A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
BACKGROUND
Maintenance of problem lists in electronic medical records is required for the meaningful use incentive and by the Joint Commission. Linking indication with prescribed medications using computerized physician order entry (CPOE) can improve problem list documentation. Prescribing of antihypertensive medications is an excellent target for interventions to improve indication-based prescribing because antihypertensive medications often have multiple indications and are frequently prescribed.


OBJECTIVE
To measure the accuracy and completeness of electronic problem list additions using indication-based prescribing of antihypertensives.


METHODS
Clinical decision support (CDS) was implemented so that orders of antihypertensives prompted ordering physicians to select from problem list additions indicated by that medication. An observational analysis of 1000 alerts was performed to determine the accuracy of physicians' selections.


RESULTS
At least one accurate problem was placed 57.5% of the time. Inaccurate problems were placed 4.8% of the time. Accuracy was lower in medications with multiple indications and the likelihood of omitted problems was higher compared to medications whose only indication was hypertension. Attending physicians outperformed other clinicians. There was somewhat lower accuracy for inpatients compared to outpatients.


CONCLUSIONS
CDS using indication-based prescribing of antihypertensives produced accurate problem placement roughly two-thirds of time with fewer than 5% inaccurate problems placed. Performance of alerts was sensitive to the number of potential indications of the medication and attendings vs. other clinicians prescribing. Indication-based prescribing during CPOE can be used for problem list maintenance, but requires optimization.
Department of Medicine, Section of General Internal Medicine, University of Illinois Hospital and Health Sciences System (UIHHSS), United States. Electronic address: sfalck@uic.edu.
Suzanne
S
Falck
Department of Pharmacy Administration, College of Pharmacy, UIHHSS, United States.
Sruthi
S
Adimadhyam
Section of Hospital Medicine, University of Chicago, United States.
David O
DO
Meltzer
Department of Pharmacy Administration, College of Pharmacy, UIHHSS, United States.
Surrey M
SM
Walton
Department of Medicine, Section of General Internal Medicine, University of Illinois Hospital and Health Sciences System (UIHHSS), United States; Department of Pharmacy Practice, College of Pharmacy, UIHHSS, United States.
William L
WL
Galanter
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D004282:Documentation / Q000379:methods*; D055695:Electronic Prescribing; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D062527:Meaningful Use / Q000706:statistics & numerical data*; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data*; D008498:Medical Record Linkage / Q000379:methods; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents
CDS; CPOE; Clinical decision support; EMR; Hypertension; Indication based; Problem list