Value of New Drug Labeling Knowledge for e-Prescribing

以Regenstrief Medical Gopher CPOE系统和新开发的完全基于HL7标准的开源电子处方为例，研究即将推出的FDA强制性电子药品标签HL7标准将为现有和新兴的计算机化供应商订单输入（CPOE）系统和电子处方工具带来的价值。用于提供决策支持的处方工具，可为不同医疗保健环境中的从业者提供安全的处方帮助（包括小，农村）。推力1：将Gopher药物知识结构映射到HL7标准药物知识结构，研究自动导入公共药物知识以填充基于适应症的剂量、SIG默认值、禁忌症、相互作用和后续订单数据结构的可行性。研究最低必要需求 对于定制，知识覆盖面的增加和由此产生的知识成本节约 上维护这些经验将有助于标签内容的标准化。推力2：基于现有的开源HL7 v3工具开发，创建一个轻量级的开源处方工具，提供决策支持功能（包括默认剂量和剂量检查、禁忌症和过敏检查、后续订单）。来自威斯康星州西部和北卡罗来纳州农村的一个焦点小组的供应商谈判一套最低限度的共同要求，以保持工具的重量轻，可推广。实施和试用该工具，并评估其 效益和成本：（1）时间序列对照试验，证明减少处方错误的有效性（效益），（2）时间运动研究，评估可用性和成本（以提供者的时间为单位）。用户和患者满意度调查将评估感知价值。在试点之后，扩大用户社区，以评估在新地点实施的成本，证明基于标准的开源轻量级设计可以产生可推广的工具，使供应商能够实现CPOE的价值。

Study the value that the upcoming FDA mandated electronic drug labeling HL7 standard will bring to existing and emerging Computerized Provider Order Entry (CPOE) systems and e-prescribing tools on the example of the Regenstrief Medical Gopher CPOE system and on a newly developed completely HL7 standards-based open-source e-prescribing tool used for delivering decision support enabled safe prescribing assistance to practitioners in diverse healthcare settings (incl. small and rural). THRUST 1: Map the Gopher drug knowledge structures to and from the HL7 standard drug knowledge structures, studying the feasibility of automatically importing the public drug knowledge to populate indication-based dosage, SIG defaults, contraindications, interactions, and consequent orders data structures. Study the minimum necessary need for customization, the gain in knowledge coverage and the resulting cost-savings for knowledge maintenance. This experience will be contributed into the standardization of the labeling content. THRUST 2: Based on existing open-source HL7 v3 tools development, create a light-weight open-source prescribing tool that delivers decision support functions (incl. default dosing and dose checks, contraindication and allergy checking, consequent orders) based solely on standards and open terminology and knowledge structures. A focus-group of providers from rural West-Wisconsin and North-Carolina negotiates a minimal set of common requirements to keep the tool light-weight and generalizable. Implement and pilot the tool and evaluate its benefits and costs with (1) a time-series controlled trial demonstrating efficacy to reduce prescribing errors (benefits), (2) time-motion study evaluating usability and cost (in terms of providers' time.) User and patient satisfaction survey will evaluate perceived value. After the pilot, grow the user community to assess the cost of implementation at new sites, demonstrating that standards-based open-source light-weight design can lead to generalizable tools allowing providers to realize the value of CPOE.