Project Members: Lisa Mahoney, John Doole, Wendy Chao, Jiby Joseph-Thomas, Elaine Recklet, Fay Moy, Eileen Yoshida, Saverio Maviglia, Roberto Rocha

Our team oversees the clinical content of the medication knowledge bases that are used by many of the order entry systems across the Partners enterprise. We work directly with frontline clinicians to support and maintain appropriate clinical information relating to medications in Partners proprietary drug knowledge bases.

Our scope of responsibility also includes maintaining knowledge bases that support specialized medication decision support including drug dosing in renally compromised patients, drug dosing in the elderly population and drug-drug interactions. These knowledge bases are deployed across the Partners enterprise.

We work alongside a variety of personnel, including frontline physicians, pharmacists and other healthcare professionals, project managers, analysts and developers. Our roles on projects vary, but the expertise we typically provide is our working knowledge of the medication use process, drug knowledge, and informatics background.

Here is a brief description of some of our most recent/current work:

DAC Oral Chemotherapy Project

This project focused on improving existing functionality within the LMR application to support safe prescribing of oral chemotherapy medications. Our primary role was to work directly with hematologist-oncologists to develop decision support for chemotherapy drugs prescribed as take home medications for patients. We also participated in the design of safeguards such as weight based and BSA dosing limits to minimize the risk of dosing errors.

This functionality was released by the LMR team in June 2009.

Review of Nephros Medication Knowledge Base

In 1997, BWH implemented clinical decision support for a subset of renally cleared or nephrotoxic drugs in their inpatient order entry application. When triggered, the decision support presents a drug substitution, adjusted dose, or adjusted frequencies. This functionality was found to increase the rate of appropriate prescriptions based on a patient’s calculated renal function (59 vs. 35%, p<0.001) and to decrease a patient’s length of stay (4.3 vs. 4.5 days, p<00.01). Since that time, this functionality has been deployed in all Partners order entry applications.

We are currently coordinating the review and update of the original Nephros medication knowledge base that was deployed in 1997 with subject matter experts from BWH and MGH. It is anticipated that the Nephros knowledge base will soon be deployed to some Partners community hospitals.

Medication Knowledge Committee (MKC) and the Drug-Drug Interaction Knowledge Base

The MKC is the centralized decision making body for Partners-wide medication decision support content and knowledge issues. It is also the arbitrating body for medication decision support content, when there is no consensus among different Partners sites, applications or advisory groups. The Committee is compromised mostly of pharmacists and physicians.

One of the key responsibilities of the Committee is to maintain a proprietary drug-drug interaction knowledge base which is deployed in order entry applications across the enterprise. The Partners DDI knowledge base differs significantly from some of the commercially available DDI knowledge bases in that it carefully weighs the clinical impact/significance of a DDI alert with the need to interrupt a physician during the order entry process at Partners, in an effort to minimize alert fatigue.

Duplicate Therapy Project

Partners High Performance Medicine Team 2:1 has determined that detecting and preventing duplicate medication therapy is a priority for Partners, therefore, enterprise-wide duplicate therapy clinical decision support services are being developed. Duplications of medication therapy are defined as therapeutic or pharmacologic use repetitions of two or more drugs that create an increased potential for additive toxicity or adverse effects, or cause therapeutic redundancy without increased benefit. Duplicate therapy checking at Partners will occur during the order entry process by comparing new medication orders to medications that already exist on a patient’s active medication profile. The alerts will surface for any clinicians with medication order entry privileges.

The areas of focus for the Medication Knowledge Management team is the development of the duplicate therapy knowledge base that will be used, as well as the development of a content authoring tool that will create and maintain the knowledge base.

This functionality is due to be released in the Winter 2009.