Re: [Hardhats-members] Archives of Internal Medicine Article
It was pointed out in the article, and I should have mentioned it, the the reason the counts were high is because the system was able to identify them. It also mentioned that drug interactions were checked, although the interaction checking was not described inthe same detail as you described it. The article said that other things, like making sure a checks of serum potassium were ordered for the future for patients started on Lasix, were not implemented. It was not blaming the records system for causing the high numbers, but it was indicting it for not having better decision support to prevent the high numbers. As I understand it, some of that sort of decision support is implemented but, as you can imagine, the amount of decision support that is available on a system could vary very widely in type, amount and quality from system to system. Readily available, targeted order sets were felt to be one way to cut down on these problems. On Sunday 29 May 2005 01:26 am, Chris Richardson wrote: Nancy; There is drug/drug, alergy, and drug/food interaction associated with orders (OR*). At the hospitals, drug orders are written by physicians (bolstered by CPRS) and must be reviewed and signed by a pharmacist. Then the point of care interface, Bar Code Medication Administration (BCMA) system (PSB*) also is another check to make sure that the proper drug is given in the proper dose at the proper time to the proper patient. The nurse is the final check on the delivery of the drug and records the result of the administration (dose given/patient refused/etc). Please remember that the increased counts are a measure of looking for these errors as well as having automated methods of the recording of the dispensing of the drugs. The actual count of drug errors in hospitals where these automated methods are not used may never be known. If drug delivery cannot be measured in a meaningful way, no policy change is likely to have much effect. - Original Message - From: Nancy Anthracite [EMAIL PROTECTED] To: hardhats-members@lists.sourceforge.net Sent: Saturday, May 28, 2005 9:27 PM Subject: [Hardhats-members] Archives of Internal Medicine Article The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding that there is some decision support already present in VistA but it is less than the ideal according to this article I doubt any record system out there is ideal, but I can see this as something that will be cited as a reason not to adopt VistA . I bring it to your attention so you will not be surprised by this also so that we can work toward adding more decision support to VistA with the help of the medical community as it grows. I am hoping that the release of VistA Office and the web site that will come with it will be a place for the VIstA users to debate and contribute specific decision support suggestions as well as templates, clinical reminders, etc. I hope that users within the VA will also be willing to contribute and that this will lead to improvements in VistA for everyone's benefit. -- Nancy Anthracite --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members -- Nancy Anthracite --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005
Re: [Hardhats-members] Archives of Internal Medicine Article
Well, I guess they got their desired professional recognition out of this publication. It reminds me that repeatedly over recent modern medical history the appearance of a treatment for an illness is reliably followed by a sharp rise in the incidence of the disease. Do people get sick just because there is a treatment for the illness? As a matter of prevention then, the best course of action is to avoid finding treatments for diseases. ??? Of course, the answer in NO. But, do physicians begin to diagnose a disease only after there is a treatment? Or, is the apparent rise in incidence of a disease an artifact of the process of treatment and the footprints that process leaves behind. So, the incidence rate of Adverse Drug Events (ADE) is higher. Higher that what? What is the scale by which one can make such comparative measurements? What are the norms for ADE and how are the ADR rates measured in other settings by a methodology that is also being used in this study so that the higher rates can be known in the present setting? The value in VistA on the subject of ADE is in its inherent ability to measure the extent of the ADE's. Once this can be reliably measured, then the process of control and eventual reduction of ADE's can finally begin. ...oh, yes, I forgot, since the introduction of insulin caused a steep increase in the incidence of diabetes, we are going to cite the adverse effects of insulin to justify removing it from the medical treatment inventory. ...and, likewise, VistA should be avoided as well... DOH! Regards, Richard. From: Nancy Anthracite [EMAIL PROTECTED] Reply-To: hardhats-members@lists.sourceforge.net Date: Sun, 29 May 2005 00:27:25 -0400 To: hardhats-members@lists.sourceforge.net Subject: [Hardhats-members] Archives of Internal Medicine Article The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding that there is some decision support already present in VistA but it is less than the ideal according to this article I doubt any record system out there is ideal, but I can see this as something that will be cited as a reason not to adopt VistA . I bring it to your attention so you will not be surprised by this also so that we can work toward adding more decision support to VistA with the help of the medical community as it grows. I am hoping that the release of VistA Office and the web site that will come with it will be a place for the VIstA users to debate and contribute specific decision support suggestions as well as templates, clinical reminders, etc. I hope that users within the VA will also be willing to contribute and that this will lead to improvements in VistA for everyone's benefit. -- Nancy Anthracite --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
