Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States.
Harvard Business School, Boston, Massachusetts, United States.
Appl Clin Inform. 2021 Jan;12(1):153-163. doi: 10.1055/s-0041-1722917. Epub 2021 Mar 3.
Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed.
To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot.
The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists.
For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug-drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot.
Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.
大量研究已经针对电子医嘱录入系统对住院环境下药物安全的影响展开，但在大多数药物都被开出的门诊环境中，相关研究相对较少。
概述门诊电子健康记录（EHR）评估工具的开发和试点过程，并报告试点的定量和定性结果。
门诊 EHR 评估工具与 The Leapfrog Group 管理的住院版本评估工具非常相似。该工具在全美 7 家诊所进行了试点，每家诊所都使用了不同的 EHR。该工具包括药物安全测试和药物重整模块。在药物测试中，诊所将测试患者及其相关测试医嘱输入到他们的 EHR 中，并记录他们收到的任何决策支持信息。诊所会收到一个不安全医嘱检测的总体百分比分数和订单类别分数。对于药物重整模块，诊所展示了他们的 EHR 如何通过电子方式检测两个药物清单之间的差异。
在药物安全测试中，诊所正确警示了 54.6%的不安全药物医嘱。诊所在药物过敏（100%）和药物相互作用（89.3%）类别中得分最高。较低的评分类别包括药物年龄（39.3%）和治疗性重复用药（39.3%）。没有一家诊所对药物实验室或药物监测医嘱发出警示。在药物重整模块中，有 3 家（42.8%）诊所具有基于 EHR 的药物重整功能；但只有一家诊所能够在试点中演示该功能。
诊所难以处理药物年龄、药物实验室和药物监测等高级决策支持领域的问题。大多数诊所没有基于 EHR 的药物重整功能，而且该过程依赖于获取患者的药物清单。更广泛地使用该工具可以提高门诊药物安全性，并为供应商提供改进方向的信息。
