chc_2015

Rachel Hagemann, RPh
Krista Sanders, CPhT
October 10, 2015
Cerner Millennium®:
mCDS – Making
Clinical Alerts
Meaningful

BRNDEXP 2.1 0714 © 2014 Cerner Corporation. All rights reserved.
This document contains Cerner confidential and/or proprietary information belonging to Cerner Corporation and/or its related affiliates which may not be reproduced or transmitted in any form or by any means without the express written consent of Cerner
1
Learning Record Transfer
• Transfer Learning Record from CLM to uLearn
• If you have not already done this.
• https://ulearn.cerner.com
• Sign in with your Cerner Care email address and password.
• Follow instructions on main page.
• If you have questions about your learning record, please contact
LearningSolutions@Cerner.com

2
Objectives
• Understand clinical alerts
• Understand meaningful alerts
• Be able to use the functionality within
medication clinical decision support (mCDS) to
create meaningful alerts

3
Agenda
• mCDS Introduction
• Venue of Care Filtering
• Preferences
• Customization
• Drug Allergies
• Drug Drug
• Duplication Checking
• Repeat Numbers
• Using Discern Rules
• Discern alerts displayed within mCDS
• Filtering drug drug interactions using discern rules
• Order Detail Filtering
• TPNs
• Alert Maintenance
• Questions/Examples

4
Scheduled Break Times
• After Venue of Care Filtering
• Lunch
• Noon
• Snack
• 2:10
• PRN

Medication Clinical Decision
Support (mCDS) Overview

6
mCDS Objective
Is that Cerner solutions no longer
filters medication alerts that are a
nuisance, but create meaningful
alerts that enhance safety and
improve patient care.

7
Documentation for mCDS
• All About Medication Clinical Decision Support
• Dashboard  Reference Pages  PharmNet Inpatient
Reference Pages  All About Medication Clinical Decision
Support
• https://wiki.ucern.com/display/public/reference/All+About+Med
ication+Clinical+Decision+Support
• Go under the additional information hyperlink
• Medication Clinical Decision Support (mCDS) Scenarios Build
• Venue of Care Filtering PowerPoint
• mCDS – Making Clinical Alerts Meaningful
• uCern Medication Clinical Decision Support (mCDS)
• https://connect.ucern.com/groups/medication-clinical-decision-
support-mcds

8
Support
support-mcds

9
Support
support-mcds

10
Support
support-mcds

11
Support
support-mcds

12
Packages
• mCDS package
• Innovations Dev (US): Medication Clinical Decision Support
Window
• Need 83848 or higher
• MultumCustom.exe
• Need 68066 or higher

13
Nuisance Alerts
• Not unique to Cerner solutions
• Have seen studies where up to 85% of the alerts are
ignored
• Not unique to drug content provider
• Cerner Multum
• FDB (First Databank)
• Medi-Span
• Varies across venues of care
• Ambulatory vs. Inpatient

14
What’s the cause of nuisance alerts?
• Conservative nature of content produced by
commercial vendors
• Cerner Multum/FDB/Medi-Span
• Lack of context from not considering available data,
objectives, role, and venue of care

15
Approach to reducing nuisance alerts has been to
reduce the “noise”, not to make them meaningful
• Turn alerting off
• Mainly drug drug and duplicate therapy
• Leave allergy checking on
• Disable lower severity alerts
• “Fine tune” higher severity alerts
• Government recommendations (FDA)

17
Healthcare Informatics Article – mCDS

18
JAMIA Article – Duplicate Therapy Checking

19
Duplicate Checking Analysis

20
mCDS Development Approach
• Improve the user experience
• Enhance the user interface
• Address major functional gaps/limitations
• Improve ability to “localize” the experience
• Required changes and “tightening”
• Meaningful use
• “Bugs”/Client feedback
• Incorporate Discern capabilities
• Filter alerts based upon order details
• Existing ADE packages, local rules
• Utilize future Cerner capabilities
• Cerner Math
• DAAKOS
• Hansten and Horn

21
Meaningful Use
• Stage 1
• Drug allergy checking
• Drug drug interaction checking
• Stage 2
• Citations
• Allergies
• Drug Interactions
• Requirements
• mCDS window
• Latest/Greatest Cerner Multum content package
• Stage 3
• Cerner working on requirements

