage information, medicine lists,or pediatric dosing information for EMRs, Emergency Room EMRs, EHRs and HIS systems, stop by the booth to learn more.

Dosing Issues in the News

Friday, January 14, 2011 by Mark Bonfiglio

Drug dosing has been the focus of recent news reports related to FDA actions. Manufacturers of acetaminophen containing products have been instructed to limit the amount of acetaminophen in their products. This is evidence that even in the case of drug classifications which are familiar and include over-the-counter products, dosage ranges should be carefully evaluated. When drug exposure includes more than one product, this can be a particularly difficult scenario in pediatric dosage calculations. This recent news demonstrates that regulatory agencies will attempt to address these issues as they relateto product strengths. The full exposure to a drug though all possible sources should be checked prior to dose administration.

EMR company looking to get certification in the near future.

Friday, January 14, 2011 by David Wilkof

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

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

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

Use of Mobile Medical Apps Continues to Rise

Thursday, January 13, 2011 by Matt Snodgrass

"Not only is the medical community using smartphones and their applications for basic tasks, but they report using them to complete some of the work that would have previously been done on a desktop or laptop computer. With one of the main focuses in healthcare today centered on the reduction of costs, any tool that can help medical personnel become more efficient is a boon to the industry." So says Melissa Elder, chief author of a new report from Kalorama Information detailing the state of the current mobile medical app market.

With mobile devices becoming the preferred way for consumers to manage everything from their finances to personal health, it's no surprise that the mobile medical apps market is on the move. And the sky appears to be the limit. According to the study, medical app sales more than doubled from $41 million in 2009 to $84 million in 2010, with over 50% of physicians reportedly using smartphones or PDA devices.

Do you have a mobile component to your EHR?

Are you working vendors that are already established in the mobile arena? Do they have mobile-ready content covering drug interactions, drug-allergy interactions, duplicate therapy, drug identification, dosage range checking, dosage administration, patient education, drug classifications, pediatric drug information?

If not...why?

The technology exists, the infrastructure is being put in place, the users are clamoring to be able to access this information on their devices and their numbers will only continue to increase. Can you afford not to?

4,000 Health Care Provides Register for Incentive Payments. Do you have a piece of that pie?

Monday, January 10, 2011 by Michelle Curren

According to the Government Health IT, as of January 6 there have been 4,000 healthcare providers that have registered for the EHR incentive program. Also, according to the Centers for Medicare and Medicaid Services spokesman, Joseph Kuchler, “We expect that number will continue to increase daily.” With as many as 4,000 already started the registration process and more to follow, there are lots of opportunities to gain business. What will make your EHR stand out from the crowd?

Healthcare providers that need a complete EHR are looking for drug data that will enhance and improve patient safety. What better drug information than from a trusted company that's been developing content for over 30 years? Not only will Lexicomp provide all the basic drug data information such as: drug interactions; drug-allergy interactions, therapeutic dosages, drug classifications, dosage administration, pediatric drug information, and more; but Lexicomp will also provide the service and support to allow you to move quickly in the fast paced environment.

ePrescribing mandates are spreading along with the need to include drug database information

Thursday, January 6, 2011 by David Wilkof

Recently, I posted the blog below and since then, it seems the scramble to gain Meaningful Use dollars through ePrescribing is on. The first reimbursements for this MU compliance occurred this week for medicaid reimbursement. EMR companies that are quickly trying to get certified by early 2011.    ePrescribing and Meaningful Use are the mantras of the day, and one area that should not be overlooked is the inclusion of selecting the right drug data and working with the right drug information supplier.

"Quoting a colleague of mine: 'A recent article by HealthData Management summarizes that, 'The new law mandates use of electronic prescribing by Jan. 1, 2011. Prescribers and dispensers must use either the Health Level Seven messaging standards or the National Council for Prescription Drug Programs’ SCRIPT standard to transmit prescriptions and prescription-related information. The law does not mandate use of electronic health records. But to ensure EHR systems are interoperable, they must be CCHIT-certified. Further, the EHRs must meet the e-prescribing provisions of the law.'

Looks like ePrescribing will become a widespread reality within 2 years. There will likely be some business opportunities for some small companies to fill in the gap between ePrescribing as part of robust EMR systems and those that just need a tool to facilitate ePrescribing, without integration into their system.

As more companies look for opportunity in the business "seams," they will need to work with a drug database company to close the loop.   And if they want to do it quickly and work with a vendor who serves as a partner, and not just a supplier, more and more are turning to Lexicomp.

