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Computerized Drug Prescription Decision Support

  • B. Séroussi
  • J. Bouaud
  • C. Duclos
  • J. C. Dufour
  • A. Venot
Chapter
Part of the Health Informatics book series (HI)

Abstract

Drug prescription has to satisfy three quality criteria. Orders have to be adapted to the patient state, be compatible with all the other drugs of the prescription, and in compliance with the recommendations described in clinical practice guidelines (CPGs). Computer provider order entry systems (CPOEs) have been developed to secure drug orders and they address the first two criteria. Clinical decision support systems (CDSSs) have been developed to improve the implementation of CPGs and promote evidence-based medicine. This chapter first introduces the different medication errors. Then, the general architecture of CPOEs (user interface, drug database, interface with electronic medical records (EMRs) and inference engine) is presented. The main modalities of entering drug orders are described. Alert generation for contra-indications, or drug-drug interactions, are detailed. CDSSs are tools to provide patient-specific recommended treatments. They rely on a knowledge base embedding CPGs. The translation process of CPGs from their original narrative format to a structured formalized representation is described. The difficulty of text translation is emphasized and documentary tools such as GEM that help formalize guideline content are described. The main guideline representation formalisms, Arden Syntax, decision trees, EON and GLIF, are presented. Then, ways of operating CDSSs are described, from the totally automated alert-based mode, to various documentary approaches where the user navigates through a structured knowledge base. Finally, examples of clinical decision support systems currently routinely used are given.

Keywords

Medication errors Computer provider order entry systems Drug contra-indications Drug-drug interactions Alert generation Clinical decision support systems Clinical practice guidelines Evidence-based medicine Guideline representation formalism Documentary approaches 

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Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • B. Séroussi
    • 1
  • J. Bouaud
    • 2
  • C. Duclos
    • 3
  • J. C. Dufour
    • 4
  • A. Venot
    • 3
  1. 1.Département de Santé Publique, UFR de MédecineUPMC, Paris 6, Hôpital TenonParisFrance
  2. 2.INSERM, UMR_S 872, eq. 20, CRCParisFrance
  3. 3.LIM&BIO EA 3969, UFR SMBHUniversité Paris 13Bobigny CedexFrance
  4. 4.SESSTIM - UMR 912INSERM/IRD/Aix-Marseille Université, Faculté de MédecineMarseille CEDEX 5France

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