Guilherme Del Fiol

16 – Infobuttons and point of care access to knowledge

Publisher Summary The belief that better informed decisions lead to better patient outcomes is one of the underlying tenets of evidence-based medicine and health care education. The integration of information resources into clinical information systems appears to be a viable approach to automated support of clinician decision-making. The information needs that arise while clinicians use clinical information systems are particularly disposed to resolution with such resources, and many researchers have investigated approaches to integrate these systems with each other. One method that is being tried by the authors, in two separate efforts, is called infobuttons. Work is under way to develop infobutton managers that provide a flexible, generic method for integrating infobuttons with clinical systems. These managers have been integrated successfully with several different clinical information systems in an institution-independent manner. By lowering barriers to information at the moment when it is needed, the hope is that clinicians will use the information to make better-informed decisions. Though the impact on, and quality of, decisions are difficult to measure, we at least are seeing the increased access to information resources that we believe is a necessary, but not sufficient step in the right direction. Additional work is needed to adapt existing clinical information systems such that they are able to export context information for use in information retrieval, just as work is needed to adapt information resources to standardize on methods for facilitating that retrieval.

Decision support for evidence-based pharmacotherapy detects adherence problems but does not impact medication use

Although evidence-based pharmacotherapies are a principal component of patient care, 30-50% of patients do not take their medications as prescribed. We conducted a randomized trial of two clinical decision support (CDS) interventions in 2219 patients: patient adherence reports to providers (n=744), patient adherence reports to providers + email notices to care managers (n=736), and controls (739). At 18-month follow-up, there were no treatment-related differences in patient medication adherence (overall, by medication class, and by medical condition). There also were no treatment-related differences in patient clinical and economic outcomes. Thus, while this studys CDS information interventions were successfully delivered to providers and care managers, and were effective in identifying medication adherence deficits and in increasing care manager responses to medication adherences issues, these interventions were not able to alter patient medication behavior.

Modeling a decision support system to prevent adverse drug events

Adverse drug events are known to be a major health problem worldwide. Decision support systems (DSSs) that assist drug ordering have demonstrated to be a powerful tool to prevent prescription errors and adverse drug events. On the other hand, some issues related to the development, implementation, configuration and evaluation of these DDSs still need further research. The objective of this project was the development of a DSS prototype that helps with the prevention of adverse drug events by detecting drug-drug interactions in drug orders. The structure of the system tries to solve some of the problems described by the literature, such as integration with hospital information systems, adaptability to local needs, and knowledge base maintenance. The proposed model has been shown to be an effective method for representing drug-drug interactions.

Information Exchange Between Providers During Transitions of Surgical Care: Communication, Documentation and Sometimes Both.

Poor communication of health information between healthcare providers is associated with over 80% of medical errors that occur during transitions of care [1]. We interviewed a diverse sample of primary care providers and surgical providers during their patients transitions of care before and after surgery at a Veterans Health Administration hospital and a large tertiary academic medical center to understand how providers communicate and exchange health information for medically complex older patient across different care settings. Our objective was to identify factors that lead to poor communication as well as strategies to optimize provider-provider communication. This paper highlights the methods providers use to communicate and document health information within two separate electronic medical record (EMR) systems during transition of care and presents a conceptual diagram of how information exchange occurs within these two EMR systems.