Medication CPOE (Computerized Prescriber Order Entry), currently lacks an essential safety feature-the indication for the prescription. Re-engineering CPOE to incorporate drug indications is vital and likely to markedly improve quality and safety in 6 key areas: medication error prevention and mitigation, facilitating patient education, promoting prescribing drugs-of-choice, enhanced team communication, organizing med lists for medication reconciliation, enabling more meaningful comparative outcomes research. We will bring together key stakeholders with experts in HIT, patient safety, pharmacy practice, HIT knowledge and EMR vendors, and user-centered design to achieve consensus on key issues related to the rationale, feasibility, features, barriers, and risks related to indicatins-based prescribing (I-CPOE). We will create 6 panels to: 1) delineate the construct and experience with I-CPOE, 2) indentify role and approaches of I-CPOE in preventing and recognizing med errors, 3) spell out role and practical logistics for I-CPOE related to pharmacists and pharmacies, 4) develop ways I-CPOE can impact patient education, 5) understand ways to implement drugs-of-choice recommendations into CPOE, and 6) develop strategies for overcoming technical challenges and interface with knowledge and EMR vendors. Using a modified Delphi approach we will achieve consensus on these key strategic and design issues. Based on the findings from this consensus development phase, along with formally collected user requirements, we will build and test a working prototype for an I-CPOE ordering system. This will be accomplished in four phases: creation of user requirements document, participatory design sessions, contextual inquiry sessions, and usability testing with iterative completion of a final high fidelity prototype. We will proceed to test the safety, speed, and satisfaction of this working prototype compared to two well established EMRs (LMR, and Epic). We will also compare the usability and safety of the prescriptions generated from these 3 systems (2 standard vs I-CPOE prototype) from the perspective of pharmacists and patients, examining their assessments of indications-enabled prescriptions and medication lists. Overall, these tests will test the hypothesis that I-CPOE prescribing, prescriptions, and medication lists are safer and superior in key measures of HIT safety, efficiency and satisfaction. Finally we will work with our partnering stakeholders to disseminate our tools, prototype and findings to advance the agenda and development of indications-based prescribing thereby facilitating progress toward this stalled patient safety recommendation and goal. ,

Public Health Relevance

Medication CPOE (Computerized Prescriber Order Entry) currently lacks the medication indication-- an important and widely recommended safety feature. We will convene expert and stakeholder panels to achieve consensus and design requirements for advancing this vital but missing medication prescription element. We will then build and test a working prototype to test the hypothesis that indications-enabled prescribing demonstrates superior quality, safety, and efficiency for prescribers, pharmacists, and patients.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Health Care Technology and Decision Science (HTDS)
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Randhawa, Gurvaneet
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Brigham and Women's Hospital
United States
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