24
Drug Drug Interaction Citation
• Select icon next to the drug interaction pair to display

25
AHS_FL Alert Reduction since implementing
mCDS Window

27
Window Improvements
• Window defaults to all sections open – ability to
collapse individual sections or all sections
• Triggering and existing medications display honors
MNEM_DISP_LEVEL preference
• Additional order information available via order detail
tool tip
• Triggering and existing medications display Simplified
Display Line
• Drug reference, patient leaflets, and alert history
accessed from hyperlink on medication order
• Ability to discontinue medication being ordered and
profile medication from the mCDS window

28
Window Improvements
• Ability to identify orders as historical, prescription, or
an inpatient medication order
• Severity level of interaction is displayed in text, not an
icon, with Major Contraindicated interactions color
coded in red
• Access additional interaction information via a
hyperlink
• Allergy and drug drug interaction citation information
available

29
Allergy Improvements
• Access allergy control via a hyperlink
• Allergy Comments, Reaction Type, and Information
Source are displayed
• Allergy Citation information is available – Meaningful
Use requirement

30
Override Reasons Improvements
• Override Reason selection available for individual
alerts
• Previous Override Reason is available
• “Apply to All” Override Reasons configurable in
Bedrock

31
mCDS Alert Override Reasons
• Design Decisions
• Not Required
• Required
• Which application(s)
• Which alert type(s)
• Which provider(s)
• Which individual(s)
• Configure in PrefMaint.exe
• PowerChart  Chart  PowerOrders
• MUL_OVERRIDEREQUIRED (0 =Override Reason not required; 1=
Override Reason Required)
• MUL_OVERRIDEREQUIRED_TYPE
• Pharmacy
• MUL_OVERRIDEREQUIRED_TYPE
• Bedrock
• Override Reason filters for All Alert Types and each specific Alert Type

32
Requiring Override Reasons in PowerChart
• PowerChart  Chart  PowerOrders 
MUL_OVERRIDEREQUIRED and
MUL_OVERRIDEREQUIRED_TYPES

33
Requiring Override Reasons in Med
Manager
• Pharmacy  MUL_OVERRIDEREQUIRED_TYPES

34
Override Reasons Display
• Bedrock Override Reasons Filters
• In order for an Override Reason to be available for “Apply to
All” it must be included in the “Override Reason for all Types”
filter

35
mCDS Discontinue Reasons
• Design Decisions
• Not Required
• Required
• What reasons to display
• Configure
• DCPTools.exe  Order Management  Order Entry Format
Tool  Formats  Pharmacy Order Entry Formats 
Discontinue Order Action  Discontinue Reasons Field
• Discontinue format build is required or mCDS window will
display an error
• Selections for field: Do Not Display, Display Only, Optional,
Required

36
Discontinue Reason Format
Selections for field: Do Not
Display, Display Only, Optional,
Required

37
mCDS Discontinue Reasons
• Must use code set 1309 for the drop down
• DCPTools.exe  Order Management  Order Entry Format
Tool  Fields  Discontinue Reason
• Must use Meaning of Discontinue Reason

38
Filtering Discontinue Reasons
• Configure in Bedrock
• Design, Build and Maintenance  Core – Orders  Order Entry
Field Value (Code Set) Filtering  Discontinue Reason (Code Set
1309)
• Catalog Type
• Activity Type
• Orderable

40
Agenda for Venue of Care Filtering
• Description
• Diagrams
• Diagrams – a second time
• How to set up
• Example
• Questions????

41
Support
support-mcds

42
Venue of Care Filtering
• Definition
• Filtering of all alert types (drug drug, drug food, drug allergies,
and duplicate therapy) when moving from home
(prescriptions) to inpatient and back to prescriptions.
• Rationale for filtering alerts
• Reduction of nuisance alerts when patients move across
venues of care (prescriptions (home) to inpatient to
prescriptions).
• Customization
• Bedrock mCDS wizard

43
• Applies to all alert types
• Drug Drug
• Drug Food
• Drug Allergy
• Duplicate Therapy
• Filters are in Bedrock
• Code set extension settings in CoreCodeBuilder.exe no longer
honored
• Home Medication to Inpatient Filtering (HXIP)
• Inpatient Filtering (IP)
• Inpatient to Prescription Filtering (IPRX)
• Prescription Filtering (RX)
• Filtering applies to all solutions and position codes

44
Venue Filters Off
• When all venue of care filters are off, checking will
occur across documented home medications, inpatient
orders, and prescription orders.