RE: [Hardhats-members] Archives of Internal Medicine Article
Dumb Docs... Ouch. That seems like an unwarranted slap. Of course all errors that occur are because the doctor is dumb, right? Kevin --- Thurman Pedigo [EMAIL PROTECTED] wrote: It's already on the WIRE: http://www.wired.com/news/medtech/0,1286,67639,00.html?tw=wn_tophead_6 Computers No Cure for Dumb Docs 02:00 AM May. 26, 2005 PT What is interesting about this article is it comes from the back yard of Intermountain Healthcare (IHC) and Brent James,M.D., the legendary medical quality guru who has probably impacted our health systems to save more lives than almost any living clinician. It was his study that set the standards for pre-operative prophylactic antibiotics in the 80's. Among other of his accomplishments is the demonstration that adverse drug events (ADE) jumped from 15/year in the 80's (detected by incidence reporting), to 580 in 1991 when IT was added to the equation. Few reporting environments are as open in reporting weaknesses as this group (IHC and VA). In this (Archives) study, only 1% of all ADEs were documented in the allergy and adverse reaction section of the record. It's also important to note that only 1% of all the errors were dispensing and 0% transcription. The authors point out the need for decision support if we are to further impact ADEs. Thanks, thurman -Original Message- From: [EMAIL PROTECTED] [mailto:hardhats- [EMAIL PROTECTED] On Behalf Of Nancy Anthracite Sent: Sunday, May 29, 2005 12:07 AM To: hardhats-members@lists.sourceforge.net Subject: Re: [Hardhats-members] Archives of Internal Medicine Article It was pointed out in the article, and I should have mentioned it, the the reason the counts were high is because the system was able to identify them. It also mentioned that drug interactions were checked, although the interaction checking was not described inthe same detail as you described it. The article said that other things, like making sure a checks of serum potassium were ordered for the future for patients started on Lasix, were not implemented. It was not blaming the records system for causing the high numbers, but it was indicting it for not having better decision support to prevent the high numbers. As I understand it, some of that sort of decision support is implemented but, as you can imagine, the amount of decision support that is available on a system could vary very widely in type, amount and quality from system to system. Readily available, targeted order sets were felt to be one way to cut down on these problems. On Sunday 29 May 2005 01:26 am, Chris Richardson wrote: Nancy; There is drug/drug, alergy, and drug/food interaction associated with orders (OR*). At the hospitals, drug orders are written by physicians (bolstered by CPRS) and must be reviewed and signed by a pharmacist. Then the point of care interface, Bar Code Medication Administration (BCMA) system (PSB*) also is another check to make sure that the proper drug is given in the proper dose at the proper time to the proper patient. The nurse is the final check on the delivery of the drug and records the result of the administration (dose given/patient refused/etc). Please remember that the increased counts are a measure of looking for these errors as well as having automated methods of the recording of the dispensing of the drugs. The actual count of drug errors in hospitals where these automated methods are not used may never be known. If drug delivery cannot be measured in a meaningful way, no policy change is likely to have much effect. - Original Message - From: Nancy Anthracite [EMAIL PROTECTED] To: hardhats-members@lists.sourceforge.net Sent: Saturday, May 28, 2005 9:27 PM Subject: [Hardhats-members] Archives of Internal Medicine Article The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding that there is some decision support already present in VistA but it is less than the ideal according to this article I doubt any record system out there is ideal, but I can see this as something that will be cited as a reason not to adopt VistA . I bring it to your attention so you will not be surprised by this also so that we can work toward adding more decision support to VistA with the help of the medical
RE: [Hardhats-members] Archives of Internal Medicine Article
