Rapport final
Development and evaluation of a computerized clinical decision support system for drug allergy checking - Legat Laura
Worldwide the prevalence of allergic diseases has risen importantly, especially drug allergies are becoming increasingly common. A leading approach to improve patient safety is the use of clinical decision support systems (CDSS) which are computer systems that assist clinicians in decision making at the point in time that these decisions are made by for example providing alerts at the moment of prescribing. Challenges remain for increasing the specificity of drug allergy alerts. Current CDSS have very high alert override rates of up to 90%.
In this project we started with conducting a systematic review to provide a comprehensive overview regarding all aspects of CDSS for drug allergy, including documenting, coding, rule bases, alerts and alert fatigue, and outcome evaluation.
We found that accurate and comprehensive recording of drug allergies is required for good use of CDSS and that considerable variation in the way drug allergies are recorded in electronic health records (EHRs) exists. It remains difficult to reduce drug allergy alert overload while maintaining patient safety as the highest priority.
Subsequently, we analyzed previously recorded drug allergy information from the electronic medical record in a retrospective cohort study. This analysis showed serious shortcomings in the current documentation of drug allergy information. As a result, we started with the development of an intelligent allergy documentation tool based on SNOMED CT concepts. This documentation tool is currently being finalized for implementation in clinical practice.
The last phase of the project, the development and implementation of the CDSS is ongoing.