Download PDF
Methods Inf Med 2014; 53(05): 336-343
DOI: 10.3414/ME14-01-0040
Original Articles
Schattauer GmbH

Memorandum on the Use of Information Technology to Improve Medication Safety

E. Ammenwerth
1   Institute of Health Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
,
A.-F. Aly
2   Drug Commission of the German Medical Association, Berlin, Germany
,
T. Bürkle
3   Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Germany
,
P. Christ
4   Medizinische Medien Information, Neu Isenburg, Germany
,
H. Dormann
5   Department of Emergency Medicine, Klinikum Fürth, Fürth, Germany
,
W. Friesdorf
6   Institute for Health Care Systems Management Berlin, Berlin, Germany
,
C. Haas
7   DIMDI – German Institute of Medical Documentation and Information, Köln, Germany
,
W. E. Haefeli
8   Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
,
M. Jeske
9   Department of Pharmacology and Toxicology, Institute of Pharmacy, University of Innsbruck, Innsbruck, Austria
,
J. Kaltschmidt
8   Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
,
K. Menges
10   Federal Institute for Medicinal Products and Medical Devices (BfArM), Bonn, Germany
,
H. Möller
2   Drug Commission of the German Medical Association, Berlin, Germany
,
A. Neubert
11   Department of Paediatric and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
,
W. Rascher
11   Department of Paediatric and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
,
H. Reichert
12   Master of Science in Medical Informatics, Berlin, Germany
,
J. Schuler
13   Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
,
G. Schreier
14   Assistive Healthcare Information Technology, AIT Austrian Institute of Technology GmbH, Graz, Austria
,
S. Schulz
15   Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
,
H. M. Seidling
16   Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany
,
W. Stühlinger
17   Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria
,
M. Criegee-Rieck
3   Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Germany
› Author Affiliations
Further Information

Publication History

received:16 March 2014

accepted:01 May 2014

Publication Date:
20 January 2018 (online)

    Permissions and Reprints

Summary

Background: Information technology in health care has a clear potential to improve the quality and efficiency of health care, especially in the area of medication processes. On the other hand, existing studies show possible adverse effects on patient safety when IT for medication-related processes is developed, introduced or used inappropriately.

Objectives: To summarize definitions and observations on IT usage in pharmacotherapy and to derive recommendations and future research priorities for decision makers and domain experts.

Methods: This memorandum was developed in a consensus-based iterative process that included workshops and e-mail discussions among 21 experts coordinated by the Drug Information Systems Working Group of the German Society for Medical Informatics, Biometry and Epidemiology (GMDS).

Results: The recommendations address, among other things, a stepwise and comprehensive strategy for IT usage in medication processes, the integration of contextual information for alert generation, the involvement of patients, the semantic integration of information resources, usability and adaptability of IT solutions, and the need for their continuous evaluation.

Conclusion: Information technology can help to improve medication safety. However, challenges remain regarding access to information, quality of information, and measurable benefits.

Keywords

Drug therapy safety - information technology - medication safety - decision support systems - drug safety - patient safety
 

