(Taken from project abstract): Webster's Third New International Dictionary (unabridged) (Merriam-Webster, Inc., Springfield MA, 1986) defines tactics as: """"""""the art or skill of employing available forces with an end in view"""""""". Through the attention-focusing mechanism provided by direct health-care provider order entry, the Patient Care Provider Order Entry with Tactical Support (PC-POETS) project will develop tactics that make the use of patient-centered decision support capabilities logical, straightforward, and efficient. The central theme of the PC-POETS project is that patient care providers convert their decisions into actions at the time of order-writing, so intervention to provide decision support is implemented optimally through an order entry system. The project will complete the development, already under way at Vanderbilt, of a PC-based interface to a patient care provider order entry system, which will serve as the platform for delivering decision support capabilities. The project will test a fundamental and long-held tenet in medical informatics: """"""""Good counselors lack no clients"""""""" (Shakespeare, Measure for Measure) - i.e., that medical decision support systems will gain widespread acceptance when a critical mass of functionality is made available through a common platform and interface. Subcomponents of the PC-POETS system related to decision support capabilities include: (a) automated or semi-automated pharmacological advice regarding a patient's medications: drug monographs, allergy alerts, drug-drug interactions, index of expenses, (b) automated or semi-automated links to the literature regarding a patients diagnoses and therapeutic interventions: UMLS-based indexing and retrieval of relevant citations and abstracts, automated or semi-automated linkages to the QMR Knowledge Base for diagnostic decision support, (d) ability to review charges/costs for given orders (lab, pharmacy, radiology) on a patient-specific basis, (e) patient-specific reminders, (f) an antibiotic ordering tool to help suggest cost-effective regimens, (g) automated or semi-automated comparison of past or currently proposed orders to a specified schedule of orders (""""""""clinical pathway""""""""), providing a critique of similarities and differences, (h) a patient status summary tool that reviews significant changes in a patients status over a short time interval, such as 12 to 72 hours. The function will review laboratory and other data available in the MARS system to answer the question, """"""""What happened to the patient during the last 12-72 hours?"""""""", (I) formative evaluation during the first 18 months of the project, and (j) a randomized controlled trial to evaluate PC-POETS in the clinical setting during the final 18 months of the proposed project.

National Institute of Health (NIH)
National Library of Medicine (NLM)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (SRC (03))
Program Officer
Bean, Carol A
Project Start
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Budget Start
Budget End
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Vanderbilt University Medical Center
Schools of Medicine
United States
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Miller, Randolph A; Waitman, Lemuel R; Chen, Sutin et al. (2005) The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt. J Biomed Inform 38:469-85
Rosenbloom, S Trent; Geissbuhler, Antoine J; Dupont, William D et al. (2005) Effect of CPOE user interface design on user-initiated access to educational and patient information during clinical care. J Am Med Inform Assoc 12:458-73
Rosenbloom, S Trent; Chiu, Kou-Wei; Byrne, Daniel W et al. (2005) Interventions to regulate ordering of serum magnesium levels: report of an unintended consequence of decision support. J Am Med Inform Assoc 12:546-53
Neilson, Eric G; Johnson, Kevin B; Rosenbloom, S Trent et al. (2004) The impact of peer management on test-ordering behavior. Ann Intern Med 141:196-204
Bansal, P; Aronsky, D; Aronsky, D et al. (2001) A computer based intervention on the appropriate use of arterial blood gas. Proc AMIA Symp :32-6
Sanders, D L; Miller, R A (2001) The effects on clinician ordering patterns of a computerized decision support system for neuroradiology imaging studies. Proc AMIA Symp :583-7
Stead, W W; Miller, R A; Musen, M A et al. (2000) Integration and beyond: linking information from disparate sources and into workflow. J Am Med Inform Assoc 7:135-45
Starmer, J M; Talbert, D A; Miller, R A (2000) Experience using a programmable rules engine to implement a complex medical protocol during order entry. Proc AMIA Symp :829-32
Geissbuhler, A; Miller, R A (1999) Distributing knowledge maintenance for clinical decision-support systems: the ""knowledge library"" model. Proc AMIA Symp :770-4
Brown, S H; Miller, R A; Camp, H N et al. (1999) Empirical derivation of an electronic clinically useful problem statement system. Ann Intern Med 131:117-26

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