Patient Safety Informatics: Adverse Drug Events, Human Factors and IT Tools for Patient Medication Safety

285 Pages·2011·4.28 MB·English

by  V. Koutkias

PATIENT SAFETY INFORMATICS
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Patient Safety Informatics
Adverse Drug Events, Human Factors and
IT Tools for Patient Medication Safety
Edited by
Vassilis Koutkias
Aristotle University of Thessaloniki, Thessaloniki, Greece
Julie Niès
MEDASYS, Gif-sur-Yvette Cedex, France
Sanne Jensen
Capital Region of Copenhagen, Copenhagen, Denmark
Nicos Maglaveras
Aristotle University of Thessaloniki, Thessaloniki, Greece
and
Régis Beuscart
CHRU de Lille, Lille Cedex, France

Amsterdam • Berlin • Tokyo • Washington, DC
© 2011 The authors and IOS Press.
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ISBN 978-1-60750-740-6 (online)
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PRINTED IN THE NETHERLANDS
Patient Safety Informatics v
V. Koutkias et al. (Eds.)
IOS Press, 2011
© 2011 The authors and IOS Press. All rights reserved.
Preface
Patient safety has become an important theme of the research agenda in the course of
the last decade, both throughout Europe and worldwide. Improving patient safety and
the quality of healthcare poses many challenges, and information technology (IT) has
always been seen as having the potential to support the measures necessary to address
these. But the risk of adverse events is unfortunately rising alongside the increasing
sophistication and maturity of the health IT systems incorporated into the hospital envi-
ronment. One major source of such errors is related to medication, i.e. adverse drug
events (ADEs), which can incur considerable extra healthcare costs, as well as posing a
risk to the safety of patients.
From a research perspective, different approaches have been introduced to elimi-
nate ADEs, such as reporting systems, records and chart reviews, detection methods
(with varying degrees of automation), etc. The major concerns raised by all of these
approaches and methods are related to reliability and quality of results, reproducibility
or generalisation of the conclusions drawn, appropriate identification of the contribut-
ing factors and interpretation of the outcomes, and knowledge management.
From a practical perspective, the transferability and use of such tools in clinical
practice is a major challenge. Aspects related explicitly to the healthcare environment
have to be taken carefully into account, such as organisational and procedural parame-
ters, contextualisation issues, human factors and usability features, to name but a few.
The adoption of these tools into real clinical settings is only possible by means of a
holistic, validated and qualitative approach.
Following the success of the first workshop, organised in the context of the EU-
funded Patient Safety through Intelligent Procedures in medication (PSIP) project and
held in Belgirate, Italy, in September 2009, this second workshop presents current,
novel methods and applications that have achieved concrete results and that are rele-
vant to the domain of patient safety as a whole. Reading the papers of this book, which
review the state-of-the-art, it is evident that significant progress has been made in the
field, but that even greater challenges must still be faced if a successful transfer of re-
search ideas and outcomes into clinical practice is to be accomplished. It is the diver-
sity of these challenges and the complexity of the domain which indicate and justify the
necessity to introduce a new direction in healthcare IT devoted to patient safety per se.
Hence the title of this book: “Patient Safety Informatics”.
To this end, the contributions in this book include: (a) designing IT systems for pa-
tient safety, coping in particular with information contextualisation, human factor engi-
neering, the design aspects of clinical decision support systems, and e-prescription
frameworks; (b) methods and technologies for developing patient safety systems, de-
voted to medical information extraction via semantic mining techniques, multi-
terminology systems linked with semantic interoperability, knowledge representation
techniques and standardisation aspects, etc.; (c) novel applications of patient safety
informatics, such as an ADE retrospective analysis framework, the exploitation of deci-
sion support services for ADE prevention via a variety of systems (i.e. a commercial
electronic health record, a commercial computerised physician order entry system, and
an autonomous web-based platform), a standardised patient summary framework, a
vi
terminology mapping framework applicable in several domains, etc., and (d) validation
and impact assessment studies for patient safety informatics outcomes, analysing in
particular patient empowerment solutions, clinical decision support systems and
knowledge bases targeting ADE prevention, an ADE retrospective analysis system,
medical information extraction from discharge letters, etc.
In addition, this workshop is an opportunity for experts active in the field, includ-
ing the contributors to this book, to meet and confront ideas and experiences arising
from many different perspectives, i.e. research, clinical practice and healthcare IT in-
dustry oriented, as well as from several EU projects funded to contribute to patient
safety as a whole.
We would like to express our gratitude to Prof. David Bates, Prof. Jos Aarts and
Dr. Beth Lilja for their participation and their keynote speeches; to Mr. Michele Caren-
ini, Prof. Peter Elkin, Dr. Zoi Kolitsi, Prof. Andre Kushniruk and Prof. Gianluca Trifirò
for accepting the invitation to participate in the Workshop; to all the participants and
the authors of the Workshop; to the Scientific Committee and the reviewers who helped
in the preparation of qualitative contributions in the Workshop and, last but not least, to
the European Commission which, by funding European projects in the domain of pa-
tient safety, have made the organisation of this workshop possible, as well as the edit-
ing and publication of this book.
The book cover is inspired by the paper entitled “Implementation of a Taxonomy
Aiming to Support the Design of a Contextualised Clinical Decision Support System”
by Stéphanie Bernonville, Romaric Marcilly, Radja Messai, Nicolas Leroy, Emma
Przewozny, Nathalie Souf and Marie-Catherine Beuscart-Zéphir which is published in
this book (pp. 74–83). The picture denotes the design approach proposed by the authors
for developing contextualised clinical decision support systems (CDSS) for medication
safety.
Vassilis Koutkias, Julie Niès, Sanne Jensen, Nicos Maglaveras and Régis Beuscart
(editors)
May 2011
vii