45

46
Venue of Care Filtering -- HXIP
• No alerts
• HXIP filtering on – No checking against medications when moving
from home meds to inpatient orders
• potassium chloride and diphenhydrAMINE drug drug interaction suppressed
• diphenhydrAMINE and loratadine duplicate checking suppressed
• same orderable duplicate checking suppressed
• This filter will always occur across solutions
HXIP Alerts Filtered

47

48
Venue of Care Filtering -- IP
• No alerts
• IP filtering on – No checking between medications continued
as inpatient orders
• Potassium chloride and diphenhydrAMINE drug drug interaction
suppressed
• diphenhydrAMINE and loratadine duplicate checking suppressed
• One time blocking
• Second time (e.g., verification by pharmacy) will see this alert
IP Alerts Filtered

49

50
Venue of Care Filtering -- IPRX
• No alerts
• IPRX filtering on – No checking against inpatient medications when
moving from inpatient meds to prescription orders
• This filter will always occur across solutions IPRX Alerts Filtered

51

52
Venue of Care Filtering -- RX
• No alerts
• RX filtering on – No checking between inpatient medications
continued as prescription orders
 Alert Checking does occur for medications that were not continued from
inpatient order – hydrOXYzine was not an inpatient medication
• One time blocking
• Second time will see this alert RX Alerts Filtered

53

54

55

56
• Bedrock.exe  Quality Reporting and MPages  MPage Setup
 Medication Clinical Decision Support (mCDS)

57
• Home Medication to Inpatient Filtering

58
• This setting determines if clinical checking will be filtered
between history and inpatient venues. This filter will be used
when an order moves from history to inpatient
venue(s) of care or an inpatient order is placed.

59

60
CoreCodeBuilder.exe

61
• Inpatient Filtering
• This setting is used to determine how clinical checking is
filtered during the patient’s inpatient stay. If enabled, one-time
blocking of clinical checking (drug drug, drug food, drug
allergy, duplicate therapy) will occur within the “inpatient”
venue of care.

62
• Inpatient Medication Filtering

63
• Inpatient to Prescription
• This setting determines if clinical checking will be filtered
between inpatient and discharge venues. This filter will be
used when an order moves from inpatient to discharge
venue(s) of care or an inpatient or prescription order is placed.

64
• Inpatient to Prescription Filtering

65
Venue Filtering
• Prescription Filtering
• This setting is used to determine how clinical checking is
filtered when prescriptions are prescribed. If enable, one-time
blocking of clinical checking (drug drug, drug food, drug
allergy, duplicate therapy) will occur within the discharge
venue of care.

66
• Prescription Filtering

67
• Example
• HXIP – On
• IP – On
• IPRX – On
• RX – On

68

69
• No alerts
• No duplicate checking against the same medications because
of HXIP from hx meds to inpatient orders
• IP blocked inpatient orders
• diphenhydrAMINE and loratadine duplicate checking

70
• Alert when ordering potassium chloride IV
• Potassium chloride IV was not a hx med therefore it checked
against all current inpatient orders

71
• Orders to be verified by pharmacy
• The one time blocking has occurred in PowerChart therefore
there will not be any IP blocking when verifying
• If orders are entered directly in PharmNet then the one time
blocking of IP will apply

72
• Alert with diphenhydrAMINE and potassium chloride IV

73
• Alert for loratadine and diphenhydrAMINE

74
• Alert when verifying potassium chloride IV
• Potassium chloride IV was not a hx med therefore it checked against
all current inpatient orders

75
• Pharmacy orders are verified

76
• Discharging the patient
• No alerts
• No duplicate checking against the same medications because
of IPRX from inpatient meds to prescription orders
• RX blocked prescription orders
• diphenhydrAMINE and loratadine duplicate checking

77
• Alert against the home medication hydrOXYzine and
diphenhydrAMINE
• hydrOXYzine was a hx med and not an inpatient medication therefore
it will be checked against prescription medications

78
loratadine
• hydrOXYzine was a hx med and not an inpatient medication
therefore it will be checked against prescription medications

79
potassium chloride
• hydrOXYzine was a hx med and not an inpatient medication
therefore it will be checked against prescription medications

80
Support
support-mcds

81
• Questions????

