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Rapid Correction of Clinical Decision Support Failures with Real-Time Surveillance of Provider Responses and Patient Outcomes

Utilization of clinical decision support (CDS) is increasing among healthcare facilities with computerized provider order entry or electronic medical records. Real-time surveillance of user responses and patient outcomes helps operate a safety net which intercepts CDS failures. We present a prototype application for high-risk medication surveillance. The tool is populated automatically when CDS is used or ignored, and it allows verification of prescription safety and accuracy by informatics personnel and clinical pharmacists.

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Rapid Correction of Clinical Decision Support Failures with Real-Time Surveillance of Provider Responses and Patient Outcomes

  1. 1. Rapid Correction of Clinical Decision Support Failures with Real-Time Surveillance of Provider Responses and Patient Outcomes<br />INTRODUCTIONWhile clinical decision support (CDS) systems can improve patient care, CDS failures, including unjustified provider overrides and error-producing conditions, are common. Rapid proactive response to failures can increase user satisfaction and prevent unintended adverse consequences. <br />SURVEILLANCE TOOL<br />The surveillance view displays all admitted patients that have experienced a CDS interaction. This view allows identification of patients at high risk for harm following multiple CDS failures and CDS modules with high failure rates.<br />The patient detail view displays a detailed timeline of orders, order administrations, lab values, and CDS interactions for a patient, and it allows saving of comments within the tool or to the EMR. This view allows understanding of provider actions and patient condition changes occurring in conjunction with CDS failures without having to redirect to and search a patient’s EMR.<br />1<br />Surveillance Tool<br />Workflow<br />Consultation<br />Patient View<br />Data<br />Design<br />Informatics Personnel<br />In 3 months of trial use, a study pharmacist monitored XX patients. Of these, XX% remained active for monitoring and XX% required an intervention. Comments frequently summarized comorbidities, lab values and trends, and indications; served as reminders for monitoring; and elaborated recommendations. <br />CONCLUSIONErrors of both provider usage and system design and development contribute to commonly occurring failures. Real-time surveillance allows identification of these failures, intervention to prevent further patient harm, and early initiation of system design corrections.<br />Surveillance View<br />Allison B. McCoy, MS1<br />Lemuel R. Waitman, PhD2<br />Josh F. Peterson, MD, MPH1,3,4<br />1 Department of Biomedical Informatics Vanderbilt School of Medicine<br />2 Department of Biostatistics University of Kansas Medical Center<br />3Department of Medicine Vanderbilt University Medical Center<br />4 Geriatric Research Education Clinical Center VA Tennessee Valley Healthcare System<br />OBJECTIVE: <br />To describe a web-based surveillance tool that serves as a safety net for monitoring clinical decision support failures and high-risk patients.<br />Architecture<br />BCMA<br />Orders<br />Labs<br />Admini-strations<br />InterfaceEngine<br />Medication Administrations<br />EMR<br />Patient Demographics<br />ScheduledTasks<br />EMR<br />Laboratory Values<br />Providers<br />Pharmacists<br />SurveillanceTool<br />CPOE<br />Surveillance Tool<br />Surveil-lance<br />Medication Orders<br />ACKNOWLEDGMENTS<br />The authors were funded by grants T15LM 007450-08 and R01LM 009965-02.<br />CDS<br />CPOE/CDS<br />Logs<br />Queue<br />Parser<br />Log Files<br />Log Files<br />

Utilization of clinical decision support (CDS) is increasing among healthcare facilities with computerized provider order entry or electronic medical records. Real-time surveillance of user responses and patient outcomes helps operate a safety net which intercepts CDS failures. We present a prototype application for high-risk medication surveillance. The tool is populated automatically when CDS is used or ignored, and it allows verification of prescription safety and accuracy by informatics personnel and clinical pharmacists.

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