Examples from JSS
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- if chronic renal failure, then calcium should be given.
- If HB electrophoresis is SS from lab, whether patient is started on hydroxyurea or not should be informed to clinical coordinator.
- If CBNAAT MTB Detected, then ATT started or not.
- If Acute infection, iron may be postponed till beyond 7 days (How to define acute infections?)
- Patients with high blood pressure should be prescribed pain killers such as Ibuprofen with caution, since it can cause BP to rise. A notification that the patient is hypertensive can be useful in such conditions.
- When diagnosed with TB following blood tests must be done - Hb, S. Albumin, ALT, RBS, HIV, S. Creatinine, GGT. If RBS > 100, FBS, PP2BS.
- On prescribing X Ray in a woman over 15 years of age, a warning saying have you checked last menstrual period and it is less than 20 days ago.
- Contraindication in Pregnancy
- Chloramphenicol, Doxycycline
- Streptomycin, Kanamycin, Tetracycline, Amikacin
- XRay (chest, Erect Abdomen)
- Used in Pregnancy
- Cephalosporin
- NFT, Erythromycin, Penicillin
- In Sickle Cell, hydroxyurea must be asked for, except in pregnancy.
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Drug Interactions
- If patient having warfarin and ATT started then shift heparin
- Iron and calcium not to be prescribed to be taken at same time as they reduce each other’s effecitivity.
- If ATT going on then patient should not be given OC pills, warfarin
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Patient X comes in, is prescribed drug penicillin. Searching through the patient's obs is concept "ALLERGY" and the value is penicillin, or 'penicillin' is in any concept the has "ALLERGY" or "ALLERGIC" in the name. Send a message back that says "Patient is allergic to <penicillin>. Recommend <different antibiotic>."
CDS during data-entry tasks
- Smart Documentation Forms that are tailored based on patient data to emphasize data elements pertinent to the patient’s conditions and healthcare needs.
- Order Sets, Care Plans and Protocols that encourage correct and efficient ordering, promote evidence-based best practices, and can provide different management recommendations for different patient situations.
- Parameter Guidance to promote correct entry of orders and documentation.
- Critiques and Warnings - the“Immediate Alerts” that are presented just after a user has entered an order, prescription, or documentation item, to show a potential hazard, or a recommendation for further information. E.g. drug you are about to administer is contraindicated for your patient at this time
CDS not triggered by a user task
- Event-driven Alerts (Data-triggered) and Reminders (Time-triggered), which alert the clinical user to a new event occurring asynchronously, such as an abnormal lab result, abnormal vitals
- Filtered Reference Information and Knowledge Resources
- Relevant Data Summary. E.g. preventive care measures - such as flu vaccine, colon cancer screening, cholesterol tests - that are due for your patient, based on age, medical history (problem list), and medication list stored in the EHR.
Duke Family Medicine Center Care Guidelines for Diabetes Mellitus
- Foot examination monthly in patients with diabetic neuropathy, peripheral neuropathy, or history of lower limb ulcers.
- Annual complete physical examination.
- Determination of chronic blood glucose control every 6 months.
- Annual urine protein determination.
- Annual cholesterol level.
- Annual ophthalmologic examination.
- Seasonal influenza vaccination (September-January).
- Pneumococcal vaccination.
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