Chiang S. Jao

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

OBJECTIVE 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. DESIGN 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. MEASUREMENTS Measures included alert validity, alert yield, and accuracy of problem list additions. RESULTS 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%. CONCLUSION 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.

Making the neurology clerkship more effective: can e-Textbook facilitate learning?

Abstract Objective: In 1998, the 4-week neurology elective clerkship was converted into a 2-week required neurology rotation at the University of Illinois at Chicago. We hypothesized that the interactive e-Textbook, a computer-assisted learning tool, could successfully replace a paper-based syllabus and a traditional neurology textbook during a 2-week rotation, while incorporating department teaching conferences to replace the medical student lecture series. Methods: We created an e-Textbook and made it available simultaneously in a CD-ROM format and on a password-protected website. The online quiz and course assessment were administered by the Blackboard Web Server. Results: After implementation of the e-Textbook over 6 years, the feedback shows high student satisfaction, and student evaluations of the neurology clerkship have risen. Creation of an e-Textbook for the neurology clerkship made our faculty more productive while increasing student satisfaction and facilitating learning efficacy. Discussion: The results show that the e-Textbook is an appropriate alternative to facilitate learning of basic and clinical neurology during a 2-week rotation. The students demonstrated successful learning in a computerized environment.

Clinical Decision Support Systems: An Effective Pathway to Reduce Medical Errors and Improve Patient Safety

1.1 Background Medical errors are both costly and harmful (Hall, 2009). Medical errors cause tens of thousands of deaths in U.S. hospitals each year, more than from highway accidents, breast cancer, and AIDS combined (SoRelle, 2000). A phone survey by the National Patient Safety Foundation found that 42 percent of over 100 million Americans believed that they had personally experienced a medical mistake (Louis & Harris Associates, 2007). The 1999 Institute of Medicine report stated that medical errors were the eighth leading cause of death in the U.S., killing between 44,000 and 98,000 people each year (Kohn et al., 2000). Another study indicated 225,000 deaths annually from medical errors, including 105,000 deaths due to “non-error adverse events of medications” (Starfield, 2000). Medical errors threaten the quality of health care, increased healthcare costs, and add to the medical malpractice crisis (Studdert et al., 2005). According to the Patient Safety in American Hospitals Study Survey by HealthGrades (HealthGrades, 2004; HealthGrades, 2007; HealthGrades, 2008; HealthGrades, 2009), the number of deaths in U.S. hospitals each year that are reportedly due to medical errors has been disturbingly high since 2000: 1. Based on a study of 37 million patient records, an average of 195,000 people in the U.S. died due to potentially preventable, in-hospital medical errors in each of the years from 2000 through 2002. 2. Approximately 1.16 million patient safety incidents occurred in over 40 million hospitalizations for the Medicare population yielding a three-percent incident rate. These incidents were associated with

Using clinical decision support to maintain medication and problem lists A pilot study to yield higher patient safety

8.6 billion of excessive costs during 2003 through 2005. Although the average mortality rate in Medicare patients from 2003 through 2005 was approximate 21.35 percent and overall rates have been declining, medical errors may still have contributed to 247,662 deaths. 3. Patient safety incidents cost the federal Medicare program

Implementing a Computerized Charge Capture System to Improve Billing Work Flow and Reduce Errors in Data Entry

8.8 billion and resulted in 238,337 potentially preventable deaths from 2004 through 2006. 4. Approximately 211,697 patient safety events and 22,771 Medicare deaths could have been avoided with a savings of

Adapting User Interface to Expedite Physician Order Entry: A Frontline to Ensure Patient Safety

2.0 billion from 2005 through 2007. These numbers indicate the magnitude of savings in both lives and dollars from improved patient safety.

Converting Laserdisc Video to Digital Video: A Demonstration Project Using Brain Animations

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.

A frame-based peripheral nervous expert system

Background : Traditional paper-based billing operation has experienced a high illegibility error rate and the need for an extended processing time to cope with the billing tasks related to physician reimbursement. We hypothesized that information technology can be adopted to improve the effectiveness of the billing interface, assist in record keeping, and enhance financial outcomes of clinical practice. Methods : A computerized charge capture system was designed and deployed to test our hypothesis that information technology could reduce illegibility during data entry and improve patient record keeping and billing work flow. Results : Physicians found that electronic juxtaposition of the pilot system with the electronic medical record was helpful in patient data verification from the progress note. The pilot system was successfully designed to assist physicians in improving information access, and to reduce significant illegibility errors during data entry. Conclusion : Although overall technical improvements may provide access to desired information, major barriers to data entry and flawed health plan management systems still hamper the efficient implementation and financial outcomes of the adoption of clinical information systems in this time-pressured environment.

Evaluating a Digital Resident Diagnosis Log: Reasons for Limited Acceptance of a PDA Solution

Preventable medical errors are a major problem in healthcare. Maintenance of accurate problem lists and drug lists in the electronic medical record is critical to the practice of medicine and patient safety. We built a simulator of a clinical decision support system that automates the process of maintaining an electronic problem list by processing drug order requests from a simulated computerized physician order entry system. Preliminary results revealed that the productivity of the system increased when the user interface was improved. This study highlights the importance of an enhanced user interface as a frontline in expediting physician data entry, streamlining better system workflow, and maintaining an electronic problem list effectively to reduce preventable medical errors and promote patient safety.

Overcoming Limitations of Data Entry for the Semi-Automated Detection of Drug Orphans in the EMR

Interactive laserdiscs are of limited value in large group learning situations due to the expense of establishing multiple workstations. The authors implemented an alternative to laserdisc video by using indexed digital video combined with an expert system. High-quality video was captured from a laserdisc player and combined with waveform audio into an audio-video-interleave (AVI) file format in the Microsoft Video-for-Windows environment (Microsoft Corp., Seattle, WA). With the use of an expert system, a knowledge-based computer program provided random access to these indexed AVI files. The program can be played on any multimedia computer without the need for laserdiscs. This system offers a high level of interactive video without the overhead and cost of a laserdisc player.