Haefeli Walter E, Seidling Hanna M
Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018 Mar;61(3):271-277. doi: 10.1007/s00103-017-2685-8.
Because of its inherent complexity, it is a considerable challenge to tailor drug treatment to a prevalent disease and its subgroups, which are increasingly defined by genomic variability (personalized medicine) and require consideration of context information such as co-morbidity, co-medication, patient preferences, and the specific characteristics of the healthcare sector. Thus, optimum treatment decisions might not be taken intuitively any longer, because decisions must be made both rapidly and increasingly based on analyses of complex relations of numerous variables that exceed the processing performance of a human brain. Hence, computer support is indispensable to ensure error-free high-performance medicine. A key step in computer-supported medication safety is to implement a computerized physician order entry (CPOE) system that compiles a patient's medication in a structured and coded format enabling the link to clinical decision support (CDS) systems. Implementing a CPOE is hence a strategic step for a hospital, which is crucial to exhaustingly and consistently prevent medication errors. Thereby, the best performance of a CPOE is achieved if it is deeply integrated into an electronic patient record thus enabling access to relevant patient information, which again has to be structured to allow processing. To efficiently support drug treatment, CDS systems must fulfill high-quality standards with regard to underlying data, integration, and user-interaction to ensure that they support but do not impede the provision of care.
由于其内在的复杂性，针对一种常见疾病及其亚组进行药物治疗是一项相当大的挑战，这些亚组越来越多地由基因组变异性来定义（个性化医疗），并且需要考虑诸如合并症、联合用药、患者偏好以及医疗保健部门的具体特征等背景信息。因此，最佳治疗决策可能不再能凭直觉做出，因为决策必须快速且越来越多地基于对众多变量复杂关系的分析，而这些变量超出了人脑的处理能力。因此，计算机支持对于确保无差错的高性能医疗是不可或缺的。计算机支持的用药安全的关键一步是实施一个计算机化医师医嘱录入（CPOE）系统，该系统以结构化和编码格式汇编患者的用药信息，以便能够与临床决策支持（CDS）系统相链接。因此，实施CPOE是医院的一个战略步骤，对于全面且持续地预防用药错误至关重要。从而，如果将CPOE深度集成到电子病历中，使其能够访问相关患者信息，而这些信息又必须进行结构化以便处理，那么就能实现CPOE的最佳性能。为了有效地支持药物治疗，CDS系统必须在基础数据、集成和用户交互方面满足高质量标准，以确保它们支持而不阻碍医疗服务的提供。
