Subscribe to RSS
DOI: 10.4338/ACI-2010-07-RA-0044
Electronic Medical Record Prompts for Lab Orders in Patients Initiating Statins
Correspondence to:
Publication History
received:
26 July 2010
accepted:
10 February 2011
Publication Date:
16 December 2017 (online)
Summary
Background: The Institute of Medicine (IOM) reports that at least a fourth of all medication related injuries are preventable. Therefore, the IOM recommends healthcare organizations and providers implement electronic prescribing and clinical decision support systems in practices to aid in medication error prevention.
Objective: To assess the impact of noninstrusive-intrusive prompts from an electronic medical record on recommended baseline and follow up laboratory monitoring, CK and liver transaminase levels (AST and ALT), in patients initiated on statin therapy.
Methods: Hybrid nonintrusive-intrusive prompts for laboratory monitoring specific for statin initiation were implemented in the electronic medical record system in a community based, university affiliated family medicine residency program. A retrospective chart review was conducted to compare and assess laboratory monitoring in patients initiated on statin therapy from two specific time periods: a six month period prior to initiation of the prompts and a six month period after initiation of the prompts.
Results: One hundred seventy three patients met inclusion criteria. There were no significant differences in assessment of baseline liver transaminases and CK levels from the initial study period to the follow up study period. There were significant differences in follow up liver transaminase levels (18% vs 33%, p = 0.035) and CK levels (none vs 7%, p = 0.03) from the initial study period to the activated prompt interval.
Conclusion: A hybrid nonintrusive-intrusive specific prompts for laboratory monitoring triggered by statin initiation within an electronic medical record improved follow up lab assessments for liver transaminases and CK but did not improve baseline assessments of CK or liver transaminases.
#
Keywords
Computerized medical records - ambulatory care facilities - clinical laboratory techniques - statins - HMGCOA
#
Conflict of Interest
None of the authors have any conflicts of interest – financial or personal relationships – that could influence or bias the objectivity of this study and content within this manuscript. We received no funding to conduct this study or to submit this manuscript.
-
References
- 1 Preventing medication errors: quality chasm series. Aspden P, Wolcott J, Bootman JL, Croenewett LR. editors. http://books.nap.edu/openbook.php?record_id=11623. Accessed: November 29, 2010.
- 2 Shojania KG, Jennings A, Mayhew A, Ramsey CR, Eccles MP, Grimshaw J. The effects of onscreen, point of care computer reminders on processes and outcomes of care. Cochrane Database Systematic Reviews 2009; 3: CD001096.
- 3 Schoenenberger RA, Tanasijevic MJ, Jha A, Bates DW. Appropriateness of antiepileptic drug monitoring. JAMA 1995; 274: 1622-1626.
- 4 Roblin DW, Nielsen DM. Assessment of quality in adult primary care: developing process measures from administrative data. Clin Perform Qual Health Care 1994; 2: 200-208.
- 5 Graham DJ, Drinkard DR, Shatin D. Study of liver enzyme monitoring in patients receiving troglitazone. Pharmacoepidemiol Drug Saf 2000; (Suppl. 01) S131.
- 6 Emalie-Smith AM, Boyle DI, Evans JM, Sullivan F, Morris AD. Contraindications to metformin therapy in patients with type 2 diabetes: a population based study of adherence to prescribing guidelines. Diabet Med 2001; 18: 483-488.
- 7 Abookire SA, HArson AS, Fiskio J, Bates DW. Use and monitoring of “statin” lipid lowering drugs compared with guidelines. Arch Intern Med 2001; 161: 53-58.
- 8 Tegeder I, Levy M, Muth-Selbach U, Oelkers R, Neumann F, Dormann H. Retrospective analysis of the the frequency and recognition of adverse drug reactions by means of automatically recorded laboratory signals. B J Clin Pharmacol 1999; 47: 557-564.
- 9 Selby JV, Ettinger B, Swain BE. First 20 months experience with the use of metformin for type 2 diabetes in a large HMO. Diabetes Care 1999; 22: 38-44.
- 10 Calabrese AT, Coley KC, DaPos SV, Swanson D, Rao RH. Risk of lactic acidosis with metformin therapy. Arch Intern Med 2002; 162: 434-437.