  • References

  • 1 Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742-752.
    CrossrefPubMedGoogle Scholar
  • 2 Institute of Medicine Health IT and Patient Safety: Building safer Systems for better Care. Washington, D.C.: The National Academic Press; 2011
    Google Scholar
  • 3 Magrabi F, Ong MS, Runciman W, Coiera E. Patient safety problems associated with heathcare information technology: an analysis of adverse events reported to the US Food and Drug Administration. AMIA Annu Symp Proc 2011; 2011: 853-857.
    PubMedGoogle Scholar
  • 4 Bates D, Teich J, Lee J, Seger D, Kuperman G, Ma’Luf N, Boyle D, Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6 (04) 313-321.
    CrossrefPubMedGoogle Scholar
  • 5 Eslami S, Keizer NF, Abu-Hanna A. The impact of computerized physician medication order entry in hospitalized patients-A systematic review. Int J Med Inform 2008; 77 (06) 365-376.
    CrossrefPubMedGoogle Scholar
  • 6 Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events: A Systematic Review. J Am Med Inform Assoc 2008; 15 (05) 585-600.
    CrossrefPubMedGoogle Scholar
  • 7 van Rosse F, Maat B, Rademaker CM, van Vught AJ, Egberts AC, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics 2009; 123 (04) 1184-1190.
    CrossrefPubMedGoogle Scholar
  • 8 Bizovi KE, Beckley BE, McDade MC, Adams AL, Lowe RA, Zechnich AD, Hedges JR. The effect of computer-assisted prescription writing on emergency department prescription errors. Acad Emerg Med 2002; 9 (11) 1168-1175.
    CrossrefPubMedGoogle Scholar
  • 9 Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-1512.
    CrossrefPubMedGoogle Scholar
  • 10 Ash JS, Sittig DF, Dykstra RH, Guappone K, Carpenter JD, Seshadri V. Categorizing the unintended sociotechnical consequences of computerized provider order entry. Int J Med Inform 2007; 76 (Suppl. 01) S21-27.
    CrossrefPubMedGoogle Scholar
  • 11 Khajouei R, Peek N, Wierenga PC, Kersten MJ, Jaspers MW. Effect of predefined order sets and usability problems on efficiency of computerized medication ordering. Int J Med Inform 2010; 79 (10) 690-698.
    CrossrefPubMedGoogle Scholar
  • 12 van der Sijs H, Lammers L, van den Tweel A, Aarts J, Berg M, Vulto A, van Gelder T. Time-dependent drug-drug interaction alerts in care provider order entry (CPOE): Software may inhibit medication error reductions. J Am Med Inform Assoc 2009; 16 (06) 864-868.
    CrossrefPubMedGoogle Scholar
  • 13 Koppel R, Metlay J, Cohen A, Abaluck B, Localio A, SE K, Strom B. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-2003.
    CrossrefPubMedGoogle Scholar
  • 14 Eslami S, Abu-Hanna A, de Keizer NF, de Jonge E. Errors associated with applying decision support by suggesting default doses for aminoglycosides. Drug Saf 2006; 29 (09) 803-809.
    CrossrefPubMedGoogle Scholar
  • 15 Walsh KE, Landrigan CP, Adams WG, Vinci RJ, Chessare JB, Cooper MR, Hebert PM, Schainker EG, McLaughlin TJ, Bauchner H. Effect of computer order entry on prevention of serious medication errors in hospitalized children. Pediatrics 2008; 121 (03) e421-7.
    CrossrefPubMedGoogle Scholar
  • 16 Ammenwerth E, Aly A, Bürkle T, Christ P, Dormann H, Friesdorf W, Haas C, Haefeli W, Jeske M, Kaltschmidt J, Menges K, Möller H, Neubert A, Rascher W, Reichert H, Schuler J, Schreier G, Schulz S, Seidling H, Stühlinger W, Criegee-Rieck M. Zum Einsatz von Informationstechnologie zur Verbesserung der Arzneimitteltherapiesicherheit (Memorandum AMTS-IT). GMS Med Inform Biom Epidemiol 2014; 10 (01) Doc03
    PubMedGoogle Scholar
  • 17 Coordination Group “Aktionsplan AMTS” Memorandum zur Entwicklung der Forschung auf dem Gebiet der Arzneimitteltherapiesicherheit (AMTS) [Memorandum on the development of research in the area of medication safety] 2011. Available from: http://www.akdae.de/AMTS/Massnahmen/docs/Forschungsmemorandum.pdf Last access: April 30 2014
