title: Costs associated with developing and implementing a computerized clinical decision support system for medication dosing for patients with renal insufficiency in the long-term care setting.
abstract: A team of physicians, pharmacists, and informatics professionals developed a CDSS added to a commercial electronic medical record system to provide prescribers with patient-specific maximum dosing recommendations based on renal function. We tracked the time spent by team members and used US national averages of relevant hourly wages to estimate costs. The team required 924.5 hours and $48,668.57 in estimated costs to develop 94 alerts for 62 drugs. The most time intensive phase of the project was preparing the contents of the CDSS (482.25 hours, $27,455.61). Physicians were the team members with the highest time commitment (414.25 hours, $25,902.04). Estimates under alternative scenarios found lower total cost estimates with the existence of a valid renal dosing database ($34,200.71) or an existing decision support add-on for renal dosing ($23,694.51). Development of a CDSS for a commercial computerized prescriber order entry system requires extensive commitment of personnel, particularly among clinical staff.
authors.affiliation: Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605, USA. terry.field@umassmed.edu
authors.forename: Terry S
authors.initials: TS
authors.lastname: Field
authors.forename: Paula
authors.initials: P
authors.lastname: Rochon
authors.forename: Monica
authors.initials: M
authors.lastname: Lee
authors.forename: Linda
authors.initials: L
authors.lastname: Gavendo
authors.forename: Sujha
authors.initials: S
authors.lastname: Subramanian
authors.forename: Sonia
authors.initials: S
authors.lastname: Hoover
authors.forename: Joann
authors.initials: J
authors.lastname: Baril
authors.forename: Jerry
authors.initials: J
authors.lastname: Gurwitz
mesh_terms: D003365:Costs and Cost Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D004360:Drug Therapy, Computer-Assisted / Q000191:economics*; D006282:Health Personnel / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D050316:Medical Order Entry Systems / Q000191:economics*; D016347:Medical Records Systems, Computerized; D008509:Medication Systems / Q000191:economics; D009936:Organizational Innovation / Q000191:economics; D051437:Renal Insufficiency / Q000188:drug therapy* / Q000191:economics; D013647:Task Performance and Analysis; D014584:User-Computer Interface