82
“Mr. Osborne,
may I be
excused?
My brain is full.”

84

85
MULPREF
• Turns on Multum within Matrix Orders.
• 1-On
• 0-Off

86
MUL_DS_STYLE
• This preference determines the style of the
interaction checking window.
• 1-Use enhanced window
• 0-Use classic window

87
MUL_MPAGE_VIEW
• Determines if the Medication Clinical Decision
Support (mCDS) view is enabled for Multum
interaction checking. When the value is set to
1 or 2, the preference MUL_DS_STYLE=1
(Use Enhanced View) must also be set.
• 1-On for Add Order or Product
• 0-Off
• 2-On for Sign Order or OK

88
MUL_OVERRIDEREQUIRED
• This preference determines whether an
Override Reason must be entered in order to
close the alert window.
• 1-Override reason required
• 0-Override reason not required

89
MULINTR
• This preference determines whether to
perform interaction checking when medication
orders are placed using Matrix Orders.
• 1-Interaction checking
• 0-No interaction checking

90
MUL_INTRSEVERITY
• This preference determines at what level
interaction checking will occur.
• 5-Major Contraindicated
• 3-Major
• 2-Moderate
• 1-Minor

91
MUL_INTERPRETEDSEVERITY
• This preference determines if interaction
checking should be performed based on
traditional Multum severities or on interpreted
severities using the interaction severity and
interaction severity heading. Note that any
customized severities will override the
interpreted severity.
• 0-Use traditional Multum severities
• 1-Use interpreted severities

92
MULREAT
perform allergy checking for medication orders
using Matrix Orders.
• 1-Allergy checking
• 0-No allergy checking

93
MUL_ALLERGYINTERRUPTION
• Determines whether to display the interaction
checking window for allergy reactions.
• 0-Display
• 1-Do not display

94
MUL_ALLERGY_REACTIONCLASS_FILTER
• This preference determines which types of
allergy reaction class's should be filtered out of
drug-allergy and reverse allergy interaction
checking. This preference is only used when
MUL_DS_STYLE is set to 1.
• The preference is a comma-separated list of
allergy reaction class codes from code set
12021. For example “3291,3292”
• Adverse Effect
• Side Effect

95
MULDUP
perform duplicate checking when medication
orders are placed using Matrix Orders.
• 1-Duplicate checking
• 0-No duplicate checking

96
MUL_DUPINTERRUPTION
• This preference determines whether the
interaction checking window will display when
ordering duplicate medications.
• 0-Display
• 1-Do not display

97
MULDUPCHECKPREF
• This preference determines the manner in
which duplicate checking is performed for
Pharmacy orders.
• 2-Dups against both
• 0-Dups against scratchpad
• 1-Dups against existing orders
• 3-Dups against scratchpad minus same CKI’s
• 4-Dup against sp minus same cki and existing

98
MULDUPMODE
• This preference determines when the
duplicate checking window will display.
• 2-Both
• 0-Single Drug
• 1-Category

99
MULDUPCAT
• This preference determines the level of
duplicate checking when different drugs have
identical or similar clinical effects. This
preference is only used when MULDUPMODE
is set to Category or Both.
• C-Very Specific
• B-General
• A-Very General

10
0
MULDUPCLASS
• This preference determines whether duplicate
therapy checking should be applied across
both inpatient and outpatient drugs or to check
exclusively inpatient or outpatient drugs.
• 1-Mutually Exclusive
• 0-All

10
2

10
3
MultumCustom.exe
Drug Drug Interaction
• Severity
• Severity Header
• Suppression
• Text
Duplicate Therapy Checking
• Repeat Numbers – Must have package number 68066 or higher
installed
• Duplication Category
• Drug
• Suppression
• Drug
Drug Allergy Checking
• Drug to Drug
• Allergy Category to Drug
Reference Text

