Making Clinical Decision Support Valuable

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.