Linking Laboratory and Pharmacy

Schiff, Gordon D.; Klass, David; Peterson, Josh F.; Shah, Gaurav Jung; Bates, David W.

doi:10.1001/archinte.163.8.893

Cited by 122 publications

(28 citation statements)

References 91 publications

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“…For example, linking the laboratory information system with the pharmacy information system may have direct benefits for patient outcomes, such as the prevention of mismatches between microbiology data and prescription of antibiotics (30 ). A laboratory data warehouse that is standardized and horizontally and vertically integrated allows for data mining and better management of clinical laboratory test utilization.…”

Section: Cost-effective Laboratory Testingmentioning

confidence: 99%

Laboratory Medicine: Challenges and Opportunities

2007

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Technologic innovations have substantially improved the productivity of clinical laboratories, but the services provided by clinical laboratories are increasingly becoming commoditized. We reflect on how current developments may affect the future of laboratory medicine and how to deal with these changes. We argue that to be prepared for the future, clinical laboratories should enhance efficiency and reduce costs by forming alliances and networks; consolidating, integrating, or outsourcing; and more importantly, create additional value by providing knowledge services related to in vitro diagnostics.

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Section: Cost-effective Laboratory Testingmentioning

confidence: 99%

Laboratory Medicine: Challenges and Opportunities

2007

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“…Lastly, it is impossible for providers to remember and stay current with all of the new information being provided. For example, the top forty prescribed medications each has on average seven drug–laboratory interactions [14]. …”

Section: Introductionmentioning

confidence: 99%

The Effect of Automated Alerts on Provider Ordering Behavior in an Outpatient Setting

et al. 2005

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BackgroundComputerized order entry systems have the potential to prevent medication errors and decrease adverse drug events with the use of clinical-decision support systems presenting alerts to providers. Despite the large volume of medications prescribed in the outpatient setting, few studies have assessed the impact of automated alerts on medication errors related to drug–laboratory interactions in an outpatient primary-care setting.Methods and FindingsA primary-care clinic in an integrated safety net institution was the setting for the study. In collaboration with commercial information technology vendors, rules were developed to address a set of drug–laboratory interactions. All patients seen in the clinic during the study period were eligible for the intervention. As providers ordered medications on a computer, an alert was displayed if a relevant drug–laboratory interaction existed. Comparisons were made between baseline and postintervention time periods. Provider ordering behavior was monitored focusing on the number of medication orders not completed and the number of rule-associated laboratory test orders initiated after alert display. Adverse drug events were assessed by doing a random sample of chart reviews using the Naranjo scoring scale.The rule processed 16,291 times during the study period on all possible medication orders: 7,017 during the pre-intervention period and 9,274 during the postintervention period. During the postintervention period, an alert was displayed for 11.8% (1,093 out of 9,274) of the times the rule processed, with 5.6% for only “missing laboratory values,” 6.0% for only “abnormal laboratory values,” and 0.2% for both types of alerts. Focusing on 18 high-volume and high-risk medications revealed a significant increase in the percentage of time the provider stopped the ordering process and did not complete the medication order when an alert for an abnormal rule-associated laboratory result was displayed (5.6% vs. 10.9%, p = 0.03, Generalized Estimating Equations test). The provider also increased ordering of the rule-associated laboratory test when an alert was displayed (39% at baseline vs. 51% during post intervention, p < 0.001). There was a non-statistically significant difference towards less “definite” or “probable” adverse drug events defined by Naranjo scoring (10.3% at baseline vs. 4.3% during postintervention, p = 0.23).ConclusionProviders will adhere to alerts and will use this information to improve patient care. Specifically, in response to drug–laboratory interaction alerts, providers will significantly increase the ordering of appropriate laboratory tests. There may be a concomitant change in adverse drug events that would require a larger study to confirm. Implementation of rules technology to prevent medication errors could be an effective tool for reducing medication errors in an outpatient setting.

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“…Information technology can greatly enable rapid access to patients’ prescription history and clinical test results. 50 A clinic-based pharmacist, as described above, could have access to PGx results through the clinic or health system’s electronic health record. Likewise, MTM services could be documented in the electronic health record and recommendations based on the test results could also be contained within the electronic health record.…”

Section: Challenges To Integrating Pgx Into Mtm Servicesmentioning

confidence: 99%

Challenges to Integrating Pharmacogenetic Testing into Medication Therapy Management

Haga

LaPointe²,

Moaddeb³

2015

JMCP

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Background Some have proposed the integration of pharmacogenetic (PGx) testing into medication therapy management (MTM) to enable further refinement of treatment(s) to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This “enhanced” MTM might also reduce patient concerns about side effects and increase confidence that the medication is effective, addressing two key factors that impact patient adherence - concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. Objectives In this paper, we consider some of the challenges to the integration and delivery of PGx testing in MTM services. What is already known about this subject While the addition of pharmacogenetic testing has been suggested, little literature exists exploring the challenges or feasibility of doing so.

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Linking Laboratory and Pharmacy

Cited by 122 publications

References 91 publications

Laboratory Medicine: Challenges and Opportunities

Laboratory Medicine: Challenges and Opportunities

The Effect of Automated Alerts on Provider Ordering Behavior in an Outpatient Setting

Challenges to Integrating Pharmacogenetic Testing into Medication Therapy Management

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