Drug Listing

Electronic prescribing (e-Prescribing) is a key component to improving patient safety and reducing medication errors, because it provides real-time clinical decision support to physicians at the time of order entry.  It is estimated that approximately 7,000 deaths occur each year in the United States from preventable medication errors. That is why physician adoption of e-Prescribing has been incentivized by the federal government. However, one of the biggest challenges surrounding physician’s adoption of e-Prescribing is the ability for them to electronically transmit prescriptions for controlled substances. 

Prior to June 2010, all controlled substance prescriptions were required to be on paper, so instead of maintaining one process for paper-based controlled substances and another that is electronically based for noncontrolled substances; physicians were choosing to stick with a paper-based prescription process.  In an effort to remove this headache and extra work that was required by physcians there was a new ruling made by the US Drug Enforcement Administration (DEA) to encourage physicians adoption. In June 2010, the DEA revised the Code of Federal Regulations to allow the electronic transmission of schedule II-V controlled substances to pharmacies.  Now physicians can migrate to an electronic system and not worry about maintaining a separate paper-based system. 

Lexi-Data is the foundation of Lexicomp's comprehensive clinical decision support database and it contains federal CSA codes as well as a list of state level overrides that e-Prescribing systems need to make this happen. 

Lexicomp will be exhibiting at HIMSS 2012 in Las Vegas from February 20 - 24. Stop by for a visit at Booth #5134 and learn more about the preferred choice of drug information databases!

 
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!
 

For years, Multum Lexicon was the source for researchers to get drug reference and drug interaction data. But where can researchers now get medication lists, pharmaceutical monographs, drug-drug interactions, drug-allery interactions, and more?

Today, there is an enhanced and updated solution built on the foundation of Multum Lexicon. It's Lexicomp's Lexi-Data transactional database. Lexi-Data provides drug names (brand name, generic name, and common abbreviations), therapeutic categories, drug classifications, indications, and standard coding such as NDC, J-Codes, and ICD-9.  The data in Lexi-Data has been utilized by many universities and research institutions, including research on pharmaceutical policy and outcomes, aging, and more.

Multum is a registered trademark of Cerner Corp.

Patients are becoming more involved in their own healthcare, and are increasingly making use of patient portals and consumer-facing websites to do research, follow their progress, and even answer questions they might have previously posed to their physician. At the very least, they are using these sites to be more informed during visits to their care providers so they can get more value from those encounters.

All of this creates an opportunity for innovative developers to provide accurate, reliable, easy-to-understand information to patients via the web. One source for medication and clinical information that can be easily integrated into such sites is Lexicomp.

Lexicomp is a leading provider of drug reference, clinical reference, and patient education leaflets and materials to clinicians. Over a thousand hospitals use Lexicomp's information every day during patient encounters. The information available includes medication lists, drug monographs, drug interaction information (including interactions with common food and natural products), drug allergy information, patient education documents, dose adminstration, warnings, and more.

And Lexicomp's information can be easily integrated into your site in a variety of ways. You can choose to have an installed local database, or to use web services to pull information from Lexicomp's servers as needed. Contact Lexicomp today to find out how to populate your patient portal or consumer website with the information your users are looking for.

• 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.

•   Drug - allergy checking
•   Drug - drug interaction
•   Duplicate therapy checking
•   Drug lists

What do these words have in common?  "Pediatric dosing information; Medicine lists; Medicine brand names;  Drug-drug interaction;  Drug-allergy interactions; Drug interaction database; ePrescribing;  Patient education."  

There are many EMR products under development, many targeting smaller hospitals and ambulatory facilities.  There are also a number of other EMR and Practice Management products that are going through major product re-design.  Many of these development groups need to confront the decision about what drug information supplier to use.  As the title of this posting says "EMR developers are now searching for drug and disease information providers that are easy to work with" (Note: most are not).   This might not sound like a tall order, but as it turns out, it is much more difficult than they think.   It's about the data as much as it about the quality of the relationship as well as the flexibility and helpfulness of the vendor. 

How much will they help in setting up the API's?  Do they have specific pediatric dose range checking?  Do they have patient education leaflets? Are they available in foreign languages? 

                         One drug data provider stands out above else....Lexicomp.  If your serious, check them out.

Don't get discourgaged when looking for a drug data partner. Whether you have a laundry list of items or a small budget, Lexicomp has an intuitive database design that will help you seamlessly integrate complex drug reference databases into your system, allowing for easy implementation.

Other items that Lexicomp can help check off your list:

• Consumer-facing patient education materials in 19 languages
• Compliance with the RxNorm 
• Dosage range checking, for both adult and pediatric

And many more!  

As it is part of Meaningful Use Stage 1, drug interaction checking is a critical piece.  Not only is it required for reimbursement, but it is also important for improving patient safety.  The difference between content and the quality and depth of the interaction information that you choose to integrate is important to understand.  Many common drug references have an interaction checker where you can manually enter the medications a patient is taking and check for the significance of any interactions.  For clinicians and patient safety this is important; however, when it resides outside of the workflow it can become time consuming.  

A drug interaction list within your system can increase the likelihood that interactions will be checked as it puts these alerts directly into the workflow.  Some of the most important aspects are not the common drug interactions, but the uncommon interactions that are not widely known. Keep in mind that users of your system will most likely want to customize or localize alerts to cut down on the number of insignificant alerts to reduce alert fatigue.  Lexi-Data can help with this as the database is structured to allow for customization, turning off of certain alerts, and is an overall robust interaction checker covering common and less common drug interactions. Lexi-data also allows for drug interaction checking via a web service so there is less IT development time and maintenance.  Contact Lexicomp to request more information on drug interaction lists. 

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.