title: A health record integrated clinical decision support system to support prescriptions of pharmaceutical drugs in patients with reduced renal function: design, development and proof of concept.
abstract: OBJECTIVE
  To develop and verify proof of concept for a clinical decision support system (CDSS) to support prescriptions of pharmaceutical drugs in patients with reduced renal function, integrated in an electronic health record system (EHR) used in both hospitals and primary care.
  
  
  METHODS
  A pilot study in one geriatric clinic, one internal medicine admission ward and two outpatient healthcare centers was evaluated with a questionnaire focusing on the usefulness of the CDSS. The usage of the system was followed in a log.
  
  
  RESULTS
  The CDSS is considered to increase the attention on patients with impaired renal function, provides a better understanding of dosing and is time saving. The calculated glomerular filtration rate (eGFR) and the dosing recommendation classification were perceived useful while the recommendation texts and background had been used to a lesser extent.
  
  
  CONCLUSIONS
  Few previous systems are used in primary care and cover this number of drugs. The global assessment of the CDSS scored high but some elements were used to a limited extent possibly due to accessibility or that texts were considered difficult to absorb. Choosing a formula for the calculation of eGFR in a CDSS may be problematic.
  
  
  CONCLUSIONS
  A real-time CDSS to support kidney-related drug prescribing in both hospital and outpatient settings is valuable to the physicians. It has the potential to improve quality of drug prescribing by increasing the attention on patients with renal insufficiency and the knowledge of their drug dosing.
authors.affiliation: Department of E-health and Strategic IT, Stockholm County Council, Sweden. Electronic address: tero.shemeikka@sll.se.
authors.forename: Tero
authors.initials: T
authors.lastname: Shemeikka
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institute, Stockholm, Sweden; Department of Healthcare Development, Stockholm County Council, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Bastholm-Rahmner
authors.affiliation: Department of Evidence Based Medicine, Stockholm County Council, Sweden; Nephrology Unit, Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Elinder
authors.affiliation: Department of Healthcare Development, Stockholm County Council, Sweden; Health Services Research at Department of Public Health and Caring Sciences, Uppsala University, Sweden.
authors.forename: Anikó
authors.initials: A
authors.lastname: Vég
authors.affiliation: Department of E-health and Strategic IT, Stockholm County Council, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Törnqvist
authors.affiliation: Department of E-health and Strategic IT, Stockholm County Council, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Cornelius
authors.affiliation: Department of E-health and Strategic IT, Stockholm County Council, Sweden; Department of Medicine, Division of Clinical Pharmacology, Karolinska Institute, Sweden.
authors.forename: Seher
authors.initials: S
authors.lastname: Korkmaz
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D004360:Drug Therapy, Computer-Assisted; D055695:Electronic Prescribing; D006801:Humans; D016347:Medical Records Systems, Computerized; D010865:Pilot Projects; D051437:Renal Insufficiency / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D013548:Sweden; D018511:Systems Integration; D014584:User-Computer Interface
keywords: Adverse events; Clinical decision support system; Knowledge base; Order entry system; Renal failure