Computerized physician order entry of medications and clinical decision support can improve problem list documentation compliance

University of Illinois at Chicago, College of Medicine, Department of Medicine, University of Illinois Medical Center, Chicago, Illinois, United States.
International Journal of Medical Informatics (Impact Factor: 2). 08/2008; 79(5):332-8. DOI: 10.1016/j.ijmedinf.2008.05.005
Source: PubMed


The problem list is a key and required element of the electronic medical record (EMR). Problem lists may contribute substantially to patient safety and quality of care. Physician documentation of the problem list is often lower than desired. Methods are needed to improve accuracy and completeness of the problem list.
An automated clinical decision support (CDS) intervention was designed utilizing a commercially available EMR with computerized physician order entry (CPOE) and CDS. The system was based on alerts delivered during inpatient medication CPOE that prompted clinicians to add a diagnosis to the problem list. Each alert was studied for a 2-month period after implementation.
Measures included alert validity, alert yield, and accuracy of problem list additions.
At a 450 bed teaching hospital, the number of medication orders which triggered alerts during all 2-month study periods was 1011. For all the alerts, the likelihood of a valid alert (an alert that occurred in patients with one of the predefined diagnoses) was 96+/-1%. The alert yield, defined as occuring when an alert led to addition of a problem to the problem list, was 76+/-2%. Accurate problem list additions, defined as additions of problems when the problem was determined to be present by expert review, was 95+/-1%.
The CDS problem list mechanism was integrated into the process of medication order placement and promoted relatively accurate addition of problems to the EMR problem list.

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Available from: Chiang Jao, Oct 02, 2015
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    • "1998 ✓ ✗ ✗ ✗ Gadd et al. [40] 1998 ✓ ✗ ✗ ✗ Panzarasa et al. [41] 2002 ✓ ✗ ✗ ✓ Young et al. [42] 2004 ✓ ✗ ✗ ✗ Shiffman et al. [43] 2004 ✓ HL7 ✓ ✗ Rosenbloom et al. [44] 2004 ✓ ✗ ✗ ✗ Galanter et al. [45] 2005 ✓ ✗ ✗ ✗ Haller et al. [46] 2007 ✓ ✗ ✗ ✗ Stutman et al. [47] 2007 ✓ ✗ ✗ ✗ Wilson et al. [24] 2007 ✓ ✗ ✗ ✗ Lobach et al. [48] 2007 - HL7 ✗ ✗ Graham et al. [49] 2008 - HL7 ✗ ✗ Marcy et al. [50] 2008 ✓ ✗ ✗ ✗ Wright et al. [51] 2008 ✓ HL7 ✗ SNOMED CT,ICD Gerard et al. [52] 2008 ✓ ✗ ✗ ✗ Field et al. [53] 2008 ✓ ✗ ✗ ✗ Schnipper et al. [54] 2008 ✓ ✗ ✗ ✗ Peleg et al. [55] 2009 ✓ ✗ GLIF ✗ Saleem et al. [56] 2009 ✓ ✗ ✗ ✗ Field et al. [57] 2009 ✓ ✗ ✗ ✗ Chen et al. [58] 2010 ✓ ✗ ✓ ✗ Galanter et al. [59] 2010 ✓ ✗ ✗ SNOMED CT,ICD Noormohammad et al. [60] 2010 ✓ HL7 ✗ ✓ Trafton et al. [61] 2010 ✓ ✗ ✗ ✗ Were et al. [62] "
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    Federated Conference on Computer Science and Information Systems - FedCSIS 2011, Szczecin, Poland, 18-21 September 2011, Proceedings; 01/2011
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    • "Additionally, to simulate clinical reminders that aim to influence both the documentation and clinical practices of physicians5,6, we inserted a single sentence prior to each clinical vignette in the intervention group, reminding the subject of the applicable “No pay for error” condition. "
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    • "The improvement in medication and problem list documentation leads to more improvement in quality of care and ultimately yields higher patient safety. Another study drew the similar conclusion that the integrated clinical decision support mechanism into the process of medication order placement promoted relatively accurate addition of problems to the problem list on the EMR at UIH [32]. "
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    ABSTRACT: To investigate whether clinical decision support that automates the matching of ordered drugs to problems (clinical diagnoses) on the problem list can enhance the maintenance of both medication and problem lists in the electronic medical record, we designed a clinical decision support system to match ordered drugs on the medication list and ongoing problems on the problem list. We evaluated the capability and performance of this clinical decision support system in medication-problem matching using physician expert chart audits to match ordered drugs to ongoing clinical problems. A clinical decision support system was shown to be useful in improving medication-problem matches in 140 randomly selected audited patient encounters in three inpatient units. Enhanced maintenance of both the medication and problem lists can permit the exploitation of advanced decision support strategies that yield higher patient safety.
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