Rogers Jeremy E, Wroe Christopher J, Roberts Angus, Swallow Angela, Stables David, Cantrill Judith A, Rector Alan L
Medical Informatics Group, Department of Computer Science, Oxford Road, University of Manchester, Manchester M13 9PL.
Br J Gen Pract. 2003 Nov;53(496):838-44.
Good clinical practice in primary care includes periodic review of repeat prescriptions. Markers of prescriptions that may need review have been described, but manually checking all repeat prescriptions against the markers would be impractical.
To investigate the feasibility of computerising the application of repeat prescribing quality checks to electronic patient records in United Kingdom (UK) primary care.
Software performance test against benchmark manual analysis of cross-sectional convenience sample of prescribing documentation.
Three general practices in Greater Manchester, in the north west of England, during a 4-month period in 2001.
A machine-readable drug information resource, based on the British National Formulary (BNF) as the 'gold standard' for valid drug indications, was installed in three practices. Software raised alerts for each repeat prescribed item where the electronic patient record contained no valid indication for the medication. Alerts raised by the software in two practices were analysed manually. Clinical reaction to the software was assessed by semi-structured interviews in three practices.
There was no valid indication in the electronic medical records for 14.8% of repeat prescribed items. Sixty-two per cent of all alerts generated were incorrect. Forty-three per cent of all incorrect alerts were as a result of errors in the drug information resource, 44% to locally idiosyncratic clinical coding, 8% to the use of the BNF without adaptation as a gold standard, and 5% to the inability of the system to infer diagnoses that, although unrecorded, would be 'obvious' to a clinical reading the record. The interviewed clinicians supported the goals of the software.
Using electronic records for secondary decision support purposes will benefit from (and may require) both more consistent electronic clinical data collection across multiple sites, and reconciling clinicians' willingness to infer unstated but 'obvious' diagnoses with the machine's inability to do the same.
基层医疗中的良好临床实践包括定期复查重复处方。已有可能需要复查的处方标记，但手动对照这些标记检查所有重复处方是不切实际的。
探讨在英国基层医疗中将重复处方质量检查应用于电子病历的计算机化可行性。
针对处方文档横断面便利样本的基准手动分析进行软件性能测试。
2001年为期4个月的时间里，在英格兰西北部大曼彻斯特的三家全科诊所。
在三家诊所安装了一个基于《英国国家处方集》（BNF）作为有效药物适应症“金标准”的机器可读药物信息资源。对于电子病历中没有该药物有效适应症的每个重复处方项目，软件会发出警报。对两家诊所软件发出的警报进行了人工分析。通过在三家诊所进行的半结构化访谈评估临床医生对该软件的反应。
14.8%的重复处方项目在电子病历中没有有效适应症。所有生成的警报中有62%是错误的。所有错误警报中有43%是由于药物信息资源中的错误，44%是由于局部特有的临床编码，8%是由于未作调整就将BNF用作金标准，5%是由于系统无法推断出那些虽然未记录但临床医生阅读记录时“明显”的诊断。接受访谈的临床医生支持该软件的目标。
将电子病历用于二级决策支持，将受益于（并且可能需要）多个地点更一致的电子临床数据收集，以及协调临床医生推断未明确但“明显”诊断的意愿与机器无法做到这一点之间的矛盾。
