HEALTH APPLICATIONS FOR THE NATIONAL INFORMATION INFRA

我们将重新实现两个成功的药学相关专家系统， DoseChecker和不良药物事件(ADE)监视器，以利用现有 一个广泛的远程医疗网络。DoseChecker提供药物剂量 基于药房订单和患者特定特征的警告，例如 年龄、性别、体重和估计的内生肌酐清除量。ADE监视器检查 病人的药物订单和实验室和实验室测试结果，提醒医院 当药剂师检测到药物不良事件的迹象时， 互动。一旦重新部署，这些专家系统将可以访问 临床数据储存库从中收集 必填数据。1996年，密苏里州和伊利诺伊州的六家医院--巴恩斯， 犹太教、基督教东北、基督教西北、奥尔顿纪念堂和巴恩斯西部 县--将拥有所需的人口统计、实验室和药房数据 对于进入资料库的DoseChecker和ADE监视器。这套 医院有两个学术设施(巴恩斯和犹太人)，两个大的 社区设施(克里斯蒂安东北和奥尔顿纪念馆)一个小社区 设施(巴恩斯西县)，主要是门诊护理 设施(克里斯蒂安西北)。重新实施的系统将作为 远程医疗试验台检查大范围、宽范围的影响 在不同的临床环境中部署临床决策支持。 具体地说，我们将评估专家系统的性能，医生 接受度和临床环境。通过利用存在的 标准的临床词汇和广泛的网络互联， 我们可以在临床实践环境中提供相同的CDS功能 这将极大地构成重大的技术障碍，并需要 大量返工。通过保持决策支持系统不变，我们的 评估研究将使我们能够研究临床环境的影响 关于这两个系统有效性的变数。此外，我们还将 实施和评估多个决策支持警报通知 方法包括基于图形用户界面的应用程序、电子邮件、传真/打印机报告、 使用商业广告的自动寻呼和交互式语音消息 电话产品检查替代通知的影响 方法对决策支持警报的及时性和临床影响进行分析。 使用这种基于电信的通知基础设施，我们还 将调查患者的机密性和隐私泄露 可能是由于其他通知方法所致。通过允许多个 可能在不同地点的临床医生将收到警报通知 条件，我们还可以评估协作使用的影响或价值 这项治疗BJC患者的技术。有了我们的学习决定，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.