- 11 Graham DJ, Drinkard DR, Shatin D, Tsong Y, Burgess MJ. Liver enzyme monitoring in patients receiving troglitazone. JAMA 2001; 286: 831-833.
- 12 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III), Final Report. Accessed at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm on September 4, 2007.
- 13 Grundy SM, Cleeman JI, Merz NB, Brewer HB, Clark LT, Hunninghake DB. et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227-239.
- 14 Pasternak RC, Smith SC, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Journal of the American College of Cardiology 2002; 40 (Suppl. 03) 567-572.
- 15 Balas E, Weingarten S, Garb CT, Blumenthal D, Boren SA, Brown GD. Improving preventive care by prompting physicians. Arch Intern Med 2000; 160: 301-308.
- 16 Raebel MA, Lyons EE, Andrade SE, Chan KA, Chester EA, Davis RI. et al. Laboratory monitoring of drugs at initiation of therapy in ambulatory care. J Gen Intern Med 2005; 20: 1120-1126.
- 17 Feldstein AC, Smith DH, Perrin N, Yang X, Rix M, Raebel MA. et al. Improved therapeutic monitoring with several interventions. Arch Intern Med 2006; 166: 1848-1854.
- 18 Steele AW, Eisert S, Witter J, Lyons P, Jones MA, Gabow P. et al. The effect of automated alerts on provider ordering behavior in an outpatient setting. PLoS Med 2005; 2 (09) e255.
- 19 Lo HG, Matheny ME, Seger DL, Bates DW, Gandhi TK. Impact of non-interruptive medication laboratory monitoring alters in ambulatory care. J Am Med Inform Assoc 2009; 16: 66-71.
- 20 Palen TE, Raebel M, Lyons E, Magid DM. Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders. Am J Manag Care 2006; 12: 389-395.
- 21 Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc 2007: 26-30.
- 22 Ash JS, Sittig DF, Poon EG, Guappone KP, Campbell EM, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14: 415-423.
- 23 Feldstein A, Simon SR, Schneider J, Krall M, Laferriere D, Smith DH. et al. How to design computerized alerts to ensure safe prescribing practices. Joint Commission Journal on Quality and Safety 2004; 30: 602-613.
- 24 Davlong Business Solutions.. Electronic medical record. Accessed at http://www.davlong.com/electronic.html on January 5, 2011.
- 25 Shoffner J, Staudt M, Marcus S, Kapp S. Using telephone reminders to increase attendance at psychiatric appointments: findings of a pilot study in rural Appalachia. Psychiatr Serv 2007; 58: 872-875.
- 26 Reda S, Makhoul S. Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database Systematic Reviews 2001; 2: CD002085.
- 27 Patel P, Forbes M, Gibson J. The reduction of broken appointments in general dental practice: an audit and intervention approach. Prim Dent Care 2000; 7: 141-144.
- 28 Lee JK, Reis V, Lui S, Conn L, Groessi EJ, Ganiats TG. et al. Improving fecal occult blood testing compliance using a mailed educational reminder. J Gen Intern Med 2009; 24: 1192-1197.
- 29 Institute of Medicine.. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press,; 2001
Correspondence to:
-
References
- 1 Preventing medication errors: quality chasm series. Aspden P, Wolcott J, Bootman JL, Croenewett LR. editors. http://books.nap.edu/openbook.php?record_id=11623. Accessed: November 29, 2010.
- 2 Shojania KG, Jennings A, Mayhew A, Ramsey CR, Eccles MP, Grimshaw J. The effects of onscreen, point of care computer reminders on processes and outcomes of care. Cochrane Database Systematic Reviews 2009; 3: CD001096.
- 3 Schoenenberger RA, Tanasijevic MJ, Jha A, Bates DW. Appropriateness of antiepileptic drug monitoring. JAMA 1995; 274: 1622-1626.
- 4 Roblin DW, Nielsen DM. Assessment of quality in adult primary care: developing process measures from administrative data. Clin Perform Qual Health Care 1994; 2: 200-208.
- 5 Graham DJ, Drinkard DR, Shatin D. Study of liver enzyme monitoring in patients receiving troglitazone. Pharmacoepidemiol Drug Saf 2000; (Suppl. 01) S131.
