HEALTH APPLICATIONS FOR THE NATIONAL INFORMATION INFRA

我们将重新实施两个成功的制药相关专家系统， 剂量监测和药物不良事件（ADE）监测，以利用 一个广泛的远程医疗网络Dosebridge提供药物给药 基于药房医嘱和患者特定特征的警告，例如 年龄、性别、体重和估计的肌酐清除率。ADE Monitor检查 患者药物订单和实验室和实验室测试结果，提醒医院 当它检测到药物不良事件的迹象，如药物 交互.这些专家系统一旦重新部署， 临床数据存储库收集的所有临床环境 所需数据。1996年期间，密苏里州和伊利诺斯州的六家医院--巴恩斯， 犹太人，基督教东北，基督教西北，奥尔顿纪念，和巴恩斯西 县-将拥有所需的人口统计、实验室和药房数据 对于进入存储库的DoseMonitor和ADE Monitor。这套 医院包含两个学术设施（巴恩斯和犹太），两个大的 社区设施（基督教东北和奥尔顿纪念馆）一个小社区 设施（巴恩斯西县），和一个主要的门诊护理 （Christian NW）重新实施的系统将作为 远程医疗试验台，以检查大规模的影响，广泛的是 在不同的临床环境中部署临床决策支持。 具体来说，我们将评估专家系统的性能，医生 接受度和临床设置。通过利用 标准临床词汇和广泛的网络互连， 我们可以在临床实践环境中提供相同的CDS功能 这将造成重大的技术障碍，并要求 大量返工。通过保持决策支持系统不变， 评估研究将使我们能够研究临床环境的影响， 这两个系统的有效性的变量。此外，我们将 实施和评估多个决策支持警报通知 方法包括基于GUI的应用程序、电子邮件、传真/打印机报告， 自动寻呼和交互式语音按摩使用商业 电话产品，以检查替代通知的影响 决策支持警报的及时性和临床影响。 使用这种基于配置的通知基础结构，我们还 将调查患者的保密性和隐私妥协， 可能会因其他通知方法而发生。通过允许多个 可能在不同位置的临床医生， 条件下，我们还可以评估合作使用的影响或价值， 这项技术来治疗BJC患者。通过我们的研究决定，我们可以 检查警报方法、决策支持 有效性和患者保密性。

We will reimplement two successful pharmacy-related expert systems, DoseChecker and Adverse Drug Event (ADE) Monitor, to exploit the existence of an extensive telemedicine network. DoseChecker provides drug dosing warnings based on pharmacy orders and patient specific features such as age, sex, weight, and estimated creatinine clearance. ADE Monitor examines patient drug orders and lab and lab test results, alerting hospital pharmacists when it detects signs of adverse drug events such as drug interactions. Once redeployed, these expert systems will be accessible to all clinical settings from which the clinical data repository collects the required data. During 1996, six hospital in Missouri and Illinois--Barnes, Jewish, Christian NE, Christian NW, Alton Memorial, and Barnes West County--will have the demographic, laboratory and pharmacy data required for DoseChecker and ADE Monitor entering the repository. This set of hospitals contains two academic facilities (Barnes and Jewish), two large community facilities (Christian NE and Alton Memorial) a small community facility (Barnes West County), and a predominantly ambulatory care facility (Christian NW). The reimplemented systems will serve as a telemedicine test bed to examine the impact of large-scale, wide-are deployment of clinical decision support in diverse clinical environments. Specifically, we will evaluate the expert system performance, physician acceptance, and clinical settings. By exploiting the existence of a standard clinical vocabulary and extensive networking interconnectivity, we can provide identical CDS functionality at clinical practice settings which preciously would pose significant technological barriers and require substantial rework. By keeping the decision support system constant, our evaluation studies will allow us to study the impact of clinical-setting variables on the effectiveness of these tow systems. In addition, we will implement and evaluate multiple decision support alert notification methods including GUI-based applications, E-mail, fax/printer reports, automated paging, and interactive voice massaging using commercial telephony products to examine the impact of alternative notification methods on the timeliness and clinical impact of decision support alerts. Using this telecommunications-based notification infrastructure, we also will investigate the patient confidentiality and privacy compromises which may occur due to alternative notification methods. By permitting multiple clinicians, possibly in different locations, to be notified of alerting conditions, we can also assess the impact or value of collaborative use of this technology to treat BJC patients. With our study decision, we can examine explicit trade-offs between alerting methods, decision support effectiveness, and patient confidentiality.