Wednesday, February 27, 2013

Informatics for Wrong-Patient Ordering

It seems intuitive – if, perhaps, the electronic health record has an updated problem list, and the EHR knows the typical indication of various medications, then the EHR would be able to perform some cursory checks for concordance.  If the orders and the problems are not concordant – then, as these authors propose, perhaps the orders are on the wrong patient?

This study is a retrospective analysis of the authors' EHR, in which they had previously implemented alerts of this fashion in the interests of identifying problem lists that were not current.  However, after data mining their 127,320 alerts over a 6-year period, they noticed 32 orders in which the order was immediately cancelled on one patient and re-ordered on another.  They then conclude that their problem list alert also has the beneficial side-effect of catching wrong-patient orders.

A bit of a stretch – but, it's an interesting application of surveillance intelligence.  The good news is, at least, that their problem list intervention is successful (pubmed) – because a 0.25 in 1000 patient alert yield for wrong-patient orders would be abysmal!

"Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE)"
www.ncbi.nlm.nih.gov/pubmed/23396543

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