title: Linking laboratory and pharmacy: opportunities for reducing errors and improving care.
abstract: A myriad of errors and lost improvement opportunities result from failure of clinical laboratory and pharmacy information systems to effectively communicate. Pharmacotherapy could benefit from enhanced laboratory-pharmacy linkage with respect to (1) drug choice (laboratory-based indications and contraindications), (2) drug dosing (renal or hepatic, blood level-guided adjustments), (3) laboratory monitoring (laboratory signals of toxicity, baseline and ongoing monitoring), (4) laboratory result interpretation (drug interfering with test), and (5) broader quality improvement (surveillance for unrecognized toxicity, monitoring clinician response delays). Linkages can be retrospective or real-time. Many organizations could benefit now by linking existing pharmacy and laboratory data. Greater improvement is possible through implementation of electronic order entry with real-time decision support incorporating linked laboratory and pharmacy data. While many guidelines, admonitions, and rules exist regarding drugs and the laboratory, substantial new knowledge and evidence in this area are needed. Focusing on these unmet needs and accompanying logistical challenges is a priority.
authors.affiliation: Department of Medicine, Cook County Hospital, Rush Medical College, Chicago, IL 60612, USA. Gdschiff@aol.com
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.forename: David
authors.initials: D
authors.lastname: Klass
authors.forename: Josh
authors.initials: J
authors.lastname: Peterson
authors.forename: Gaurav
authors.initials: G
authors.lastname: Shah
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D002984:Clinical Laboratory Information Systems / Q000458:organization & administration*; D016303:Clinical Pharmacy Information Systems / Q000458:organization & administration*; D004347:Drug Interactions; D016903:Drug Monitoring; D011307:Drug Prescriptions; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D008498:Medical Record Linkage; D008508:Medication Errors / Q000517:prevention & control*; D005791:Patient Care; D011787:Quality of Health Care; D018511:Systems Integration