Costello Rebecca B, Deuster Patricia A, Michael Madeline, Utech Anne
Office of Dietary Supplements, NIH, Bethesda, MD.
Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Hébert School of Medicine, Uniformed Services University, Bethesda, MD.
Nutr Today. 2019;54(4):144-150. doi: 10.1097/nt.0000000000000348.
Of importance to federal agencies that administer health care facilities is capturing patient use of dietary supplements (DS) to avoid potential drug - supplement interactions. Digital technologies, such as use of the electronic medical record and the electronic health record (EHR) are key to monitoring health care. The particular electronic software package and the health care professional using this software influences how this documentation is recorded. A survey was conducted to determine how information on DS is being collected, recorded, and processed in EHR across federal agencies. Four federal agencies providing direct health care services to large numbers of men and women in the US were surveyed on current practices regarding the recording and processing of information on DS use either on outpatient or inpatient basis. A point of contact for each of the following federal agencies was identified, and a 13-question survey was sent to each for completion: NIH Clinical Center, Department of Defense (DoD) Military Nutrition Committee, Veterans Health Administration (VHA) Office of Specialty Care Services, and the Indian Health Service (IHS), Office of Information Technology. All four agency representatives completed the survey. No agency used the same EHR software reporting system. Most EHR have searchable fields that are in a structured format, but some information is free text and allowed entry by multiple members of the health-care team. Three different medication formulary or drug knowledge databases were utilized across the agencies. Most agencies using EHR management systems have adequately described procedures for entering and charting information on DS. The responsibility for charting, however, varies across agencies whether captured by the admitting doctor, nurse, dietitian, or pharmacist. Direct linkage between the pharmacy system and the drug knowledge database is a feature of the EHR for several but not all federal agencies. An unmet need still exists in the EHR to implement DS/drug interaction checks as many DS products have multiple active ingredients and when taken with other DS or prescription drugs increase the likelihood of an adverse event. Establishing common EHR practices could facilitate monitoring the use and potential interactions of DS with prescribed drugs.
对于管理医疗保健设施的联邦机构而言，重要的是掌握患者对膳食补充剂（DS）的使用情况，以避免潜在的药物 - 补充剂相互作用。数字技术，如电子病历和电子健康记录（EHR）的使用，是监测医疗保健的关键。特定的电子软件包以及使用该软件的医疗保健专业人员会影响信息的记录方式。开展了一项调查，以确定在联邦各机构的电子健康记录中，有关DS的信息是如何收集、记录和处理的。对在美国为大量男女提供直接医疗服务的四个联邦机构进行了调查，了解其在门诊或住院情况下记录和处理DS使用信息的现行做法。确定了以下每个联邦机构的一个联系人，并向每人发送了一份包含13个问题的调查问卷以供填写：国立卫生研究院临床中心、国防部（DoD）军事营养委员会、退伍军人健康管理局（VHA）专科护理服务办公室以及印第安卫生服务局（IHS）信息技术办公室。所有四个机构的代表都完成了调查。没有一个机构使用相同的电子健康记录软件报告系统。大多数电子健康记录都有可搜索的结构化字段，但有些信息是自由文本，允许医疗团队的多名成员录入。各机构使用了三种不同的药物处方集或药物知识数据库。大多数使用电子健康记录管理系统的机构都充分描述了录入和记录DS信息的程序。然而，记录的责任在各机构之间有所不同，可能由主治医生、护士、营养师或药剂师负责。药房系统与药物知识数据库之间的直接链接是几个但并非所有联邦机构电子健康记录的一个功能。电子健康记录中仍存在未满足的需求，即实施DS/药物相互作用检查，因为许多DS产品含有多种活性成分，与其他DS或处方药一起服用时会增加不良事件的发生可能性。建立通用的电子健康记录做法有助于监测DS与处方药的使用及潜在相互作用。
