Koutkias V G, McNair P, Kilintzis V, Skovhus Andersen K, Niès J, Sarfati J-C, Ammenwerth E, Chazard E, Jensen S, Beuscart R, Maglaveras N
V. G. Koutkias, Lab of Medical Informatics, Dept. of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece, E-mail:
Methods Inf Med. 2014;53(6):482-92. doi: 10.3414/ME14-01-0027. Epub 2014 Nov 7.
Errors related to medication seriously affect patient safety and the quality of healthcare. It has been widely argued that various types of such errors may be prevented by introducing Clinical Decision Support Systems (CDSSs) at the point of care.
Although significant research has been conducted in the field, still medication safety is a crucial issue, while few research outcomes are mature enough to be considered for use in actual clinical settings. In this paper, we present a clinical decision support framework targeting medication safety with major focus on adverse drug event (ADE) prevention.
The novelty of the framework lies in its design that approaches the problem holistically, i.e., starting from knowledge discovery to provide reliable numbers about ADEs per hospital or medical unit to describe their consequences and probable causes, and next employing the acquired knowledge for decision support services development and deployment. Major design features of the framework's services are: a) their adaptation to the context of care (i.e. patient characteristics, place of care, and significance of ADEs), and b) their straightforward integration in the healthcare information technologies (IT) infrastructure thanks to the adoption of a service-oriented architecture (SOA) and relevant standards.
Our results illustrate the successful interoperability of the framework with two commercially available IT products, i.e., a Computerized Physician Order Entry (CPOE) and an Electronic Health Record (EHR) system, respectively, along with a Web prototype that is independent of existing healthcare IT products. The conducted clinical validation with domain experts and test cases illustrates that the impact of the framework is expected to be major, with respect to patient safety, and towards introducing the CDSS functionality in practical use.
This study illustrates an important potential for the applicability of the presented framework in delivering contextualized decision support services at the point of care and for making a substantial contribution towards ADE prevention. Nonetheless, further research is required in order to quantitatively and thoroughly assess its impact in medication safety.
与用药相关的差错严重影响患者安全和医疗质量。人们普遍认为，通过在医疗点引入临床决策支持系统（CDSS）可以预防各类此类差错。
尽管该领域已开展了大量研究，但用药安全仍是一个关键问题，而很少有研究成果成熟到足以考虑在实际临床环境中使用。在本文中，我们提出了一个针对用药安全的临床决策支持框架，主要侧重于预防药物不良事件（ADE）。
该框架的新颖之处在于其整体解决问题的设计，即从知识发现入手，提供每个医院或医疗单元关于ADE的可靠数据，以描述其后果和可能原因，然后利用所获取的知识来开发和部署决策支持服务。该框架服务的主要设计特点包括：a）它们适应医疗环境（即患者特征、医疗地点和ADE的重要性），以及b）由于采用了面向服务的架构（SOA）和相关标准，它们能够直接集成到医疗信息技术（IT）基础设施中。
我们的结果表明，该框架分别与两种市售IT产品成功实现了互操作性，即计算机化医师医嘱录入（CPOE）系统和电子健康记录（EHR）系统，以及一个独立于现有医疗IT产品的网络原型。与领域专家和测试用例进行的临床验证表明，该框架在患者安全方面以及在将CDSS功能引入实际应用方面预计将产生重大影响。
本研究表明，所提出的框架在提供医疗点情境化决策支持服务以及对预防ADE做出重大贡献方面具有重要的应用潜力。尽管如此，仍需要进一步研究以定量和全面评估其对用药安全的影响。