Richard G. DAVIS said: Well, I guess they got their desired professional recognition out of this publication. This is a recognition SORELY needed. One of my prized collector's items is the 1987 HCFA Hospital performance report. State Associations and hospitals got one free. No one else in the Tennessee Medical Association wanted the report so the Exec gave it to me. That was the last report since AMA and AHA managed to squash the project. The annual report ceased after three editions, killed on the allegation that the data was imperfect. Too bad we didn't require then same standard of all new drugs and the intestinal by-pass bariatric surgery popular in those days. Now here we are nearly 20 years later playing catch up. Yes, there are REASONS to question such reports. My favorite is the JAMA May 1995 diabetes and A1c report. http://jama.ama-assn.org/cgi/content/abstract/273/19/1503 The hypothesis was all patients with diabetes should have had A1c determination at least annually. Though no longer in private practice, I had access to my former practice's FileMan database. While the study reported only 16 percent compliance in 1993, ours had been 58% in the same year. Since, at the time, I was employed by one of the top 20 (U.S. News World Report), Universities I sought to report the data. However, I could secure no interest or statistical support in that institution. Today the same institution boasts of its advanced technology by citing their current A1c experience. It wasn't until a couple years later, hearing the term self serving journal articles that I realized the true impact of that landmark study. The study (performed on Medicare tapes) was on performance of GP's, FP's, and general internal medicine. It wasn't until later, after hearing about self serving journal articles, that I recognized a gap in the report. There was no reference to the degree of endocrinologist in the article. As the data was from Medicare tapes with the specialists identified, I have no doubt the endocrinologist information was available. The other awareness I had in reviewing this article and our data was I would have had less interest in publishing, had the data not made me look good. My hat is off to those with the courage and conviction to publish their blemishes. The article is a wake-up call to all. Thanks, thurman -Original Message- From: [EMAIL PROTECTED] [mailto:hardhats- [EMAIL PROTECTED] On Behalf Of Richard G. DAVIS Sent: Sunday, May 29, 2005 9:03 AM To: hardhats-members@lists.sourceforge.net Subject: Re: [Hardhats-members] Archives of Internal Medicine Article Well, I guess they got their desired professional recognition out of this publication. It reminds me that repeatedly over recent modern medical history the appearance of a treatment for an illness is reliably followed by a sharp rise in the incidence of the disease. Do people get sick just because there is a treatment for the illness? As a matter of prevention then, the best course of action is to avoid finding treatments for diseases. ??? Of course, the answer in NO. But, do physicians begin to diagnose a disease only after there is a treatment? Or, is the apparent rise in incidence of a disease an artifact of the process of treatment and the footprints that process leaves behind. So, the incidence rate of Adverse Drug Events (ADE) is higher. Higher that what? What is the scale by which one can make such comparative measurements? What are the norms for ADE and how are the ADR rates measured in other settings by a methodology that is also being used in this study so that the higher rates can be known in the present setting? The value in VistA on the subject of ADE is in its inherent ability to measure the extent of the ADE's. Once this can be reliably measured, then the process of control and eventual reduction of ADE's can finally begin. ...oh, yes, I forgot, since the introduction of insulin caused a steep increase in the incidence of diabetes, we are going to cite the adverse effects of insulin to justify removing it from the medical treatment inventory. ...and, likewise, VistA should be avoided as well... DOH! Regards, Richard. From: Nancy Anthracite [EMAIL PROTECTED] Reply-To: hardhats-members@lists.sourceforge.net Date: Sun, 29 May 2005 00:27:25 -0400 To: hardhats-members@lists.sourceforge.net Subject: [Hardhats-members] Archives of Internal Medicine Article The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding
Re: [Hardhats-members] Archives of Internal Medicine Article
IMHO this is exactly what is going onthe article does not say VistA is the culpritit's just the messenger...the real message is that VistA is the canary in the coal mine as far as the rest of the health system is concerned. Just imagine what the situation is like everywhere else that doesn't have the VA's capabilities or their transparency Kevin Toppenberg wrote: Without reading the article, I suspect that the high rate of reported errors might in part be due to an excellect error tracking and reporting system--i.e. a reporting bias. Our hospital does not have a decision support system, and it is not using VistA. And yet it might not report as many errors. Kevin --- Nancy Anthracite [EMAIL PROTECTED] wrote: The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding that there is some decision support already present in VistA but it is less than the ideal according to this article I doubt any record system out there is ideal, but I can see this as something that will be