10
4
Duplicate Therapy
• Suppression
•Duplication Category
• Drug
• Repeat Number
• Drug

10
5
Duplication Therapy Searches
Drug
• Individual drug
Category
• All individual drugs within a drug category
Duplication Category
• The actual duplication category

10
6
Duplicate Therapy
• Example
• Laxatives
Reference Pages  All About Medication Clinical
Decision Support
• https://wiki.ucern.com/display/public/reference/All+About
+Medication+Clinical+Decision+Support

10
7
Drug Allergy
• Allergy Category
• Suppression of documented allergy
category
• Additional searches
• Allergy Category Drug
• The documented allergy category to a drug
• Allergy Category Category
• The documented allergy category to all individual drugs within a drug category

10
8
Drug Allergy
Drug Drug
• Individual drugs
• e.g. oxyCODONE / meperidine
Category Drug
• All individual drugs within a drug category to a drug
• e.g. penicillins / aztreonam
Category Category
• All individual drugs within categories
• e.g. loop diuretics / sulfonamides
Allergy Category Drug
• The documented allergy category to a drug
• e.g. penicillins / aztreonam
Allergy Category Category
• The documented allergy category to all individual drugs within a
drug category
• e.g. loop diuretics / Sulfa drugs

10
9
Drug Allergy
• Example
• Sulfa Drugs and Loop Diuretics
Decision Support

11
0
Drug Allergy Suppression Client Example
Suppression
loop diuretics (category) / sulfonamides (category)
loop diuretics (category) / sulfa drugs (allergy category)
loop diuretics (category) / sulfonamides (allergy category)
loop diuretics (category) / COX-2 inhibitors (category)
penicillins (allergy category) / aztreonam (drug)
penicillins (category) / aztreonam (drug)
codeine (drug) / meperidine (drug)
codeine (drug) / fentanyl (drug)
morphine (drug) / meperidine (drug)
oxyCODONE (drug) / meperidine (drug)
oxyCODONE (drug) / fentanyl (drug)
fentaNYL (drug) / HYDROmorphone (drug)
meperidine (drug) / acetaminophen-oxycodone (drug)
meperidine (drug) / HYDROmorphone (drug)
acetaminophen-propoxyphene (drug) / HYDROmorphone (drug)
acetaminophen-propoxyphene (drug) / acetaminophen-oxycodone (drug)
acetaminophen-hydrocodone (drug) / meperidine (drug)
nalbuphine (drug) / meperidine (drug)
carbapenems (category) / third generation cephalosporins (category)

111
Drug Allergy Suppression Most Questioned/Reviewed
Sulfonamides and Related Compounds Classification
carbonic anhydrase inhibitor sulfonylurea sulfonamide
d00161 acetaZOLAMIDE d00162 acetoHEXAMIDE d04428 amprenavir
d04301 brinzolamide ophthalmic d00042 chlorproPAMIDE d04301 brinzolamide ophthalmic
d00639 dichlorphenamide d03864 glimepiride d04380 celecoxib
d03805 dorzolamide ophthalmic d00246 glipiZIDE d05825 darunavir
d00640 methazolamide d00248 glyBURIDE d00129 diazoxide
sulfa topical d00393 TOLAZamide d04901 fosamprenavir
d01258 mafenide topical d00394 TOLBUTamide d00031 probenecid
d01259 silver sulfADIAZINE topical thiazide or thiazide-like diuretic d08182 simeprevir
d01208 sulfacetamide sodium ophthalmic d00641 bendroflumethiazide d00118 sulfADIAZINE
d01265 sulfacetamide sodium topical d00644 benzthiazide d03742 sulfadoxine
d01240 sulfanilamide topical d00190 chlorothiazide d01090 sulfamethizole
d03980 sulfiSOXAZOLE ophthalmic d00253 hydrochlorothiazide d00119 sulfamethoxazole
d03231 triple sulfa topical d00645 hydroflumethiazide d00379 sulfaSALAzine
sulfonamide-type loop diuretic d00260 indapamide d00120 sulfiSOXAZOLE
d00179 bumetanide d00643 methyclothiazide d07942 sulfonated phenolics topical
d00070 furosemide d00647 polythiazide d04121 tamsulosin
d03189 torsemide d00646 trichlormethiazide d05538 tipranavir
sulfone thiazide-like diuretic d04778 valdecoxib
d00098 dapsone d00192 chlorthalidone d04527 zonisamide
d05543 dapsone topical d00299 metolazone

