Medication Databases

As EMRs and EHRs incorporate more and more functions, they are going to be giving more advice and warnings to their users. A very real concern among many developers of health informatics systems is "alert fatigue" -- the idea that too many irrelevant alerts will annoy users. And worse, that a flood of useless alerts will cause users to ignore all alerts and warnings, rendering the system's automated checks pointless.

The only way to limit alert fatigue is to be more intelligent about when alerts are shown, and to whom. The key problem is not "too many alerts" -- it's "too many irrelevant alerts". There are two strategies that can help with this.

1. Allow users to customize their own alerts

Each user of your system likely has their own login which is theirs alone. This means that savvy EHR vendors can make it possible for clinicians to customize their own alerts. When an alert is shown, they can select whether they want to see the alert again -- in effect, controlling the information they see by telling the system not to show them alerts they consider irrelevant.

2. Intelligently manage alerts by types of users and circumstances

Another strategy is for the system to do some of this work ahead of time. If an alert applies only to administration, the system would know to show the alert to the prescribing doctor or the compounding pharmacist -- but instead only to the administering nurse. Likewise, if an alert applies only to pregnant women, the system would know not to show it if the patient in question is a man. This strategy relies on knowing things about your users (e.g., what kind of cilnician they are) and the circumstances of the encounter to anticipate which alerts may be irrelevant.

The most successful EMRs will likely use a combination of both approaches. But the second strategy can help alleviate alert fatigue immediately -- your users don't have to manage their own preferences to see the benefits. However, it also relies on detailed drug interaction databases able to finely slice alerts for you. Lexicomp is one medication information vendor that is innovating in this arena, and creating complex filters for many of its alerts and warnings.

Lexicomp's drug interaction database has grown by leaps and bounds over the past few years. Now used by hundreds of EMR, EHR, HIS and other healthcare vendors, it is the information behind medication reference and clinical decision support for tens of thousands of physicians.

What makes Lexicomp the preferred choice?

• Easier implementation when compared to other data sources
• Superior customer service for all customers, regardless of size
• Full support of Meaningful Use Stage 1 clinical decision support requirements
• New innovative features like patient education in multiple languages
• Flexible delivery, including robust APIs and web services

More and more healthcare information vendors are discovering that Lexicomp can save them development time, making the road to certification and market faster and smoother. Find out today if Lexicomp can do the same for you!

 
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!
 

Medication errors and adverse drug events are serious issues in healthcare.  Apprx 770,000 injuries or deaths related occur each year.  For this reason and to comply with the certification and meaningful use requirements, every EMR should look at partnering with and providing their customers top rated drug interaction, duplicate therapy, allergy and dose range checking information integrated into their EMR.  Lexicomp and Lexi-Data can offer this solution. 

This information and its quality, customizability, and delivery format can really set your EMR apart from the competition.  In 2010 the EMR market grew by almost 13.5% while competition in this area is also growing at a higher than predicted rate.  More and more physicians are now starting to look at implementation of an EMR although the rate of adoption has been slowed by the complicated maze of meaningful use.  None the less, it is critical that EMRs differentiate and help physicians understand how to navigate through this maze.   Drug Data Vendors that are able to offer what others may not can help these EMR companies win more deals.  Drug interactions that are cusomizable, dose range checking for specific populations (adult, pediatric, geriatric) duplicate therapy checking and an overall solid patient education offering are areas that can be easily implemeted from Lexi-Data.  Lexicomp's expertise and customer service can also help get you up and running fast.  The database is easy to work with, available in mutliple formats and even has a web-service set can help start up and established EMRs build the structure needed to help physicians.

For more information visit www.lexi.com/businesses/ehr-vendors/
 

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.

Since ONC and CMS permitted specialists to file for exemptions from Meaningful Use guidelines, the challenge has been providing them with cost effective EHR and EMR solutions that meet their needs but are also government certified.

EHR vendors who build systems for specialists may not previously have thought about such functionality as ePrescribing, drug-drug interaction checking, drug-allergy interaction checking, and the ability to print patient education materials. But all these things are required in certified EHR systems -- even if specialists have exemptions from reporting on them.

Lexicomp is one drug information vendor that can help EHR vendors get their products certified for Meaningful Use more quickly, especially now that they have an extensive set of web services calls that provide the most important functionality without the need for on-site database integration. EHRs for specialists like chiropractors, dentists, oncologists, dermatologists, and more now have a new way to provide more value to their users.

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.

Now that ONC and CMS allow specialists and dentists to file exceptions from Meaningful Use requirements, many classes of clinicians find themselves able to qualify for incentive money. But even though they may not use much of a certified EHR's functionality, they're still required to implement a fully functional package to qualify.

