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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    • "Many hospitals tend to utilize a commercially available EMR for example the University of Illinois Hospital, a 450-bed teaching hospital, utilizes a commercially available EMR (Millennium®, Cerner Corporation, Kansas City, MO) which is used as the primary repository for all results, problem lists, clinical notes, medication lists, and orders. All inpatient medication orders are placed using computerized physician order entry (CPOE) (Galanter and others, 2010). To best of our knowledge the only hospital in Egypt utilizes a commercially available EMR from Cerner is CCH-E 57357, also the data get entered either codified or as free text, Codified data could use either ICD-9 CM, ICD-10, or SNOMED® codes. "
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    • "The Institute of Medicine's 1998 report entitled 'Crossing the Quality Chasm' documented problems with the American healthcare delivery system that substantively undermined the quality of care that was being delivered to the public [1] [2] [3] [4] [5]. "
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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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