11
2
Penicillins and Related Drugs Classification
beta lactamase inhibitor cephalosporin
d04405 clavulanate d00081 cefaclor
d04403 sulbactam d00080 cefadroxil
d04404 tazobactam d00062 cefamandole
carbapenem d00007 ceFAZolin
d07049 doripenem d04256 cefdinir
d04783 ertapenem d04767 cefditoren
d04401 imipenem d03882 cefepime
d04027 meropenem d00072 cefixime
monobactam d00093 cefmetazole
d00067 aztreonam d00063 cefonicid
penicillin d00074 cefoperazone
d00088 amoxicillin d00008 cefotaxime
d00003 ampicillin d00055 cefoTEtan
d00151 bacampicillin d00094 cefOXitin
d00092 carbenicillin d00095 cefpodoxime
d00152 cloxacillin d00073 cefprozil
d00153 dicloxacillin d07706 ceftaroline
d00107 methicillin d00009 cefTAZidime
d00109 mezlocillin d03874 ceftibuten
d00029 nafcillin d00010 ceftizoxime
d00115 oxacillin d00052 cefTRIAXone
d00116 penicillin d00056 cefuroxime
d07727 penicillin G benzathine d00096 cephalexin
d07729 penicillin G potassium d00186 cephalothin
d07728 penicillin G sodium d00187 cephapirin
d07730 penicillin V potassium d00053 cephradine
d00057 piperacillin d00105 loracarbef
d07390 procaine penicillin
d00121 ticarcillin

11
3
Narcotic Analgesics Classification
methadone-like opiate phenanthrene derivative
d03187 levomethadyl acetate d04991 apomorphine
d00050 methadone d00840 buprenorphine
d00360 propoxyphene d00838 butorphanol
opioid-like analgesic d04251 butorphanol nasal
d03826 traMADol d00012 codeine
phenylpiperidine derivative d00837 dezocine
d00167 alfentanil d03168 dihydrocodeine
d03069 difenoxin d03877 heroin (Schedule I substance)
d03071 diphenoxylate d03075 HYDROcodone
d00233 fentaNYL d00255 HYDROmorphone
d04313 fentanyl topical d00825 levorphanol
d00017 meperidine d00308 morphine
d04034 remifentanil d05295 morphine liposomal
d00378 SUFentanil d00839 nalbuphine
d00824 opium
d00329 oxyCODONE
d00833 oxymorphone
d00334 pentazocine

11
4
Drug Drug
• Suppression
• Severity
• Major
• Moderate
• Minor
• Header Severity
• Contraindicated
• Major and Contraindicated is the major contraindicated
preference
• Generally Avoid
• Monitor Closely
• Adjust Dosing Interval
• Adjust Dose
• Additional Contraception Recommended
• Monitor
• Monograph Text

11
5
Drug Drug
Drug Drug
• Individual drugs
Category Drug
• All individual drugs within a drug category to a drug
Category Category
• All individual drugs within categories

11
6
Drug Drug
• Example
• Customizing to Major Contraindicated
Decision Support

Filtering Medication Alerts
Using Discern Expert

11
8
Filtering Medication Alerts Using Discern Expert
• Apply Discern Expert rules to interaction pairs
• Display additional information
• Suppress alerts based on patient parameters
• The Discern Expert rule is built in Discern EKM
Development application available in Discern Launch
• Evoke MUST be SYNCHEVENT
• Rule firing will not result in the mCDS window displaying;
result will display when other alert types involving the
interaction pair have fired, displaying the window
• The Expert Synch trigger is included in multumcustom.exe

11
9

12
0

12
1
Filtering Medication Alerts Using Discern Expert
• Examples
• Suppression drug drug interactions based on lab values
• Displaying Lab Values
Support

12
3
TPN
• Filters within the TPN when TPNs are built as an IV set
• Alert before the filter is applied

12
4
• Filtering duplication checking within a TPN
Support
TPN

12
6
Order Detail Filtering
• Create meaningful alerts that enhance safety
and improve patient care by making alert more
patient specific.