- 6 Emalie-Smith AM, Boyle DI, Evans JM, Sullivan F, Morris AD. Contraindications to metformin therapy in patients with type 2 diabetes: a population based study of adherence to prescribing guidelines. Diabet Med 2001; 18: 483-488.
- 7 Abookire SA, HArson AS, Fiskio J, Bates DW. Use and monitoring of “statin” lipid lowering drugs compared with guidelines. Arch Intern Med 2001; 161: 53-58.
- 8 Tegeder I, Levy M, Muth-Selbach U, Oelkers R, Neumann F, Dormann H. Retrospective analysis of the the frequency and recognition of adverse drug reactions by means of automatically recorded laboratory signals. B J Clin Pharmacol 1999; 47: 557-564.
- 9 Selby JV, Ettinger B, Swain BE. First 20 months experience with the use of metformin for type 2 diabetes in a large HMO. Diabetes Care 1999; 22: 38-44.
- 10 Calabrese AT, Coley KC, DaPos SV, Swanson D, Rao RH. Risk of lactic acidosis with metformin therapy. Arch Intern Med 2002; 162: 434-437.
- 11 Graham DJ, Drinkard DR, Shatin D, Tsong Y, Burgess MJ. Liver enzyme monitoring in patients receiving troglitazone. JAMA 2001; 286: 831-833.
- 12 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III), Final Report. Accessed at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm on September 4, 2007.
- 13 Grundy SM, Cleeman JI, Merz NB, Brewer HB, Clark LT, Hunninghake DB. et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227-239.
- 14 Pasternak RC, Smith SC, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant C. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Journal of the American College of Cardiology 2002; 40 (Suppl. 03) 567-572.
- 15 Balas E, Weingarten S, Garb CT, Blumenthal D, Boren SA, Brown GD. Improving preventive care by prompting physicians. Arch Intern Med 2000; 160: 301-308.
- 16 Raebel MA, Lyons EE, Andrade SE, Chan KA, Chester EA, Davis RI. et al. Laboratory monitoring of drugs at initiation of therapy in ambulatory care. J Gen Intern Med 2005; 20: 1120-1126.
- 17 Feldstein AC, Smith DH, Perrin N, Yang X, Rix M, Raebel MA. et al. Improved therapeutic monitoring with several interventions. Arch Intern Med 2006; 166: 1848-1854.
- 18 Steele AW, Eisert S, Witter J, Lyons P, Jones MA, Gabow P. et al. The effect of automated alerts on provider ordering behavior in an outpatient setting. PLoS Med 2005; 2 (09) e255.
- 19 Lo HG, Matheny ME, Seger DL, Bates DW, Gandhi TK. Impact of non-interruptive medication laboratory monitoring alters in ambulatory care. J Am Med Inform Assoc 2009; 16: 66-71.
- 20 Palen TE, Raebel M, Lyons E, Magid DM. Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders. Am J Manag Care 2006; 12: 389-395.
- 21 Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc 2007: 26-30.
- 22 Ash JS, Sittig DF, Poon EG, Guappone KP, Campbell EM, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14: 415-423.
- 23 Feldstein A, Simon SR, Schneider J, Krall M, Laferriere D, Smith DH. et al. How to design computerized alerts to ensure safe prescribing practices. Joint Commission Journal on Quality and Safety 2004; 30: 602-613.
- 24 Davlong Business Solutions.. Electronic medical record. Accessed at http://www.davlong.com/electronic.html on January 5, 2011.
- 25 Shoffner J, Staudt M, Marcus S, Kapp S. Using telephone reminders to increase attendance at psychiatric appointments: findings of a pilot study in rural Appalachia. Psychiatr Serv 2007; 58: 872-875.
- 26 Reda S, Makhoul S. Prompts to encourage appointment attendance for people with serious mental illness. Cochrane Database Systematic Reviews 2001; 2: CD002085.
- 27 Patel P, Forbes M, Gibson J. The reduction of broken appointments in general dental practice: an audit and intervention approach. Prim Dent Care 2000; 7: 141-144.
- 28 Lee JK, Reis V, Lui S, Conn L, Groessi EJ, Ganiats TG. et al. Improving fecal occult blood testing compliance using a mailed educational reminder. J Gen Intern Med 2009; 24: 1192-1197.
- 29 Institute of Medicine.. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press,; 2001