Screening for medication errors using an outlier detection system
Screening for medication errors using an outlier detection system
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DOI：
10.1093/jamia/ocw171
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发表时间：
2017-03-01
影响因子：
6.4
通讯作者：
Rozenblum, Ronen
中科院分区：
文献类型：
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作者：
Schiff, Gordon D.;Avolk, Lynn;Rozenblum, Ronen
目的：本研究的目的是评估的准确性，有效性和临床实用性的用药错误警报系统使用离群值检测screening.Materials和方法：五年的临床数据提取的电子健康记录系统的747 985例患者在2012-2013年期间至少有一次访问的做法附属于2个学术医疗centers. Materials。使用该系统筛选数据，以检测提示潜在用药错误的离群值。从生成的15693个警报中选择了300个图表样本进行审查。一个编码系统的开发和代码分配的基础上，图表审查，以反映的准确性，有效性和临床价值的alerts.Results：四分之三的图表审查警报产生的筛选系统被认为是有效的，其中潜在的用药错误被确定。在这些有效警报中，发现大多数（75.0%）在标记潜在用药错误或问题方面具有临床意义。讨论内容：临床决策支持（CDS）系统使用基于统计导出的离群值的概率机器学习方法来检测用药错误，该系统生成了具有适度误报率的潜在有用警报。这样一个监督和警报系统的性能是严重依赖于质量和完整性的基础data.Conclusion：筛选系统能够生成警报，否则可能会错过与现有的CDS系统，这样做了一个合理的高度的警报有用性时，审查患者的临床背景和细节。
Objective: The study objective was to evaluate the accuracy, validity, and clinical usefulness of medication error alerts generated by an alerting system using outlier detection screening.Materials and Methods: Five years of clinical data were extracted from an electronic health record system for 747 985 patients who had at least one visit during 2012-2013 at practices affiliated with 2 academic medical centers. Data were screened using the system to detect outliers suggestive of potential medication errors. A sample of 300 charts was selected for review from the 15 693 alerts generated. A coding system was developed and codes assigned based on chart review to reflect the accuracy, validity, and clinical value of the alerts.Results: Three-quarters of the chart-reviewed alerts generated by the screening system were found to be valid in which potential medication errors were identified. Of these valid alerts, the majority (75.0%) were found to be clinically useful in flagging potential medication errors or issues. Discussion: A clinical decision support (CDS) system that used a probabilistic, machine-learning approach based on statistically derived outliers to detect medication errors generated potentially useful alerts with a modest rate of false positives. The performance of such a surveillance and alerting system is critically dependent on the quality and completeness of the underlying data.Conclusion: The screening system was able to generate alerts that might otherwise be missed with existing CDS systems and did so with a reasonably high degree of alert usefulness when subjected to review of patients' clinical contexts and details.