This is something of a dilemma for vendors of EHR systems for specialists and dentists. How can they provide lightweight versions of functionality that may never be used, while still giving robust coverage of important features like e-prescribing? It's a development puzzle with seemingly no easy solution.

Are web services the answer?
Not every EHR or EMR can be successful relying on web services to fulfill Meaningful Use criteria, but specialists and dentists may be able to reap the benefits. Web services are inexpensive and quick to implement, and don't require you to maintain and update a complicated database of medications and other clinical concepts. Simply request the information you need via the web service when you need it, and it can be delivered to your application.

Lexicomp is one vendor that supplies robust web services to their own database of drug and clinical information. They provide enough functionality to fulfill every Stage 1 Meaningful Use requirement related to drug screening and interaction checking. They also have web services for the delivery of patient education materials.

If you think web services may be beneficial to your development, contact Lexicomp today to learn more.

When developing an EHR system, when is the right time to evaluate a drug interaction database? Because there are only a handful of vendors in the market, it makes sense to evaluate their respective offerings several times. Certainly, before you make the final decision to go with any particular vendor, you should talk once more to the other data providers to ensure nothing has changed.

A lot can change in a few months
One vendor that has added a lot of enhancements to their medication and clinical information is Lexicomp. Evaluating their solution today versus a year ago would show many differences in capabilities.

Some of the new enhancements include:

• New web services calls that allow for implementation of Meaningful Use Stage 1 requirements without an installed database
• New Black Box Warnings information that helps alleviate alert fatigue
• Expanded patient education leaflets in multiple languages

In an industry like this where things can change quickly but in which product development can sometimes span years, it's important to check in with possible vendors more than once! If you haven't talked to Lexicomp recently, click the links on this page to set up a conversation with them now.

Consumers are increasingly taking an active role in their own healthcare -- a trend which can only result in better care. A key source of information for these patients are consumer-facing websites that include clinical and medication information. But those sites must of course get their information from somewhere.

Lexicomp is one such provider of information to consumer-facing medical websites. They specialize in best-in-class pharmaceutical information -- including indications, interactions (with other drugs, natural products, and more), possible allergies, dosing for adults and children, precautions and warnings, and more. Lexicomp also offers patient education leaflets in a variety of languages.

What's more, Lexicomp supplies its information in a variety of formats, including access through convenient web services. Web services allows you to pull specific Lexicomp information into your website without the hassle of maintaining an on-site database. This solution requires less development and maintenance, and means that your users always have up-to-date information. It's a perfect solution for consumer-facing websites looking to expand their content offerings. Contact Lexicomp to learn more today.

For over 30 years, Lexicomp has been a trusted provider of drug information.  Lexicomp can provide consumer websites or patient portals with drug reference content specifically designed for the consumer audience. When integrated into your websites or patient portals, our drug information will provide patients the knowledge they need to better understand their medications.

We provide patient education information that allows patients to generate their own handouts for medications (available in 19 languages) and drug images that will enable patients to easily identify their medications based on appearance. We also provide a drug interactions database that enables patients to view information on drug-allergy, drug-drug and drug-food interactions. 

One of the most common comments I hear from users of Electronic Medical Records (EMR) systems is associated with “alert fatigue” from unwelcome drug interaction notifications. Many users tell me that they are flooded with unavoidable but unnecessary alerts that interrupt their workflow, decrease productivity, and make the important alerts harder to see. Clinicians find themselves clicking through the alerts as quickly as possible which defeats the purpose of clinical decision support. 

In today's fast-paced healthcare industry, electronic health record (EHR) and other healthcare information system vendors need smart, current drug data that will enable their systems to drive patient safety and improve healthcare -- without generating a flood of annoying alerts that will only be ignored. Lexicomp has recently included new functionality that can alert users with the appropriate Black Box Warning where appropriate in the current workflow. 

 

In the most simple terms, an FDA Black Box Warning is the strongest warning that the US Food and Drug Administration (FDA) puts on a drug. It means that you should pay close attention to the drug's usage because there are some potentially extremely harmful or dangerous threats to your health that the already FDA approved drugs could pose.

The other side of the coin, however, is that an FDA Black Box Warning means that despite the FDA's knowledge of these harmful, serious and sometimes deadly side effects that they are still leaving the FDA approved drug on the market for you to be able to take and potentially experience these harmful side effects. In theory, these FDA Black Box Warnings are designed for both the doctor who is prescribing the drug to be aware of the problems and for you as the consumer to be more aware.