Not only will Lexicomp provide all the basic drug data information such as: drug interactions; drug-allergy interactions, therapeutic dosages, drug classifications, dosage administration, pediatric drug information, and more; but Lexicomp will also provide the service and support to allow the vendor to move quickly. With this quickly changing marketplace, working with a drug interaction software company to facilitate the product launch is imperative.    If you are looking for a stand alone online ePrescribing application, I would strongly suggest taking a look at DoseSpot. They have a great product."

Building Mobility Into EHR Systems

Wednesday, December 22, 2010 by Matt Snodgrass

The current market opportunity for mobile apps in the healthcare enterprise is $100 million and Chillmark Research predicts that within three years this will increase to over $1.7 billion based the rapid evolution of mobile devices, physician demand, and the healthcare enterprise’s need to improve quality and efficiencies. This leaves little room for debate that the mobile era is officially here and that adoption of mobile apps in healthcare enterprise is only going to continue to proliferate.

Do you have a mobile component to your EHR?

Why not work with a vendor that's already established in the mobile arena? Lexicomp has been providing mobile apps to the healthcare market for over 10 years and has mobile-ready content covering drug interactions, drug-allergy interactions, duplicate therapy, drug identification, dosage range checking, dosage administration, patient education, drug classifications, pediatric drug information, and more.

Partnering with Lexicomp not only ensures that you're using the most well known, trusted content available, but our support staff is on hand at all times to assist you throughout the integration and implementation process. Don't waste another day debating, Lexicomp is ready to help you through the process!

Pediatric hospitals: An untapped opportunity for EHR vendors?

Monday, December 13, 2010 by Matt Bennardo

Recent reports on research from the December 2010 issue of the Archives of Pediatric & Adolescent Medicine (abstract here) have pointed out that less than 3% of pediatric hospitals have what the researchers considered a "comprehensive EHR". Those with "basic EHRs" amounted to just 18% more.

According to the researchers, this means that an overwhelming majority of pediatric hospitals lack standard EHR functionality like ePrescribing. Clinical decision support functions are also not widely available.

Is the reason money... or value?
The survey cites lack of financing as the main reason for the low adoption. But we all know that questions of money are really questions of value -- if pediatric hospitals found EHR systems highly valuable, they would be more likely to find financing for them.

When you think about the data that drives most of the common functions of EHRs (functions like drug interaction checking, duplicate therapy, dosage range checking, dosage administration, and even patient education), it's no wonder that pediatric hospitals aren't seeing the value. Most of that data -- and, by extension, EHR functionality -- is designed for adults!

Lexicomp -- the industry leader in pediatric drug information
At the very least, pediatric hospitals need an EHR that they can customize with their own clinical guidelines on pediatric dosing and interactions. But better than that would be a system that already takes into account their specific needs. Lexicomp has been the undisputed market leader for reference information for pediatric hospitals for decades -- and now Lexicomp is offering transactional data as well.

See how Lexicomp can make your clinical decision support system valuable to pediatric hospitals and pediatric practices all over the country. Sign up to learn more today, and start taking advantage of this under-served market!

As ePrescribing compliance gains momentum, drug data options take on more meaning.

Saturday, December 11, 2010 by David Wilkof

ePrescribing is gaining momentum. Partly this is due to more hospitals, doctors and dentists aiming to be compliant. In several states, this is happening because of state mandates.

There will likely be some business opportunities for some small companies to fill in the gap between ePrescribing as part of robust EMR systems and those that just need a tool to facilitate ePrescribing, without integration into their system.

There is a mad scramble by companies and start-ups to fill this compliant gap as soon as possible. Whether they know it or not, they will need to work with a drug database company to secure compliance. And if they want to do it quickly and work with a vendor who serves as a partner, and not just a supplier, more and more are turning to Lexicomp. Lexicomp is becoming a force in the delivery of drug data for those firms that are now (or will become) involved in the ePrescribing sector.

Not only will Lexicomp provide all the basic drug data information such as: drug interactions; drug-allergy interactions, therapeutic dosages, drug classifications, dosage administration, pediatric drug information, and more; but Lexicomp also takes the time to work with their customers to resolve situations in a timely way.

EMRs should work with a drug interaction software company early in the process to avoid any late surprises in the certification process.

Also, if you are looking for a stand alone online ePrescribing application, I would strongly suggest taking a look at DoseSpot. They have a great product.