title: Linking Orders in Electronic Medical Records Can Improve the Frequency With Which Recommended Treatments Are Ordered as Illustrated in the Treatment of Alcohol Withdrawal.
abstract: OBJECTIVE
  The purpose of this study was to collect objective data concerning the prescription of vitamin supplementation treatment in hospitalized patients at risk for alcohol withdrawal.
  
  
  METHODS
  This study compared the total number of orders for folate, thiamine, and multivitamins with assessments ordered using the revised Clinical Institute Withdrawal Assessment of Alcohol (CIWA-Ar) during 2 congruent time periods in a hospital system before and after these orders were linked to determine the effectiveness of the link. Frequency counts of the order sets containing CIWA-Ar with and without doses of folate, thiamine, and multivitamins were extracted from the electronic medical record. One set of frequencies was collected between January 1, 2012, and June 15, 2012. The second set was collected between January 1, 2013, and June 15, 2013, after the intervention in which these orders were linked. Percentages were calculated from the frequency counts.
  
  
  RESULTS
  Results of the study showed that before the intervention linking these orders, thiamine was ordered only 41 times, folate 42 times, and multivitamin 42 times, whereas CIWA-Ar was ordered 1228 times within the same time parameters (3.34%, 3.42%, and 3.42%, respectively), for a total average rate of 10.18%. After orders for thiamine, folate, and multivitamins were linked to the CIWA-Ar, the average rate of these vitamins being ordered with CIWA-Ar reached 77.94%.
  
  
  CONCLUSIONS
  This study found that linking CIWA-Ar and vitamin supplementation orders within the electronic medical record increases the likelihood of them being ordered together. We propose that this can be applied to other treatments that are commonly ordered together and that such orders should be linked to improve the standards of care for all patients.
authors.affiliation: POPE and DELOS REYES: Department of Psychiatry, University Hospitals-Case Medical Center, Cleveland, OH GUSTAW-ROTHENBERG: at the time the manuscript was prepared, Department of Psychiatry, University Hospitals-Case Medical Center; currently Neurologic Institute, Cleveland Clinic.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Pope
authors.forename: Kasia
authors.initials: K
authors.lastname: Gustaw-Rothenberg
authors.forename: Christina
authors.initials: C
authors.lastname: Delos Reyes
mesh_terms: D057286:Electronic Health Records / Q000458:organization & administration*; D000431:Ethanol / Q000009:adverse effects*; D006801:Humans; D008498:Medical Record Linkage; D010818:Practice Patterns, Physicians'; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D000431:Ethanol