Expert systems. Assisting formulary decision making in the ambulatory setting.
In this article, the author reviews the application of a computer-assisted decision support system to their formulary decision-making process. Basic information is presented describing expert systems, which are a type of computer-assisted decision support system, and their advantages and disadvantages. A specific example of an expert system, 'RXPERT', is described. 'RXPERT' is a prototype expert system that models the decision-making process for an ambulatory (nonhospital) formulary. This formulary is the underpinning of the prescription drug benefit programme for the nearly 1 million residents of Saskatchewan, Canada. In the current formulary decision process, each drug product is evaluated by 2 separate committees, with the third and final decision resting with the Ministry of Health. The first committee, the Drug Quality Assessment Committee (DQAC), comprises members with expertise in medicine, pharmacology, clinical pharmacy, pharmaceutics, statistics, and regulatory processes. The DQAC evaluates information from the drug manufacturer and other independent sources, and makes an initial assessment with respect to clinical aspects of alternative therapies and generic interchangeability. The committee then makes its recommendation to the Saskatchewan Formulary Committee (SFC). The SFC reviews the recommendation of the DQAC and considers the administrative and economic implications of accepting the product for the patient, the programme, and healthcare professionals' practice. The SFC either reaffirms the recommendation of the DQAC or modifies it based on further review, and forwards its recommendation to the Ministry of Health. Finally, the Ministry of Health reviews the evaluation and determines the drug's formulary status.(ABSTRACT TRUNCATED AT 250 WORDS)
Nash
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Office of Health Policy, Thomas Jefferson University Hospital, Philadelphia, USA.
Windt
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Peterson
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D003658:Decision Making, Computer-Assisted; D005103:Expert Systems; D005572:Formularies, Hospital as Topic; D010607:Pharmacy Service, Hospital