Allison Beck McCoy

Publications

• 3.97

  Impact points

  Development and evaluation of a crowdsourcing methodology for knowledge base construction: identifying relationships between clinical problems and medications.

  Allison B McCoy, Adam Wright, Archana Laxmisan, Madelene J Ottosen, Jacob A McCoy, David Butten, Dean F Sittig

  Journal of the American Medical Informatics Association : JAMIA. 05/2012;

  ObjectiveWe describe a novel, crowdsourcing method for generating a knowledge base of problem-medication pairs that takes advantage of manually asserted links between medications and problems.MethodsThrough iterative review, we developed metrics to estimate the appropriateness of manually entered pr... [more] ObjectiveWe describe a novel, crowdsourcing method for generating a knowledge base of problem-medication pairs that takes advantage of manually asserted links between medications and problems.MethodsThrough iterative review, we developed metrics to estimate the appropriateness of manually entered problem-medication links for inclusion in a knowledge base that can be used to infer previously unasserted links between problems and medications.ResultsClinicians manually linked 231 223 medications (55.30% of prescribed medications) to problems within the electronic health record, generating 41 203 distinct problem-medication pairs, although not all were accurate. We developed methods to evaluate the accuracy of the pairs, and after limiting the pairs to those meeting an estimated 95% appropriateness threshold, 11 166 pairs remained. The pairs in the knowledge base accounted for 183 127 total links asserted (76.47% of all links). Retrospective application of the knowledge base linked 68 316 medications not previously linked by a clinician to an indicated problem (36.53% of unlinked medications). Expert review of the combined knowledge base, including inferred and manually linked problem-medication pairs, found a sensitivity of 65.8% and a specificity of 97.9%.ConclusionCrowdsourcing is an effective, inexpensive method for generating a knowledge base of problem-medication pairs that is automatically mapped to local terminologies, up-to-date, and reflective of local prescribing practices and trends.

• Clinical Summarization Capabilities of Commercially-available and Internally-developed Electronic Health Records.

  Archana Laxmisan, Allison B McCoy, Adam Wright, Dean F Sittig

  Applied clinical informatics. 02/2012; 3(1):80-93.

  OBJECTIVE: Clinical summarization, the process by which relevant patient information is electronically summarized and presented at the point of care, is of increasing importance given the increasing volume of clinical data in electronic health record systems (EHRs). There is a paucity of research on... [more] OBJECTIVE: Clinical summarization, the process by which relevant patient information is electronically summarized and presented at the point of care, is of increasing importance given the increasing volume of clinical data in electronic health record systems (EHRs). There is a paucity of research on electronic clinical summarization, including the capabilities of currently available EHR systems. METHODS: We compared different aspects of general clinical summary screens used in twelve different EHR systems using a previously described conceptual model: AORTIS (Aggregation, Organization, Reduction, Interpretation and Synthesis). RESULTS: We found a wide variation in the EHRs' summarization capabilities: all systems were capable of simple aggregation and organization of limited clinical content, but only one demonstrated an ability to synthesize information from the data. CONCLUSION: Improvement of the clinical summary screen functionality for currently available EHRs is necessary. Further research should identify strategies and methods for creating easy to use, well-designed clinical summary screens that aggregate, organize and reduce all pertinent patient information as well as provide clinical interpretations and synthesis as required.
• 3.97

  Impact points

  A framework for evaluating the appropriateness of clinical decision support alerts and responses.

  Allison B McCoy, Lemuel R Waitman, Julia B Lewis, Julie A Wright, David P Choma, Randolph A Miller, Josh F Peterson

  Journal of the American Medical Informatics Association : JAMIA. 08/2011;

  Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the nee... [more] Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. Methods Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI). Results Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate. Conclusion The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types.

• Adopting real-time surveillance dashboards as a component of an enterprisewide medication safety strategy.

  Lemuel R Waitman, Ira E Phillips, Allison B McCoy, Ioana Danciu, Robert M Halpenny, Cori L Nelsen, Daniel C Johnson, John M Starmer, Josh F Peterson

  Joint Commission journal on quality and patient safety / Joint Commission Resources. 07/2011; 37(7):326-32.

