Spyropoulos Alex C, Viscusi Anna, Singhal Nakul, Gilleylen Jason, Kouides Peter, Howard Maureen, Rudd Kelly, Ansell Jack, Triller Darren M
North Shore Long Island Jewish Health System at Lenox Hill Hospital, New York, NY, USA
IPRO, Albany, NY, USA.
Ann Pharmacother. 2015 Jan;49(1):113-24. doi: 10.1177/1060028014555176. Epub 2014 Oct 16.
Oral anticoagulants are prescribed to millions of Americans, and consequently are among the medications most likely to contribute to emergency department visits and hospitalizations. Although guidelines and consensus statements promote systematic approaches to therapy, anticoagulation (AC) management is often suboptimal. Electronic health records (EHRs) have the potential to improve safety and quality but have not yet incorporated specialized features necessary to optimize therapy.
To generate a comprehensive, consensus-based list of EHR features clinically necessary to deliver optimized AC management, provide a "language bridge" to accelerate incorporation of features into EHR systems, and suggest mechanisms for the objective evaluation of available EHRs.
A multidisciplinary panel of AC specialists utilized the framework of a previously published consensus statement to map outpatient AC management and developed a comprehensive array of sequential computer logic steps using a restricted language scheme. Logic steps were then translated into narrative descriptions of potential EHR features, which were refined through multiple group evaluations. A finalized list of proposed features was ranked according to perceived clinical necessity by physician, pharmacist, and nurse panelists in a blinded manner using a 5-point Likert scale. Features receiving no more than 1 dissenting opinion were included in a finalized list of clinically necessary features.
The task force generated 78 recommended EHR features across 20 key discrete areas and 425 individual logic steps. All recommended features received Strongly Agree or Agree rankings regarding their perceived clinical necessity, and no feature received more than a single Disagree response.
The incorporation of key AC-related features into existing EHRs or specialized AC management systems has the potential to systematize the delivery of optimal AC care by health care professionals at the point of care. Optimized AC management has the potential to reduce adverse drug events associated with anticoagulant therapy in the outpatient setting.
数百万美国人正在服用口服抗凝药，因此这类药物是导致急诊就诊和住院的最常见药物之一。尽管指南和共识声明提倡采用系统的治疗方法，但抗凝管理往往并不理想。电子健康记录（EHR）有潜力提高安全性和质量，但尚未纳入优化治疗所需的专门功能。
生成一份基于共识的全面列表，列出优化抗凝管理在临床上所需的电子健康记录功能，提供一座“语言桥梁”以加速这些功能融入电子健康记录系统，并提出客观评估现有电子健康记录的机制。
一个由抗凝专家组成的多学科小组利用先前发表的共识声明框架来规划门诊抗凝管理，并使用受限语言方案制定了一系列全面的顺序计算机逻辑步骤。然后将逻辑步骤转化为对潜在电子健康记录功能的叙述性描述，并通过多次小组评估进行完善。由医生、药剂师和护士小组成员以盲法使用5点李克特量表，根据感知到的临床必要性对最终提出的功能列表进行排序。获得不超过1条反对意见的功能被纳入临床必需功能的最终列表。
该特别工作组在20个关键离散领域和425个单独逻辑步骤中生成了78条推荐的电子健康记录功能。所有推荐功能在其感知到的临床必要性方面均获得了“强烈同意”或“同意”的排名，且没有一个功能获得超过一条“不同意”的回复。
将关键的抗凝相关功能纳入现有的电子健康记录或专门的抗凝管理系统，有可能使医疗保健专业人员在护理点系统地提供最佳抗凝治疗。优化的抗凝管理有可能减少门诊环境中与抗凝治疗相关的药物不良事件。
