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.
The final rules for Meaningful Use of Electronic Medical Records were published a few weeks ago. EMR vendors are scrambling to understand if their products will meet these specifications and pass the associated certification requirements of testing bodies. But what does this mean for a drug content vendor? While those companies are not under any direct ruling regarding meaningful use, their products are tightly integrated with the EMRs. Content vendors provide the drug database to support the meaningful use specified functionality of drug interaction checking and drug allergy checking. Additionally, drug database vendors provide the basic medication lists that support a number of EMR functions, including medication selection for provider order entry, medication lists that drive patient education materials and medication lists that support e-prescribing activities. It is important to understand the key role that a drug database can have in successfully meeting the meaningful use criteria.
Pediatric dosing is a complicated affair. With the increasing trend of childhood obesity in the United States, the risks of ordering and administering improper doses also increases. Additionally there are the complicating factors of physiological development - pediatric patients cannot be dosed as "little adults." There are a number of well regarded pediatric drug reference books available, however when choosing one of these resources it is important to understand the publisher's editorial model. Do they have pediatric specialists as authors and editors? How frequently is the information reviewed and updated? Does it contain easy to read pediatric dosing charts that can be highly useful in reviewing medications across a drug class?
Additionally, there is an emerging approach to pediatric dosing through the use of drug content, both referential and transactional data. Pediatric dose range checking functionality can be associated with content used to support electronic medical records. The advantage to this publishing model is the frequency with which updates can be made - rather than waiting for the next edition of a reference to be printed, the on-line products can be updated at any time. However the same questions should be considered with an electronic format of information: who are the authors and how frequently is the body of content reviewed? Special care should be taken when choosing any source of information for pediatric dosing.
Meaningful use is a criteria set defining the software capabilities necessary to be implemented in the clinical work flow by electronic medical record users. Meaningful use must be demonstrated by the end user of an EMR application to meet these specific requirements in order to receive reimbursements from Medicare and Medicaid that the government has identified. There has been approximately 17 billion dollars set aside for this in the American Recovery and Reimbursement Act specific to the use of EMRs.
Lexi-Data, when integrated into an EMR, will provide the end user the data necessary to demonstrate meaningful use through clinical decision support (CDS). This data supports allergy checking, interaction checking, and dose range checking. Localization functionality within this database can help make the clinical decision support more meaningful to users and create a more rewarding experience of delivering care.
Learn more about Lexi-Comp Integrated Data Solutions and how they can make your clinical decision support valuable to your clinicians.
Clinical decision support (CDS) is a broad term that can encompass a wide variety of tools or systems whose primary purpose to provide clinical guidance to health care professionals responsible for order entry and documentation in an electronic medical record (EMR).
Typically one thinks of the pop-up alerts within an EMR during order entry or documentation activities. Before CDS, clinicians performed the task of reviewing patient drug profiles in a "manual" method. For example a clinician completing an allergy review had to compare each drug record against each allergy noted. The clinician's personal knowledge of drugs and allergies were the tools of clinical decision support.
In today's world the EMR uses coded vocabularies to automate that clinical checking process. This automation improves the reliability and accuracy of the patient profile review; however, it also brings it's own "baggage" of potentially overwhelming the clinician with trivial information. Thoughtful implementation of the EMR settings, as well as the drug content data sets, can avoid provider dissatisfaction before it starts. Some drug content sets, such as Lexi-Data from Lexi-Comp, allow for some customization of data to help reduce the noise factor and make the CDS alerts more meaningful.
Learn more about Lexi-Comp Integrated Data Solutions and how they can make your clinical decision support valuable to your clinicians.
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