Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · May 2014
Overrides of medication-related clinical decision support alerts in outpatients.
Electronic prescribing is increasingly used, in part because of government incentives for its use. Many of its benefits come from clinical decision support (CDS), but often too many alerts are displayed, resulting in alert fatigue. ⋯ About half of CDS alerts were overridden by providers and about half of the overrides were classified as appropriate, but the likelihood of overriding an alert varied widely by alert type. Refinement of these alerts has the potential to improve the relevance of alerts and reduce alert fatigue.
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J Am Med Inform Assoc · May 2014
Content and functional specifications for a standards-based multidisciplinary rounding tool to maintain continuity across acute and critical care.
Maintaining continuity of care (CoC) in the inpatient setting is dependent on aligning goals and tasks with the plan of care (POC) during multidisciplinary rounds (MDRs). A number of locally developed rounding tools exist, yet there is a lack of standard content and functional specifications for electronic tools to support MDRs within and across settings. ⋯ We recommend an initial list of 11 universal CDEs for continuity in MDRs across settings and 27 CDEs that can be configured to meet setting-specific needs.
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J Am Med Inform Assoc · May 2014
Clinical decision support for atypical orders: detection and warning of atypical medication orders submitted to a computerized provider order entry system.
The specificity of medication-related alerts must be improved to overcome the pernicious effects of alert fatigue. A systematic comparison of new drug orders to historical orders could improve alert specificity and relevance. Using historical order data from a computerized provider order entry system, we alerted physicians to atypical orders during the prescribing of five medications: calcium, clopidogrel, heparin, magnesium, and potassium. ⋯ Fifty of the 68 atypical order alerts were over-ridden (74%). However, the over-ride rate is misleading because 28 of the atypical medication orders (41%) were changed. Atypical order alerts were relatively few, identified problems with frequencies as well as doses, and had a higher specificity than dose check alerts.
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J Am Med Inform Assoc · Mar 2014
A sense inventory for clinical abbreviations and acronyms created using clinical notes and medical dictionary resources.
To create a sense inventory of abbreviations and acronyms from clinical texts. ⋯ Clinical sense inventories of abbreviations and acronyms created using clinical notes and medical dictionary resources demonstrate challenges with term coverage and resource integration. Further work is needed to help with standardizing abbreviations and acronyms in clinical care and biomedicine to facilitate automated processes such as text-mining and information extraction.
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J Am Med Inform Assoc · Mar 2014
From vital signs to clinical outcomes for patients with sepsis: a machine learning basis for a clinical decision support system.
To develop a decision support system to identify patients at high risk for hyperlactatemia based upon routinely measured vital signs and laboratory studies. ⋯ Effective predictions of lactate levels and mortality risk can be provided with a few clinical variables when the temporal aspect and variability of patient data are considered.