 

The warning is placed in a prominent 'black box' on the package insert of an FDA approved drug so that people and their doctors can be more aware of it, but few doctors ever see the pill bottles and the vast majority of consumers realistically aren't going to go through the amazingly large amount of technical and medically detailed information on a package insert. This can lead to doctors note being aware of a serious alert which can have serious consequences. With Lexicomp’s inclusions of Black Box Warnings within their medication database, the warnings can be provided to the physician during the prescription process where they are most needed.

What agony when a clinician’s workflow is interrupted because they need to confirm clinical information such as a correct dose, REMS Information (Information about FDA approved Risk Evaluation and Mitigation Strategies is included in Medication Guide, REMS Components and Prescribing and Access Restriction fields),  or to find and print patient education materials. 

• Our Web API solution empowers integration of all Lexicomp content. Consistent API programming calls save time and allow clinicians to launch from their internal applications into our clinical databases, utilizing whatever delivery platform they choose.

• Our Web Services platform is written for compatibility with Microsoft® .NET™ and Java™ programs. XML data can be obtained via standardized calls and is then processed and returned in real-time. Your application will retrieve and parse the content into your display, making complete customization a reality.

XML Datasets

• If live Internet calls are not preferred, XML datasets are available for download from an FTP site and incorporated directly into the database.

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. 

There are many universities and institutions that now require access to an up-to-date standardized drug database which would be used for analytics, claims review / auditing, or research purposes.  Many of these universities and/or institutions now have a Pharmaceutical Outcomes and Policy department or Institute on Aging department that are focused on various aspects of research.  

One solution that has long served the needs of these researchers and univerisities is Multum's Lexicon. Another is Lexi-Data Basic.
 
Lexi-Data Basic provides drug information that includes drug names (brand name, generic name, and common abbreviations), therapeutic categories, drug classifications, indications, and standard coding such as NDC, J-Cods, and ICD-9. Lexi-Data Basic is powered by the widely known and trusted Multum Lexicon which has been utilized by hundreds of universities and institutions in the past.  Multum is a registered trademark of Cerner Corp. 

For more information on Lexi-Data Basic, click the links to fill out the form on this page.

Having a sick child can be a challenging and stressful time for any parent.  A sick child also presents challenges for health care professionals as well as health information systems as it relates to prescribing medications.  For a number of medications, pediatric dosage calculations are based on weight.  Having a weight available in the community pharmacy setting is often challenging, however this is only the first step in being able to validate the correct dosage range.  The second piece necessary to accurately check the validity of a pediatric prescription is having the correct information in your pharmacy system. 

All too often, community pharmacy systems are not equipped with the necessary drug reference database to accurately evaluate a pediatric dose.  For over 15 years, pediatric practitioners have been using Lexicomp's Pediatric Dosage Handbook and more recently, our electronic versions to prescribe and validate pediatric dosing.  Now, this information has been transformed into a data set that can be integrated into pharmacy systems to allow your HIS to help you validate these critical doses.  For more information, visit http://www.lexi.com/businesses/ehr-vendors/. 

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. 

Back in January of this year, I wrote about the steady increase of Electronic Health Records/Electronic Medical Records with the market projected to be at $3.8 billion in 2015.  Now, according to this report, "The U.S. EMR market is expected to grow from $2,177 million in 2009 to $6,054 million in 2015."  This number is almost double!! 
So leave the drug content to us and know you have made the right decision.

With the expected increase in the anesthesia information systems market as noted by Ryan Smith in his meaningful use blog, it seems that many EHR, HIS, or EMR developers might do themsevles a favor by planning ahead and creating these systems now.  With this being a new area for most companies, the question of where to purchase a drug database comes into play...who has the most trusted, reliable, and valuable data?

• anesthesia and critical care concerns, use, dosage, and monitoring parameters
• anesthetic drug interactions

This information comes together to support improved decisions at the point-of-care.

What do all of these have in common?  Well for one thing,  they are being driven in part by the demands of Meaningful Use requirements.  Here is just one example of Meaningful Use effect.  Some of the demands are actually in place, and many others roll out over the next few years.    EPrescribing in Florida looks like it might be taking an interesting turn as free application provided by the State may be going away,  or so I have heard.  This recently posted ePrecribing  blog described it  in greater detail.  And a second blog.

As Meaningful Use requirements have dictated more relevant application of medication and drug data within EMR and EHR systems,   the awareness of the nuances of these databases has also gone up.    Recognition of the following terms is becoming more commonplace:  Drug Reference Database; Dosage Range,  Dosing in Pediatrics, Drug Interaction List,  Pediatric Dosage Calculator,  Medicine Interaction.  Clinical Decision Support Systems,  Drug Content,  and more.