cited as a reason not to adopt VistA . I bring it to your attention so you will not be surprised by this also so that we can work toward adding more decision support to VistA with the help of the medical community as it grows. I am hoping that the release of VistA Office and the web site that will come with it will be a place for the VIstA users to debate and contribute specific decision support suggestions as well as templates, clinical reminders, etc. I hope that users within the VA will also be willing to contribute and that this will lead to improvements in VistA for everyone's benefit. -- Nancy Anthracite --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members __ Do you Yahoo!? Yahoo! Small Business - Try our new Resources site http://smallbusiness.yahoo.com/resources/ --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members . --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
RE: [Hardhats-members] Archives of Internal Medicine Article
Well - almost all the errors occurred at the level of ordering. Our nation loves to have a scapegoat. Unfortunately identifying scapegoats offers little or no improvement. It's the SYSTEM - first step to improving the system is identify its weakness. ...thx/t -Original Message- From: [EMAIL PROTECTED] [mailto:hardhats- [EMAIL PROTECTED] On Behalf Of Kevin Toppenberg Sent: Sunday, May 29, 2005 10:06 AM To: hardhats-members@lists.sourceforge.net Subject: RE: [Hardhats-members] Archives of Internal Medicine Article Dumb Docs... Ouch. That seems like an unwarranted slap. Of course all errors that occur are because the doctor is dumb, right? Kevin --- Thurman Pedigo [EMAIL PROTECTED] wrote: It's already on the WIRE: http://www.wired.com/news/medtech/0,1286,67639,00.html?tw=wn_tophead_6 Computers No Cure for Dumb Docs 02:00 AM May. 26, 2005 PT What is interesting about this article is it comes from the back yard of Intermountain Healthcare (IHC) and Brent James,M.D., the legendary medical quality guru who has probably impacted our health systems to save more lives than almost any living clinician. It was his study that set the standards for pre-operative prophylactic antibiotics in the 80's. Among other of his accomplishments is the demonstration that adverse drug events (ADE) jumped from 15/year in the 80's (detected by incidence reporting), to 580 in 1991 when IT was added to the equation. Few reporting environments are as open in reporting weaknesses as this group (IHC and VA). In this (Archives) study, only 1% of all ADEs were documented in the allergy and adverse reaction section of the record. It's also important to note that only 1% of all the errors were dispensing and 0% transcription. The authors point out the need for decision support if we are to further impact ADEs. Thanks, thurman -Original Message- From: [EMAIL PROTECTED] [mailto:hardhats- [EMAIL PROTECTED] On Behalf Of Nancy Anthracite Sent: Sunday, May 29, 2005 12:07 AM To: hardhats-members@lists.sourceforge.net Subject: Re: [Hardhats-members] Archives of Internal Medicine Article It was pointed out in the article, and I should have mentioned it, the the reason the counts were high is because the system was able to identify them. It also mentioned that drug interactions were checked, although the interaction checking was not described inthe same detail as you described it. The article said that other things, like making sure a checks of serum potassium were ordered for the future for patients started on Lasix, were not implemented. It was not blaming the records system for causing the high numbers, but it was indicting it for not having better decision support to prevent the high numbers. As I understand it, some of that sort of decision support is implemented but, as you can imagine, the amount of decision support that is available on a system could vary very widely in type, amount and quality from system to system. Readily available, targeted order sets were felt to be one way to cut down on these problems. On Sunday 29 May 2005 01:26 am, Chris Richardson wrote: Nancy; There is drug/drug, alergy, and drug/food interaction associated with orders (OR*). At the hospitals, drug orders are written by physicians (bolstered by CPRS) and must be reviewed and signed by a pharmacist. Then the point of care interface, Bar Code Medication Administration (BCMA) system (PSB*) also is another check to make sure that the proper drug is given in the proper dose at the proper time to the proper patient. The nurse is the final check on the delivery of the drug and records the result of the administration (dose given/patient refused/etc). Please remember that the increased counts are a measure of looking for these errors as well as having automated methods of the recording of the dispensing of the drugs. The actual count of drug errors in hospitals where these automated methods are not used may never be known. If drug delivery cannot be measured in a meaningful way, no policy change is likely to have much effect. - Original Message - From: Nancy Anthracite [EMAIL PROTECTED] To: hardhats-members@lists.sourceforge.net Sent: Saturday, May 28, 2005 9:27 PM Subject: [Hardhats-members] Archives of Internal Medicine Article The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some
