Prescribing safety features of general practice computer systems: evaluation using simulated test cases
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《英国医生杂志》
1 Thames Avenue Surgery, Rainham, Kent, 2 Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, 3 Division of Community Health Sciences: GP Section, University of Edinburgh, 4 PRIMIS, University of Nottingham
Correspondence to: Anthony J Avery tony.avery@nottingham.ac.uk
Introduction
We used a two round Delphi approach to reach agreement on the most important safety features of general practice computer systems.5 This involved electronically circulating a list of 55 theoretically derived statements related to safety to 22 members of a selected multidisciplinary expert panel. Statements related to eight broad themes covering key areas in the medicines management process: prescriber alerts, reports and clinical audit, user interface, repeat prescribing, decision support, coding, monitoring, and links to laboratories.
Over 90% of the panel judged 32 of these statements to be important, and these were then used to develop 18 scenarios, which were tested using dummy patient records on the four computing systems. The systems (labelled A, B, C, and D in order to preserve suppliers' anonymity) were independently evaluated at Primary Care Information Services (PRIMIS) laboratories by two members of the project team. To minimise risk of bias, systems were tested with each of the scenarios in random order and data were recorded on to piloted data extraction sheets.
We defined the standards against which the computing systems were to be evaluated. These included appropriate alerts when contraindicated drugs or hazardous drug-drug combinations were prescribed. For each scenario, the safety profile of the computing system was categorised as appropriate or inappropriate. Evaluators compared findings, and an agreed mechanism was available for resolving disagreements should these arise. Finally, to ensure that there were no technical set-up problems that could have accounted for the observed failures, we reported the problems that were identified to the manufacturers and invited comment.
None of the systems produced alerts for all of the 18 scenarios (table). In terms of prescription of drugs with similar names, none of the systems warned for all 10 drug pairs considered.
Responses of computer systems tested for prescribing scenarios
The evaluators produced no discrepancies in assessing the safety of systems. Each of the four system suppliers agreed with our assessments.
Comment
Department of Health. Delivering 21st century IT support for the NHS: national strategic programme. London: Department of Health, 2002. www.dh.gov.uk/assetRoot/04/06/71/12/04067112.pdf (accessed 23 Apr 2004).
Magnus D, Rodger S, Avery AJ. GPs' views on computerised drug interaction alerts: questionnaire survey. J Clin Pharm Ther 2002;27: 377-82.
Yen-Fu C, Avery AJ, Neil K, Johnson C. Assessing the occurrence and preventability of prescribing potentially hazardous/contraindicated drug combinations in general (family) practice. Pharmacoepidemiol Drug Safety 2001;10: S53.
Wilson T, Sheikh A. Enhancing public safety in primary care. BMJ 2002;324: 584-7.
Avery AJ, Savelyich B, Teasdale S. Improving the safety features of general practice computer systems. Informatics Prim Care 2003;11: 203-6.(Bernard Fernando, general)
Correspondence to: Anthony J Avery tony.avery@nottingham.ac.uk
Introduction
We used a two round Delphi approach to reach agreement on the most important safety features of general practice computer systems.5 This involved electronically circulating a list of 55 theoretically derived statements related to safety to 22 members of a selected multidisciplinary expert panel. Statements related to eight broad themes covering key areas in the medicines management process: prescriber alerts, reports and clinical audit, user interface, repeat prescribing, decision support, coding, monitoring, and links to laboratories.
Over 90% of the panel judged 32 of these statements to be important, and these were then used to develop 18 scenarios, which were tested using dummy patient records on the four computing systems. The systems (labelled A, B, C, and D in order to preserve suppliers' anonymity) were independently evaluated at Primary Care Information Services (PRIMIS) laboratories by two members of the project team. To minimise risk of bias, systems were tested with each of the scenarios in random order and data were recorded on to piloted data extraction sheets.
We defined the standards against which the computing systems were to be evaluated. These included appropriate alerts when contraindicated drugs or hazardous drug-drug combinations were prescribed. For each scenario, the safety profile of the computing system was categorised as appropriate or inappropriate. Evaluators compared findings, and an agreed mechanism was available for resolving disagreements should these arise. Finally, to ensure that there were no technical set-up problems that could have accounted for the observed failures, we reported the problems that were identified to the manufacturers and invited comment.
None of the systems produced alerts for all of the 18 scenarios (table). In terms of prescription of drugs with similar names, none of the systems warned for all 10 drug pairs considered.
Responses of computer systems tested for prescribing scenarios
The evaluators produced no discrepancies in assessing the safety of systems. Each of the four system suppliers agreed with our assessments.
Comment
Department of Health. Delivering 21st century IT support for the NHS: national strategic programme. London: Department of Health, 2002. www.dh.gov.uk/assetRoot/04/06/71/12/04067112.pdf (accessed 23 Apr 2004).
Magnus D, Rodger S, Avery AJ. GPs' views on computerised drug interaction alerts: questionnaire survey. J Clin Pharm Ther 2002;27: 377-82.
Yen-Fu C, Avery AJ, Neil K, Johnson C. Assessing the occurrence and preventability of prescribing potentially hazardous/contraindicated drug combinations in general (family) practice. Pharmacoepidemiol Drug Safety 2001;10: S53.
Wilson T, Sheikh A. Enhancing public safety in primary care. BMJ 2002;324: 584-7.
Avery AJ, Savelyich B, Teasdale S. Improving the safety features of general practice computer systems. Informatics Prim Care 2003;11: 203-6.(Bernard Fernando, general)