IMPROVING SAFETY BY COMPUTERIZING OUTPATIENT PRESCRIBING

采取措施提高患者安全性和减少药物不良事件（ADE）是医疗保健质量的重要组成部分。已知ADES在医院环境中很常见且可预防。 然而，尽管大多数医疗护理都是在门诊环境中进行的，但在这种环境中识别、跟踪和预防ADE的知识相对较少。造成这一差距的原因有很多，但也许最关键的是，由于未观察到的环境和不良记录，识别门诊事件具有挑战性。 然而，随着电子病历在门诊环境中变得越来越普遍，其好处之一是它们将使检测门诊ADE变得更加容易。 此外，处方的计算机化是预防ADE的有力工具。我们建议研究电子病历和计算机化处方在与合作伙伴医疗保健系统和Regenstrief研究所/印第安纳州大学相关的各种诊所环境中的影响。 这项合作将汇集在ADE检测和监测以及门诊计算机化决策支持方面具有丰富经验的研究小组。这项研究有三个主要目标。 首先，我们寻求通过使用自动ADE监测器来开发ADE检测的改进方法。 该监查员将在电子病历以及临床信息系统中搜索极有可能代表ADES的触发因素。 通过这种方式，监测器Fill有助于改进ADE的识别，并允许跟踪和分析以进行预防。 其次，我们通过检查基本电子处方系统（包括默认剂量和药物过敏检查）与纸质处方系统相比对可预防ADE的影响，研究电子处方对门诊可预防ADE发生率的影响。 第三，我们将研究更先进的决策支持的额外好处，如药物实验室检查和肾脏给药，这有助于处方过程。 我们计划传播我们在ADE监测和预防方面以及潜在成本节约方面获得的知识，以鼓励其他机构实施这些类型的系统。

Taking steps to improve patient safety and reducing adverse drug events (ADEs) is a crucial component of health care quality. ADES are known to be common and preventable in the hospital setting. However, despite the fact that most medical care is given in the ambulatory setting, relatively little is known about identifying, tracking, and preventing ADEs in this setting. There are many reasons for this gap, but perhaps the most critical is that it is challenging to identify outpatient events because of unobserved settings and poor documentation. However, as electronic medical records become increasingly common in the ambulatory setting, one of their benefits is that they will make it much easier to detect outpatient ADEs. Furthermore, computerization of prescribing represents a powerful tool for preventing ADEs. We propose to study the impact of electronic medical records and computerized prescribing in a diverse array of clinic settings associated with Partners HealthCare System and the Regenstrief Institute/Indiana University. This collaboration will bring together research groups with substantial experience in ADE detection and monitoring and outpatient computerized decision support. This study has three primary goals. First, we seek to develop improved methods for ADE detection by the use of an automated ADE monitor. This monitor will search the electronic medical record as well as the clinical information system for triggers that are highly likely to represent ADES. In this manner, the monitor Fill facilitate improved identification of ADEs, and allow tracking and analysis for prevention. Second, we seek to study the impact of electronic prescribing on preventable ADE rates in the outpatient setting by examining the impact of a basic electronic prescribing system (that includes default dosing and drug-allergy checking) on preventable ADEs, as compared to a paper-based prescribing system. Third, we will study the additional benefits of more advanced decision support, such as drug-laboratory checking and renal dosing, that aids in the prescribing process. We plan to disseminate the knowledge we gain in terms of both ADE monitoring and prevention, and in terms of potential cost savings, in order to encourage other institutions to implement these types of systems.