RE: [Hardhats-members] Archives of Internal Medicine Article
Wholeheartedly agree. I guess the real value is we now have an honest benchmark! ...thx/t -Original Message- From: [EMAIL PROTECTED] [mailto:hardhats- [EMAIL PROTECTED] On Behalf Of Joseph Dal Molin Sent: Sunday, May 29, 2005 10:20 AM To: hardhats-members@lists.sourceforge.net Subject: Re: [Hardhats-members] Archives of Internal Medicine Article IMHO this is exactly what is going onthe article does not say VistA is the culpritit's just the messenger...the real message is that VistA is the canary in the coal mine as far as the rest of the health system is concerned. Just imagine what the situation is like everywhere else that doesn't have the VA's capabilities or their transparency Kevin Toppenberg wrote: Without reading the article, I suspect that the high rate of reported errors might in part be due to an excellect error tracking and reporting system--i.e. a reporting bias. Our hospital does not have a decision support system, and it is not using VistA. And yet it might not report as many errors. Kevin --- Nancy Anthracite [EMAIL PROTECTED] wrote: The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding that there is some decision support already present in VistA but it is less than the ideal according to this article I doubt any record system out there is ideal, but I can see this as something that will be cited as a reason not to adopt VistA . I bring it to your attention so you will not be surprised by this also so that we can work toward adding more decision support to VistA with the help of the medical community as it grows. I am hoping that the release of VistA Office and the web site that will come with it will be a place for the VIstA users to debate and contribute specific decision support suggestions as well as templates, clinical reminders, etc. I hope that users within the VA will also be willing to contribute and that this will lead to improvements in VistA for everyone's benefit. -- Nancy Anthracite --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members __ Do you Yahoo!? Yahoo! Small Business - Try our new Resources site http://smallbusiness.yahoo.com/resources/ --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg- q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members . --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
Re: [Hardhats-members] Archives of Internal Medicine Article
Nancy; There is drug/drug, alergy, and drug/food interaction associated with orders (OR*). At the hospitals, drug orders are written by physicians (bolstered by CPRS) and must be reviewed and signed by a pharmacist. Then the point of care interface, Bar Code Medication Administration (BCMA) system (PSB*) also is another check to make sure that the proper drug is given in the proper dose at the proper time to the proper patient. The nurse is the final check on the delivery of the drug and records the result of the administration (dose given/patient refused/etc). Please remember that the increased counts are a measure of looking for these errors as well as having automated methods of the recording of the dispensing of the drugs. The actual count of drug errors in hospitals where these automated methods are not used may never be known. If drug delivery cannot be measured in a meaningful way, no policy change is likely to have much effect. - Original Message - From: Nancy Anthracite [EMAIL PROTECTED] To: hardhats-members@lists.sourceforge.net Sent: Saturday, May 28, 2005 9:27 PM Subject: [Hardhats-members] Archives of Internal Medicine Article The May 23rd issue of the Archives of Internal Medicine had an article about the high rates of adverse drug related events noted in a VA Hospital. The lack of decision support for selection, dosing and monitoring was cited as a deficiency in the EMR that if corrected, might prevent some of these problems. The presence of drug interaction checking was mentioned. The abstract is here. http://archinte.ama-assn.org/cgi/content/abstract/165/10/ It is my understanding that there is some decision support already present in VistA but it is less than the ideal according to this article I doubt any record system out there is ideal, but I can see this as something that will be cited as a reason not to adopt VistA . I bring it to your attention so you will not be surprised by this also so that we can work toward adding more decision support to VistA with the help of the medical community as it grows. I am hoping that the release of VistA Office and the web site that will come with it will be a place for the VIstA users to debate and contribute specific decision support suggestions as well as templates, clinical reminders, etc. I hope that users within the VA will also be willing to contribute and that this will lead to improvements in VistA for everyone's benefit. -- Nancy Anthracite --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members --- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! Search Developer Network - Create apps using Yahoo! Search APIs Find out how you can build Yahoo! directly into your own Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 ___ Hardhats-members mailing list Hardhats-members@lists.sourceforge.net https://lists.sourceforge.net/lists/listinfo/hardhats-members