  High-alert medications are frequently responsible for adverse drug events and present significant hazards to inpatients, despite technical improvements in the way they are ordered, dispensed, and administered. A real-time surveillance application was designed and implemented to enable pharmacy revie... [more] High-alert medications are frequently responsible for adverse drug events and present significant hazards to inpatients, despite technical improvements in the way they are ordered, dispensed, and administered. A real-time surveillance application was designed and implemented to enable pharmacy review of high-alert medication orders to complement existing computerized provider order entry and integrated clinical decision support systems in a tertiary care hospital. The surveillance tool integrated real-time data from multiple clinical systems and applied logical criteria to highlight potentially high-risk scenarios. Use of the surveillance system for adult inpatients was analyzed for warfarin, heparin and enoxaparin, and aminoglycoside antibiotics. Among 28,929 hospitalizations during the study period, patients eligible to appear on a dashboard included 2224 exposed to warfarin, 8383 to heparin or enoxaparin, and 893 to aminoglycosides. Clinical pharmacists reviewed the warfarin and aminoglycoside dashboards during 100% of the days in the study period-and the heparinlenoxaparin dashboard during 71% of the days. Displayed alert conditions ranged from common events, such as 55% of patients receiving aminoglycosides were missing a baseline creatinine, to rare events, such as 0.1% of patients exposed to heparin were given a bolus greater than 10,000 units. On the basis of interpharmacist communication and electronic medical record notes recorded within the dashboards, interventions to prevent further patient harm were frequent. Even in an environment with sophisticated computerized provider order entry and clinical decision support systems, real-time pharmacy surveillance of high-alert medications provides an important platform for intercepting medication errors and optimizing therapy.

• Comparative analysis of the VA/Kaiser and NLM CORE problem subsets: an empirical study based on problem frequency.

  Adam Wright, Joshua Feblowitz, Allison B McCoy, Dean F Sittig

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2011; 2011:1532-40.

  The problem list is a critical component of the electronic medical record, with implications for clinical care, provider communication, clinical decision support, quality measurement and research. However, many of its benefits depend on the use of coded terminologies. Two standard terminologies (ICD... [more] The problem list is a critical component of the electronic medical record, with implications for clinical care, provider communication, clinical decision support, quality measurement and research. However, many of its benefits depend on the use of coded terminologies. Two standard terminologies (ICD-9 and SNOMED-CT) are available for problem documentation, and two SNOMED-CT subsets (VA/KP and CORE) are available for SNOMED-CT users. We set out to examine these subsets, characterize their overlap and measure their coverage. We applied the subsets to a random sample of 100,000 records from Brigham and Women's Hospital to determine the proportion of problems covered. Though CORE is smaller (5,814 terms vs. 17,761 terms for VA/KP), 94.8% of coded problem entries from BWH were in the CORE subset, while only 84.0% of entries had matches in VA/KP (p<0.001). Though both subsets had reasonable coverage, CORE was superior in our sample, and had fewer clinically significant gaps.

• A prototype knowledge base and SMART app to facilitate organization of patient medications by clinical problems.

  Allison B McCoy, Adam Wright, Archana Laxmisan, Hardeep Singh, Dean F Sittig

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 01/2011; 2011:888-94.

  Increasing use of electronic health records requires comprehensive patient-centered views of clinical data. We describe a prototype knowledge base and SMART app that facilitates organization of patient medications by clinical problems, comprising a preliminary step in building such patient-centered ... [more] Increasing use of electronic health records requires comprehensive patient-centered views of clinical data. We describe a prototype knowledge base and SMART app that facilitates organization of patient medications by clinical problems, comprising a preliminary step in building such patient-centered views. The knowledge base includes 7,164,444 distinct problem-medication links, generated from RxNorm, SNOMED CT, and NDF-RT within the UMLS Metathesaurus. In an evaluation of the knowledge base applied to 5000 de-identified patient records, 22.4% of medications linked to an entry in the patient's active problem list, compared to 32.6% of medications manually linked by providers; 46.5% of total links were unique to the knowledge base, not added by providers. Expert review of a random patient subset estimated a sensitivity of 37.1% and specificity of 98.9%. The SMART API successfully utilized the knowledge base to generate problem-medication links for test patients. Future work is necessary to improve knowledge base sensitivity and efficiency.
• 1.33

  Impact points

  Teaching evidence-based medicine: Impact on students' literature use and inpatient clinical documentation.

