Foster R Goss, Li Zhou, Joseph M Plasek, Carol Broverman, George Robinson, Blackford Middleton, Roberto A Rocha[show abstract] [hide abstract]
ABSTRACT: OBJECTIVE: Allergy documentation and exchange are vital to ensuring patient safety. This study aims to analyze and compare various existing standard terminologies for representing allergy information. METHODS: Five terminologies were identified, including the Systemized Nomenclature of Medical Clinical Terms (SNOMED CT), National Drug File-Reference Terminology (NDF-RT), Medication Dictionary for Regulatory Activities (MedDRA), Unique Ingredient Identifier (UNII), and RxNorm. A qualitative analysis was conducted to compare desirable characteristics of each terminology, including content coverage, concept orientation, formal definitions, multiple granularities, vocabulary structure, subset capability, and maintainability. A quantitative analysis was also performed to compare the content coverage of each terminology for (1) common food, drug, and environmental allergens and (2) descriptive concepts for common drug allergies, adverse reactions (AR), and no known allergies. RESULTS: Our qualitative results show that SNOMED CT fulfilled the greatest number of desirable characteristics, followed by NDF-RT, RxNorm, UNII, and MedDRA. Our quantitative results demonstrate that RxNorm had the highest concept coverage for representing drug allergens, followed by UNII, SNOMED CT, NDF-RT, and MedDRA. For food and environmental allergens, UNII demonstrated the highest concept coverage, followed by SNOMED CT. For representing descriptive allergy concepts and adverse reactions, SNOMED CT and NDF-RT showed the highest coverage. Only SNOMED CT was capable of representing unique concepts for encoding no known allergies. CONCLUSIONS: The proper terminology for encoding a patient's allergy is complex, as multiple elements need to be captured to form a fully structured clinical finding. Our results suggest that while gaps still exist, a combination of SNOMED CT and RxNorm can satisfy most criteria for encoding common allergies and provide sufficient content coverage.Journal of the American Medical Informatics Association 02/2013; · 3.61 Impact Factor
Article: Effectiveness of interruptive alerts in increasing application functionality utilization: a controlled trial.Alexander Turchin, Oliver D James, Eric D Godlewski, Maria Shubina, Christopher M Coley, Tejal K Gandhi, Carol Broverman[show abstract] [hide abstract]
ABSTRACT: Medical applications frequently contain a wide range of functionalities. Users are often unaware of all of the functionalities available. More effective ways of delivering information about available functionalities to the users are needed. We conducted a pseudo-randomized controlled trial to determine whether interruptive alerts will increase utilization of several functionalities by the users of the Pre-Admission Medication List (PAML) Builder application at two academic medical centers. In a log-linear model, alerts increased total utilization of the promoted functionalities per PAML built by 70% compared to the controls at the site level (p<0.0001). At the user level, frequency of utilization of the PAML Builder functionalities by individual users increased by 0.03 for every extra alert shown to the user (p<0.0001). Alerts led to a nearly 2-fold increase in utilization of the promoted functionalities. Interruptive alerts are an effective method of delivering information about application functionalities to users.Journal of Biomedical Informatics 06/2011; 44(3):463-8. · 1.79 Impact Factor
Article: Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial.Jeffrey L Schnipper, Claus Hamann, Chima D Ndumele, Catherine L Liang, Marcy G Carty, Andrew S Karson, Ishir Bhan, Christopher M Coley, Eric Poon, Alexander Turchin, Stephanie A Labonville, Ellen K Diedrichsen, Stuart Lipsitz, Carol A Broverman, Patricia McCarthy, Tejal K Gandhi[show abstract] [hide abstract]
ABSTRACT: Medication reconciliation at transitions in care is a national patient safety goal, but its effects on important patient outcomes require further evaluation. We sought to measure the impact of an information technology-based medication reconciliation intervention on medication discrepancies with potential for harm (potential adverse drug events [PADEs]). We performed a controlled trial, randomized by medical team, on general medical inpatient units at 2 academic hospitals from May to June 2006. We enrolled 322 patients admitted to 14 medical teams, for whom a medication history could be obtained before discharge. The intervention was a computerized medication reconciliation tool and process redesign involving physicians, nurses, and pharmacists. The main outcome was unintentional discrepancies between preadmission medications and admission or discharge medications that had potential for harm (PADEs). Among 160 control patients, there were 230 PADEs (1.44 per patient), while among 162 intervention patients there were 170 PADEs (1.05 per patient) (adjusted relative risk [ARR], 0.72; 95% confidence interval [CI], 0.52-0.99). A significant benefit was found at hospital 1 (ARR, 0.60; 95% CI, 0.38-0.97) but not at hospital 2 (ARR, 0.87; 95% CI, 0.57-1.32) (P = .32 for test of effect modification). Hospitals differed in the extent of integration of the medication reconciliation tool into computerized provider order entry applications at discharge. A computerized medication reconciliation tool and process redesign were associated with a decrease in unintentional medication discrepancies with potential for patient harm. Software integration issues are likely important for successful implementation of computerized medication reconciliation tools.Archives of internal medicine 05/2009; 169(8):771-80. · 11.46 Impact Factor
Article: Challenges in exchanging medication information: identifying gaps in clinical document exchange and terminology standards.[show abstract] [hide abstract]
ABSTRACT: The availability of accurate medication history information is invaluable for making sound therapeutic decisions. The Continuity of Care Document (CCD) could serve as a mechanism for exchanging interoperable medication information between EHRs. We evaluate the feasibility of representing a medication and its underlying components in a Healthcare Information Technology Standards Panel (HITSP) compliant CCD. Our evaluation resulted in successfully mapping 94% of medication entries and greater than 92% of medication component mappings to CCD constraints. We identify gaps and provide recommendations for improving the representational adequacy of the Federal Medication Terminology (FMT) to fully represent orderable medication concepts.AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2009; 2009:526-30.
Article: The use of electronic medication reconciliation to establish the predictors of validity of computerized medication records.[show abstract] [hide abstract]
ABSTRACT: Medication records in clinical information systems (CIS) are frequently inaccurate, leading to potentially incorrect clinical decisions and preventing valid decision support interventions. It is not known what characteristics of electronic medication records are predictive of their validity. We studied a dataset of 136,351 electronic medication records of patients admitted to two academic hospitals that were individually validated by admitting providers using novel medication reconciliation software. We analyzed the relationship between characteristics of individual medication records and the probability of record validation using a multivariable linear regression model. Electronic medication records were less likely to be validated if more time had passed since their last update (14.6% for every 6 months), if they represented an antiinfective (61.6%) or a prn (50.9%) medication, or if they were in an outpatient CIS rather than on an inpatient discharge medication list (18.1%); p<0.0001 for all. Several characteristics of electronic medication records are strongly associated with their validity. These findings could be incorporated in the design of CIS software to alert providers to medication records less likely to be accurate.Studies in health technology and informatics 02/2007; 129(Pt 2):1022-6.