PATIENT CARE PROVIDER ORDER ENTRY WITH TACTICAL SUPPORT

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DESCRIPTION (Taken from project abstract): Webster's Third New International Dictionary (unabridged) (Merriam-Webster, Inc., Springfield MA, 1986) defines tactics as: "the art or skill of employing available forces with an end in view". Through the attention-focusing mechanism provided by direct health-care provider order entry, the Patient Care Provider Order Entry with Tactical Support (PC-POETS) project will develop tactics that make the use of patient-centered decision support capabilities logical, straightforward, and efficient. The central theme of the PC-POETS project is that patient care providers convert their decisions into actions at the time of order-writing, so intervention to provide decision support is implemented optimally through an order entry system. The project will complete the development, already under way at Vanderbilt, of a PC-based interface to a patient care provider order entry system, which will serve as the platform for delivering decision support capabilities. The project will test a fundamental and long-held tenet in medical informatics: "Good counselors lack no clients" (Shakespeare, Measure for Measure) - i.e., that medical decision support systems will gain widespread acceptance when a critical mass of functionality is made available through a common platform and interface. Subcomponents of the PC-POETS system related to decision support capabilities include: (a) automated or semi-automated pharmacological advice regarding a patient's medications: drug monographs, allergy alerts, drug-drug interactions, index of expenses, (b) automated or semi-automated links to the literature regarding a patients diagnoses and therapeutic interventions: UMLS-based indexing and retrieval of relevant citations and abstracts, automated or semi-automated linkages to the QMR Knowledge Base for diagnostic decision support, (d) ability to review charges/costs for given orders (lab, pharmacy, radiology) on a patient-specific basis, (e) patient-specific reminders, (f) an antibiotic ordering tool to help suggest cost-effective regimens, (g) automated or semi-automated comparison of past or currently proposed orders to a specified schedule of orders ("clinical pathway"), providing a critique of similarities and differences, (h) a patient status summary tool that reviews significant changes in a patients status over a short time interval, such as 12 to 72 hours. The function will review laboratory and other data available in the MARS system to answer the question, "What happened to the patient during the last 12-72 hours?", (I) formative evaluation during the first 18 months of the project, and (j) a randomized controlled trial to evaluate PC-POETS in the clinical setting during the final 18 months of the proposed project.