  Elizabeth Ann Sastre, Joshua C Denny, Jacob A McCoy, Allison B McCoy, Anderson Spickard

  Medical teacher. 01/2011; 33(6):e306-12.

  Effective teaching of evidence-based medicine (EBM) to medical students is important for lifelong self-directed learning. We implemented a brief workshop designed to teach literature searching skills to third-year medical students. We assessed its impact on students' utilization of EBM resources... [more] Effective teaching of evidence-based medicine (EBM) to medical students is important for lifelong self-directed learning. We implemented a brief workshop designed to teach literature searching skills to third-year medical students. We assessed its impact on students' utilization of EBM resources during their clinical rotation and the quality of EBM integration in inpatient notes. We developed a physician-led, hands-on workshop to introduce EBM resources to all internal medicine clerks. Pre- and post-workshop measures included student's attitudes to EBM, citations of EBM resources in their clinical notes, and quality of the EBM component of the discussion in the note. Computer log analysis recorded students' online search attempts. After the workshop, students reported improved comfort using EBM and increased utilization of EBM resources. EBM integration into the discussion component of the notes also showed significant improvement. Computer log analysis of students' searches demonstrated increased utilization of EBM resources following the workshop. We describe the successful implementation of a workshop designed to teach third-year medical students how to perform an efficient EBM literature search. We demonstrated improvements in students' confidence regarding EBM, increased utilization of EBM resources, and improved integration of EBM into inpatient notes.
• 5.15

  Impact points

  A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report.

  Allison B McCoy, Lemuel R Waitman, Cynthia S Gadd, Ioana Danciu, James P Smith, Julia B Lewis, Jonathan S Schildcrout, Josh F Peterson

  American journal of kidney diseases : the official journal of the National Kidney Foundation. 11/2010; 56(5):832-41.

  Frequently, prescribers fail to account for changing kidney function when prescribing medications. We evaluated the use of a computerized provider order entry intervention to improve medication management during acute kidney injury. Quality improvement report with time series analyses. 1,598 adult i... [more] Frequently, prescribers fail to account for changing kidney function when prescribing medications. We evaluated the use of a computerized provider order entry intervention to improve medication management during acute kidney injury. Quality improvement report with time series analyses. 1,598 adult inpatients with a minimum 0.5-mg/dL increase in serum creatinine level over 48 hours after an order for at least one of 122 nephrotoxic or renally cleared medications. Passive noninteractive warnings about increasing serum creatinine level appeared within the computerized provider order entry interface and on printed rounding reports. For contraindicated or high-toxicity medications that should be avoided or adjusted, an interruptive alert within the system asked providers to modify or discontinue the targeted orders, mark the current dosing as correct and to remain unchanged, or defer the alert to reappear in the next session. Intervention effect on drug modification or discontinuation, time to modification or discontinuation, and provider interactions with alerts. The modification or discontinuation rate per 100 events for medications included in the interruptive alert within 24 hours of increasing creatinine level improved from 35.2 preintervention to 52.6 postintervention (P < 0.001); orders were modified or discontinued more quickly (P < 0.001). During the postintervention period, providers initially deferred 78.1% of interruptive alerts, although 54% of these eventually were modified or discontinued before patient death, discharge, or transfer. The response to passive alerts about medications requiring review did not significantly change compared with baseline. Single tertiary-care academic medical center; provider actions were not independently adjudicated for appropriateness. A computerized provider order entry-based alerting system to support medication management after acute kidney injury significantly increased the rate and timeliness of modification or discontinuation of targeted medications.

• A system to improve medication safety in the setting of acute kidney injury: initial provider response.

  Allison Beck McCoy, Josh Peterson, Cindy Gadd, Ioana Danciu, Lemuel Waitman

  AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium. 02/2008;

  Clinical decision support systems can decrease common errors related to inappropriate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a comprehensive medication safety intervention with varying levels of workflow intrusiveness within computerized provider order entry to co... [more] Clinical decision support systems can decrease common errors related to inappropriate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a comprehensive medication safety intervention with varying levels of workflow intrusiveness within computerized provider order entry to continuously monitor for and alert providers about early-onset acute kidney injury. Initial provider response to the interventions shows potential success in improving medication safety and suggests future enhancements to increase effectiveness.