12
7
• Examples
• Filter out specific alerts for providers
• Cardiologic vs. Infection Control Physician
• Filter out alerts for due to specific routes
• Anticholinergents and Potassium Chloride
• Ciprofloxacin and Antacids
• Allow multiple drugs to be ordered based on PRN
reason
• Narcotic Analgesics
• Allow multiple drugs to be ordered based on
frequency
• Midazolam
• Aspirin and NSAIDs

12
8
• Examples
reason
frequency
• Midazolam

12
9
• Examples
reason
frequency
• Midazolam

13
0
• Examples
reason
frequency
• Midazolam

13
1
• Examples
reason
frequency
• Midazolam

13
2
• Filtering alerts based on orderable or drug
category and order entry format fields
• Strength dose
• Volume dose
• Duration
• Route
• Dosage form
• Frequency
• PRN reason

13
3
• Build in Bedrock
• Filtering of orderable and order details
• When a second order is placed with the same data an alert
will fire
• Based on orderable or drug category
• Based on order entry details
• Can be based on provider’s position
• At least one orderable/drug category and one
order entry detail are required
• Up to four different scenarios
• Next package will have 10 filters

13
4
• Bedrock.exe  Quality Reporting and MPages  MPage Setup
 Medication Clinical Decision Support (mCDS)  Order Detail
Filtering Group

13
5
• Examples
• Potassium Chloride and Anticholinergic Medications
• Narcotics with Different PRN Reasons
• Amlodipine and Strength of Simvastatin
• Position Filtering
Support

13
7
mCDS Set Up
• Set preferences
• Run Bedrock Wizard for Multum content
• Up to date Multum content
• Attach missing CKI’s
• Use meds_cki_utility to remove incorrect CKI’s

13
8
mCDS Set Up
• Develop the scenario
• Criteria for filtering
• Primary level
• Drug drug interactions
• Drug allergies
• Drug duplication
• Criteria on patient’s profile
• Lab values
• Age
• Order Detail Specific
• PRN reason
• Route
• Doseform

13
9
mCDS Set Up
• For better maintenance customize or filter at the
highest level
• Preference
• Multumcustom.exe
• Drug drug interactions at primary level
• Duplicate Therapy suppression and repeat numbers
• Allergies at primary level
• Discern Alerts
• Lab Values
• Age
• PRN reason
• Route
• Doseform

14
0
Trouble Shooting
• Run scenario without filter and get an alert
• This will let you know if there is something else not set
correctly
• CKI
• Preference
• Other Customizations
• Set up filter
• If multiple order details try setting one test and then set
the second one
• Run scenario not to receive an alert
• Run scenario to receive an alert

14
1
Trouble Shooting
• When receiving an alert and not expecting an
alert
• Use the duplicate therapy text to find out if it is an
individual drug or class duplicate

14
2
Trouble Shooting
• Use Check Interactions before signing the
order.

14
3
Trouble Shooting
• Use Alert History when still verifying or
ordering.

14
4
Trouble Shooting
• Use Alert History after the order has been
signed.

14
5
Trouble Shooting
• Use Alert History after the order has been
submitted.

14
6
mCDS Set UP
• Dashboard  Reference Pages  PharmNet
Inpatient Reference Pages  All About Medication
Clinical Decision Support
• https://wiki.ucern.com/display/public/reference/All+
About+Medication+Clinical+Decision+Support
• Medication Clinical Decision Support (mCDS) Scenarios
Build

14
8
Alert Maintenance
• The ability to turn on alerts for only certain
drug orderables or drug categories.
• Allergies
• Drug Duplicates
• Set up in Bedrock

14
9
Alert Maintenance
• Alert Maintenance
Decision Support

15
1
Support
support-mcds

15
2
Support
support-mcds

chc_2015

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Editor's Notes