Search results for "Electronic Health Records"

Opioid misuse is at epidemic proportions in the United States. This commentary advocates for physicians who recognize that their patients are misusing opioids to carefully approach changes in treatment strategies. Providers should adjust their prescribing behavior, counseling skills, and use of electronic health records to determine an effective care plan to address the patient's pain.

A 5-year-old boy with transverse myelitis presented to the rehabilitation medicine clinic for scheduled quarterly botulinum toxin injections to his legs for spasticity. Halfway through the course of injections, the patient's mother noted her son was tolerating the procedure "much better than 3 weeks earlier"—the patient had been getting extra injections without the physicians' knowledge. Physicians discussed the risks of too-frequent injections with the family. Fortunately, the patient had no adverse effects from the additional injections.

Many institutions are now moving from relatively unsophisticated electronic health records (EHRs) to more advanced systems. This transition can pose safety hazards; a previous article demonstrated that replacing an older EHR with a new system resulted in a higher incidence of some types of prescribing errors. However, this follow-up study found that prescribing errors consistently decreased as users became more familiar with the new system and as the system was refined. Prior studies have also shown that at least 1 year of use is required to obtain the safety benefits of EHRs. The article provides an excellent example of the ongoing monitoring and adaptation required to effectively implement EHRs.

The impact of clinical decision support systems on improving medication safety has been limited by a lack of standardized and tailored alerts to warn prescribing clinicians about dangerous drug–drug interactions. Progress in this area has stalled owing to disagreement between clinicians and system designers along with concerns about liability if warnings are deployed incorrectly. This study reports on the development of a consensus list of 15 high-severity, clinically significant drug–drug interactions, arrived at through an expert panel approach that included input from pharmacists, physicians, electronic medical record (EMR) developers, and developers of online clinical knowledge bases. The authors recommend that alerts to prevent these interactions should be implemented in all EMRs.

The authors discuss why general practitioners' adoption of electronic health records is more prevalent in the United Kingdom than the United States and identify features that might encourage adoption in the US.

This article discusses several strategies implemented by hospitals to improve the legibility of physicians' medication orders.

This bill, which garnered bipartisan support, proposes developing health information technology networks (known as "Regional Health Information Organizations," or RHIOs) with a strong focus on state- and community-based efforts.  It is presently under consideration in the United States House of Representatives.

This study compared an outpatient pediatric clinic with pharmacist prescription medication review and electronic health record customization to one without such systems in place. The clinic with workflow and technology to prevent adverse drug events experienced fewer errors, adding to the evidence that sociotechnical approaches are needed to improve medication safety.

This case study describes the implementation of a health information technology–based solution to enable 24-hour remote pharmacist review of medication orders.

An automated weight-based calculator within a computerized provider order entry system reduced prescribing errors for pediatric patients.

A 91-year-old woman is found lethargic and incontinent, with slurred speech. Review of her medications reveals numerous duplicates, including some considered potentially inappropriate for use in elderly patients.

Measures that have been proposed to reduce the incidence of medication errors target prescribing safety (e.g., computerized provider order entry) or safety in administering medications (e.g., bar coding or automated dispensing). While each of these individual measures has been shown to decrease errors, as yet few systems "close the loop" by integrating safety measures for prescribing and administering medications. Utilizing an electronic system that incorporated CPOE, automated dispensing, bar coding, and an electronic medication record, this single-institution study demonstrated a significant reduction in both prescribing errors and administration errors. However, staff time spent on medication-related tasks increased. While the study results are promising, one caveat is that the system was not used for high-risk drugs such as anticoagulants or intravenous medications.

This qualitative study examines how the advent of information technology has influenced nursing communication with pharmacists, and discusses how prescribing systems should be structured to account for these factors.

A patient presenting to the ED with chest pain was ruled out for MI, and discharged on an ACE inhibitor. Two weeks later, he returns with a critically elevated potassium level, has a cardiac arrest, and dies.

This AHRQ–funded study discovered that the use of alerts within an electronic medical record system can reduce the number of unsafe medications prescribed in elderly outpatients. Investigators evaluated the impact of a clinical decision support system (CDSS) at the point of computerized provider order entry (CPOE), targeting two classes of contraindicated medications (long-acting benzodiazepines and tertiary amine tricyclic antidepressants). The authors discuss the rapid, significant, and persistent reductions in medication prescribing of these high-risk medications, suggesting the effectiveness of an alert system to curtail inappropriate prescribing. This study is a first to evaluate a computerized alert system in a large population-based primary care setting, although a past systematic review evaluated the effects of CDSS on practitioner performance and patient outcomes.

This study of more than 50 ambulatory practices discovered that about 7 in 1000 outpatients receive a medication that counters black box warnings. While these events were associated with very few instances of patient harm, investigators noted that older patients with multiple medical problems and taking more medications appeared to be at greater risk for being prescribed these medications. Data collection occurred through review of electronic health records that offered limited clinical decision support or alerts to providers. The authors suggest that improvements in decision support may minimize the potential for such black box warning violations. This study reports an overall lower rate of prescribing violations compared to past published work.

This article reports on the issues involved in computerized physician order entry (CPOE) adoption and offers suggestions from chief information officers on implementation.

In this AHRQ-funded study, the investigators sought to increase acceptance of alerts by devising specific decision support for the ambulatory care setting, with only critical alerts interrupting clinician workflow.

A patient arrives at the ED in acute kidney failure; another patient arrives at the ED profoundly hypoglycemic. Both mishaps were determined to stem from medication errors at the time of discharge.