Contents
Preface v
Vassilis Koutkias, Julie Niès, Sanne Jensen, Nicos Maglaveras and
Régis Beuscart
Part A. Keynote Papers on Patient Safety Informatics
PSIP: An Overview of the Results and Clinical Implications 3
Régis Beuscart
The Future of Electronic Prescribing 13
Jos Aarts
Accelerating Patient Safety Through the Innovative Use of Information
Technology 18
Beth Lilja and Jonas Egebart
Part B. Invited Papers on Patient Safety Informatics
EU-ADR Healthcare Database Network vs. Spontaneous Reporting System
Database: Preliminary Comparison of Signal Detection 25
Gianluca Trifirò, Vaishali Patadia, Martijn J. Schuemie,
Preciosa M. Coloma, Rosa Gini, Ron Herings, Julia Hippisley-Cox,
Giampiero Mazzaglia, Carlo Giaquinto, Lorenza Scotti, Lars Pedersen,
Paul Avillach, Miriam C.J.M. Sturkenboom and Johan van der Lei
on behalf of the EU-ADR group
3,520 Medication Errors Evaluated to Assess the Potential for IT-Based Decision
Support 31
Kristine Binzer and Annemarie Hellebek
Drug Knowledge Expressed as Computable Semantic Triples 38
Peter L. Elkin, John S. Carter, Manasi Nabar, Mark Tuttle, Michael Lincoln
and Steven H. Brown
Exploring the Relationship Between Usability and Technology-Induced Error:
Unraveling a Complex Interaction 48
Andre Kushniruk and Elizabeth Borycki
ICT for Quality and Safety of Care: Beyond Interoperability 57
Zoi Kolitsi
Part C. Designing IT Systems for Patient Safety
Four Principles for User Interface Design of Computerised Clinical Decision
Support Systems 65
Anne Marie Kanstrup, Marion Berg Christiansen and Christian Nøhr
viii
Implementation of a Taxonomy Aiming to Support the Design of a
Contextualised Clinical Decision Support System 74
Stéphanie Bernonville, Romaric Marcilly, Radja Messai, Nicolas Leroy,
Emma Przewozny, Nathalie Souf and Marie-Catherine Beuscart-Zéphir
Medication Related Computerized Decision Support System (CDSS): Make It
a Clinicians’ Partner! 84
Romaric Marcilly, Nicolas Leroy, Michel Luyckx, Sylvia Pelayo,
Costanza Riccioli and Marie-Catherine Beuscart-Zéphir
Information Contextualization in Decision Support Modules for Adverse Drug
Event Prevention 95
Julie Nies, Vassilis Koutkias, Vassilis Kilintzis, Bertrand Guillot,
Nicos Maglaveras, Henrik Gliese Pedersen, Anna-Lis Berg and
Peter Skjoet
Designing, Implementing and Evaluating e-Prescription: A Field Study and
Comparison with PSIP Results 105
Costanza Riccioli, P. Carlo Cacciabue, Mauro Campanini and Martin Jung
Part D. Methods and Technologies for Developing Patient Safety Systems
Shallow Medication Extraction from Hospital Patient Records 119
Svetla Boytcheva
Health Multi-Terminology Portal: A Semantic Added-Value for Patient Safety 129
Julien Grosjean, Tayeb Merabti, Badisse Dahamna, Ivan Kergourlay,
Benoit Thirion, Lina F. Soualmia and Stefan J. Darmoni
Towards a Standardised Representation of a Knowledge Base for Adverse Drug
