JMIR Publications

JMIR Medical Informatics

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Currently submitted to: JMIR Medical Informatics

Date Submitted: Sep 30, 2017
Open Peer Review Period: Sep 30, 2017 - Oct 15, 2017

NOTE: This is an unreviewed Preprint

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications across Healthcare Facilities in Taiwan

  • Cheng Yi Yang; 
  • Yu Sheng Lo; 
  • Ray Jade Chen; 
  • Chien Tsai Liu

ABSTRACT

Background:

A computerized physician order entry system (CPOE) combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without an infrastructure that supports patients’ integrated medication history across healthcare facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different healthcare facilities across Taiwan.

Objective:

This study aimed to develop a scalable, flexible, and cost-effective clinical decision support engine (CDSE) based on a national medication repository to support CPOE systems in the detection of potential duplication of medication across healthcare facilities, as well as to analyze its impact on clinical encounters.

Methods:

A CDSE was developed, which can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications (PDMs) across healthcare facilities in Taiwan. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a PDM. To investigate the impact of the CDSE on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter.

Results:

In this study, we developed a modularized CDSE to access a national medication repository, the PharmaCloud, for detection of duplicate medication across healthcare facilities in Taiwan. Because of the modularized design, the CDSE could easily extend functions for detection of adverse drug reactions when more and more EHR systems are adopted. Moreover, the CDSE can retrieve more updated and completed patients’ medication history in the PharmaCloud, so it can have better performance for detection of duplicate medication. Although our CDSE approach could enhance medication safety, it would make longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDSE.

Conclusions:

In this study, we developed a modularized CDSE to access a national medication repository, the PharmaCloud, for detection of duplicate medication across healthcare facilities in Taiwan. Because of the modularized design, the CDSE could easily extend functions for detection of adverse drug reactions when more and more EHR systems are adopted. Moreover, the CDSE can retrieve more updated and completed patients’ medication history in the PharmaCloud, so it can have better performance for detection of duplicate medication. Although our CDSE approach could enhance medication safety, it would make longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDSE.


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