Clinical decision support systems are costly to develop and rely heavily on physician and pharmacist expertise
Computerized prescriber order entry (CPOE) systems allow clinicians to electronically enter medication orders. These systems can reduce medication-related errors because they eliminate the need to decipher handwriting, improve communication between providers, and standardize care. When a clinical decision support system (CDSS) is added to a CPOE, it provides the added value of integrating a medical knowledge base, patient data, and an inference engine to generate drug alerts on the case at hand.
To determine the cost of developing a CDSS, researchers studied a team that developed one at a long-term care facility in Canada. Patients in these facilities often have weakened kidney function and take multiple medications, which puts them at a high-risk of medication-caused health problems. The team created 94 alerts for recommended maximum doses of 62 medications that could be prescribed to patients with weakened kidneys.
The cost of personnel to develop the CDSS was $48,178 and 925 hours. Physicians logged the most hours (390) to prepare the detailed content, and pharmacists contributed 180 hours preparing content and testing the drug alerts. The costs were lowered since users were familiar with prescribing alerts, thus very little time was required to train and support users.
The researchers estimated that if an off-the-shelf renal dosing CDSS were available, it could have reduced the total cost by $24,483. However, the staff would still spend 241 hours evaluating the system and its alerts, because commercial companies tend to be conservative and include too many, rather than too few, alerts to avoid liability as well as to ensure that the alerts are consistent with local clinical practice. Hence, physicians and pharmacists would likely need to spend time editing alerts and de-activating those that are considered extraneous. Researchers also estimated that if a database with dosing recommendations for patients with weakened kidneys were available and could be used with a CPOE, it could cut the cost by $13,977. This study was funded in part by the Agency for Healthcare Research and Quality (HS10481 and HS15430).
See "Costs associated with developing and implementing a computerized clinical decision support system for medication dosing for patients with renal insufficiency in the long-term care setting," by Terry S. Field, D.Sc., Paula Rochon, M.D., M.P.H., Monica Lee, R.Ph., and others in the July/August 2008 Journal of the American Medical Informatics Association 15(4), pp. 466-472.
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