Drug-drug interaction (DDI) alerts are supposed to help clinicians reduce risk of prescribing medications that may result in adverse drug events. The adverse events reflect medications that, when prescribed together, can cause bad events and outcomes for patients. But it is well proven that “alert fatigue” does harm, and in this case, negatively impacts any favorable intents or efficacy of avoiding DDIs. Alert fatigue, including for DDIs, happens because of the onerous number of alerts considered low-value by clinicians and information overload, causing prescribers to override or ignore alerts as often as 98% of the time. Another reason for limited impact of DDI-related alerts is that, for some specialties, the prescribing of the drug combinations tagged as DDI risks are commonplace and already proven to be good, efficacious medication approaches – cardiology among the most frequent. The medical staff at […]

Health systems are now well down the road of “accountability reform,” defining and managing the effectiveness of care to improve quality and reduce cost. Plexina (formerly known as Wairever) provides the Plexina Platform that helps support clinicians using electronic health records (EHRs) to provide evidence-based and best-practice care. Creating electronically actionable clinical decision support (CDS) tools — such as order sets, clinical documentation templates, rules and assessment reports – at  the point of care helps clinicians make better decisions for patients. Plexina is a complete platform that helps capture, understand, define, design and deploy high-quality CDS assets into EHRs. The continuous process of developing and maintaining CDS In each health system, the clinical transformation team or CDS team has to enable new operational capabilities to improve care. Business transformation, standardization and clinical improvement is a complex and time-consuming undertaking. First, […]

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7 keys to success with clinical decision support

I realize and admit I have biases. One bias is that I believe the principle reason for the healthcare IT industry is to optimize patient-clinician interactions to heal and keep people healthy. Another bias is that without solid financials and organizational performance, everyone ultimately loses. My third bias: I believe clinicians whom we trust with our very lives, and IT experts, are trained professionals and should be trusted to optimize electronic health records (EHRs) as a local team. EHRs should provide solid clinical decision support (CDS) to help clinicians optimize patient decisions and interactions, and help organizations exceed performance goals. CDS puts clinicians at the forefront for deciding, coding, monitoring and updating.  Here are the seven most powerful CDS-focused EHR characteristics for assisting clinicians with their decisions and documentation: 1. Programmability Programmability ensures that hospitals can remain in sync with […]

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What can a good order set really do for patients?

A real-life example is the best way to show the value of a good order set within a locally programmable electronic medical record (EMR).  Of course, any EMR that is not locally programmable would seem categorically untenable to me – no two organizations are alike on a host of internal and external measures that require a flexible EMR solution. Here’s a great story of how one large multi-hospital Allscripts client—as part of its continuous efforts to improve care—helped clinicians and the organization help stroke patients leveraging local programmability. They had successfully addressed a host of clinical challenges one at a time, and next turned specifically to better serving patients with new-onset stroke. Using best practices more consistently First, the 13 generally accepted, evidence-based best practices for treating stroke patients provided the goal. For example, completing a lipid profile within 24 […]

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Proof that high CPOE adoption reduces length of stay

  • Steven Shaha, Ph.D., DBA
  • 08/21/2014

Holy Spirit Hospital (Camp Hill, Penn., U.S.A.) wanted to know, “Does computerized provider order entry (CPOE) really make a difference?” There are some obvious answers about the benefits of CPOE. When clinicians and pharmacists communicate electronically, they’ll reduce costs and errors associated with transcription and paper. But Holy Spirit wanted to take it a step further: Does CPOE improve the overall measures of efficiency and quality of care? After conducting a rigorous study, the answer is a resounding yes, and is the subject of a recently published article in Applied Clinical Informatics.* How we measured the correlation between CPOE and improved clinical outcomes Length of Stay (LOS) is among the best proxy measures for overall efficiency and efficacy of care and clinical outcomes in hospitals. So we decided to study whether or not CPOE adoption correlates with LOS, which means […]

The Allscripts Application Store helps instantly connect Allscripts clients with approved third-party applications and devices designed to improve productivity, deliver higher-quality care, engage patients in their own care and more.  Our goal is to help our clients make the most of their electronic health record (EHR) investment. We currently have more than 60 solutions built for various Allscripts applications that tackle a wide range of healthcare challenges. One area where we’re seeing innovation growth is clinical decision support for electronic prescriptions. The benefits of electronic prescriptions According to the Office of the National Coordinator for Health Information Technology, electronic-prescribing (“e-prescribing”) adoption is growing in the United States. Between December 2008 and June 2012, the number of physicians e-prescribing with an electronic health record (EHR) increased by 41 percentage points. About half of U.S. physicians are now e-prescribing. One of the […]

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Using pharmacogenetics for safer drug orders

  • Rick Mansour, M.D.
  • 06/10/2014

The SunriseTM platform is unique because we designed it to be a central nervous system of health care organizations. It constantly gathers, aggregates, evaluates and acts on information for optimal clinical decision support. Our clients are using these capabilities to integrate evidence-based information at the point of care. For example, a team at the U.S. National Institutes of Health Clinical Center (NIH CC) recently developed a program for Sunrise using pharmacogenetics, which evaluates genetic information to predict a patient’s response to medication. The goal was to provide newly available information at the point of care to help clinicians reduce the risk of adverse drug events. The Journal of American Medical Information Association (JAMIA)* featured this patient safety project in a recent article. Starting with safety checks for three drugs The NIH CC team wanted a tool to help clinicians as […]

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The Infobutton: ONC Gets it Right

The ONC’s proposed rule for Electronic Health Record certification under Stage 2 Meaningful Use includes one requirement that will be good for clinicians and good for patients – the Infobutton.  Under the rule, EHRs certified for Stage 2 would be required to support the HL7 Infobutton standard for two distinct use cases: Providing a context-sensitive link to reference information to support clinical decision making Providing links to patient-specific education resources So what is an Infobutton?  Infobuttons link an EHR to an outside knowledge source.   Importantly, Infobuttons are context sensitive.   For example, if the patient has a diagnosis of multiple sclerosis on his or her problem list, an Infobutton next to that problem would link the user to one or more knowledge sources about multiple sclerosis.  The user can access the information immediately without opening a new application or web page, […]

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EHR Saves Lives: Cuts Sepsis Deaths By 25%

“Sepsis is preventable, and at Orlando Health we have set a high priority on infection control as our quality initiative. (Allscripts) Sunrise EHR is an essential part of our initiative to eradicate central line-associated bloodstream infection and catheter-related urinary tract infection. The capabilities of Sunrise significantly help with these efforts.” – Michael L. Cheatham, MD, FACS, FCCM, Director, Surgical Intensive Care Units, Orlando Health Most of us are familiar with sepsis — a serious medical condition caused by an overwhelming immune response to basically a whole body infection. It’s one of the leading causes of death in hospital ICUs. Every year, severe sepsis strikes about 750,000 Americans. Somewhere between 28 and 50 percent of these people die—far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. MLMs are the key The key to beating sepsis […]

Kenosha Medical Center, United Hospital System

As CMIO of United Hospital System in Wisconsin, I try to make it easy for our physicians to get the information they need to make the best clinical decision. Recently we deployed a Medical Logic Module (MLM) for all 40 of our employed physicians so they can do just that.  Using the MLM, they can view, with one click in their Sunrise Ambulatory EHR, everything they need to manage a patient with chronic disease – and they can do it in less time, with improved accuracy and better outcomes. Before I go on, though, a little history might be in order.  If you’re not familiar with MLMs, you should be.  An MLM is a bit of computer wizardry that’s designed to find all the information within an EHR database pertinent to a single question and alert doctors when the right […]