Event Prevention 139
Vassilis Koutkias, Katerina Lazou, Paul de Clercq and Nicos Maglaveras
Analysis of the Medication-Use Process in North American Hospital Systems:
Underlining Key Points for Adoption to Improve Patient Safety in French
Hospitals 148
Agnes Brouard, Jean Yves Fagon and Charles E. Daniels
An Approach to ‘Dynamic – DDD (Defined Daily Dose) Monitoring’ to Reduce
Adverse Clinical Outcomes and Increase Patient Safety: Information Repositories
and Event Triggers in Clinical Practice 156
Esat N. Eryilmaz
Part E. Novel Applications of Patient Safety Informatics
The ADE Scorecards: A Tool for Adverse Drug Event Detection in Electronic
Health Records 169
Emmanuel Chazard, Adrian Băceanu, Laurie Ferret and Grégoire Ficheur
Three Different Cases of Exploiting Decision Support Services for Adverse Drug
Event Prevention 180
Stéphanie Bernonville, Julie Nies, Henrik Gliese Pedersen, Bertrand Guillot,
Mostafa Maazi, Anna-Lis Berg, Jean-Charles Sarfati and Vassilis Koutkias
ix
Patient Summary and Medicines Reconciliation: Application of the ISO/CEN
EN 13606 Standard in Clinical Practice 189
Francisco J. Farfán Sedano, Marta Terrón Cuadrado,
Yolanda Castellanos Clemente, Pablo Serrano Balazote,
David Moner Cano and Montserrat Robles Viejo
Engineering the Electronic Health Record for Safety: A Multi-Level Video-Based
Approach to Diagnosing and Preventing Technology-Induced Error Arising from
Usability Problems 197
Elizabeth M. Borycki, Andre W. Kushniruk, Shigeki Kuwata and
Joseph Kannry
Mapping the ATC Classification to the UMLS Metathesaurus: Some Pragmatic
Applications 206
Tayeb Merabti, Hocine Abdoune, Catherine Letord, Saoussen Sakji,
Michel Joubert and Stefan J. Darmoni
Part F. Validation and Impact Assessment of Patient Safety Informatics
Approaches
Lessons Learnt from Conducting a High Fidelity Simulation Test in Health IT 217
Kitta Lawton, Kristine Binzer, Peter Skjoet and Sanne Jensen
Impact Evaluation of Innovative Technology: Estimating the Impact of the PSIP
Solutions 227
Elske Ammenwerth, Werner O. Hackl, Sanne Jensen, Kitta Lawton,
Daniel Riedmann and Martin Jung
Scorecards: A New Method to Prevent Adverse Drug Events? Preliminary
Results from a Clinical Field Study 234
Romaric Marcilly, Werner O. Hackl, Michel Luyckx and
Elske Ammenwerth
Assessment of Three Systems to Empower the Patient and Decrease the Risk
of Adverse Drug Events 246
Kitta Lawton and Peter Skjoet
Validation of Completeness, Correctness, Relevance and Understandability
of the PSIP CDSS for Medication Safety 254
Elske Ammenwerth, Werner O. Hackl, Philippe Massari and
Stefan Darmoni
Completion of Structured Patient Descriptions by Semantic Mining 260
Dimitar Tchraktchiev, Galia Angelova, Svetla Boytcheva, Zhivko Angelov
and Sabina Zacharieva
Subject Index 271
Author Index 273