    PubMedGoogle Scholar
  • 18 Möller H, Aly F. Definitionen zu Pharmakovigilanz und Arzneimitteltherapiesicherheit (AMTS). Z Evid Fortbild Qual Gesundhwes 2012; 106: 709-711.
    CrossrefPubMedGoogle Scholar
  • 19 European Medicines Agency (EMA) Guideline on good pharmacovigilance practices (GVP) - Annex I: Definitions (Version from 12.12.2012). Avail- able from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000345.jsp Last access: April 30 2014
    PubMedGoogle Scholar
  • 20 Lisby M, Nielsen LP, Brock B, Mainz J. How are medication errors defined? A systematic literature review of definitions and characteristics. Int J Qual Health Care 2010; 22 (06) 507-518.
    CrossrefPubMedGoogle Scholar
  • 21 Houghton Mifflin Harcourt The American Heritage Medical Dictionary. 2008
    Google Scholar
  • 22 European Medicines Agency (EMA) Guideline on good pharmacovigilance practices (GVP) - Annex I: Definitions (Version from 20.2.2012). Avail- able from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000345.jsp Last access: April 30 2014
    PubMedGoogle Scholar
  • 23 Kuperman G, Bobb A, Payne T, Avery A, Gandhi T, Burns G, Classen D, Bates D. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc 2007; 14 (01) 29-40.
    CrossrefPubMedGoogle Scholar
  • 24 Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. J Am Med Inform Assoc 2013; 20 (03) 470-476.
    CrossrefPubMedGoogle Scholar
  • 25 Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2012. Am J Health Syst Pharm 2013; 70 (09) 787-803.
    CrossrefPubMedGoogle Scholar
  • 26 HIMSS 2012 HIMSS Leadership Survey Healthcare Information and Management Systems Society 2012. Available from: www.himss.org/files/HIMSSorg/content/files/2012FINAL%20Leadership%20Survey%20with%20Cover.pdf Last access: April 30 2014
    PubMedGoogle Scholar
  • 27 Stürzlinger H, Hiebinger C, Pertl D, Traurig P. Computerized Physician Order Entry - Wirksamkeit und Effizienz elektronischer Arzneimittelverordnung mit Entscheidungsunterstützungssystemen. Schriftenreihe Health Technology Assessment (HTA) in der Bundesrepublik Deutschland. Köln: DIMDI; 2009
    Google Scholar
  • 28 Stausberg J, Bürkle T. IT-Umsetzung von CPOE und AMTS-Prüfung in Deutschland: Barrieren und Lösungen. KH IT Journal 2010; 2: 42-43.
    PubMedGoogle Scholar
  • 29 Hübner U, Liebe J-D, Egbert N, Frey A. IT-Report Gesundheitswesen - Schwerpunkt: IT im Krankenhaus. ISBN 978-3.9812490-2-6. Schriftenreihe des Niedersächsischen Ministeriums für Wirtschaft, Arbeit und Verkehr 2011
    Google Scholar
  • 30 Send AF, Al-Ayyash A, Schecher S, Rudofsky G, Klein U, Schaier M, Pruszydlo MG, Witticke D, Lohmann K, Kaltschmidt J, Haefeli WE, Seidling HM. Development of a standardized knowledge base to generate individualized medication plans automatically with drug administration recommendations. Br J Clin Pharmacol 2013; 76 (Suppl. 01) 37-46.
    CrossrefPubMedGoogle Scholar
  • 31 Pruszydlo MG, Walk-Fritz SU, Hoppe-Tichy T, Kaltschmidt J, Haefeli WE. Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care. BMC Med Inform Decis Mak 2012; 12: 137
    CrossrefPubMedGoogle Scholar
  • 32 Neubert A, Dormann H, Prokosch HU, Burkle T, Rascher W, Sojer R, Brune K, Criegee-Rieck M. E-pharmacovigilance: development and implementation of a computable knowledge base to identify adverse drug reactions. Br J Clin Pharmacol 2013; 76 (Suppl. 01) 69-77.
    CrossrefPubMedGoogle Scholar
  • 33 Sedlmayr B, Patapovas A, Kirchner M, Sonst A, Muller F, Pfistermeister B, Plank-Kiegele B, Vogler R, Criegee-Rieck M, Prokosch HU, Dormann H, Maas R, Burkle T. Comparative evaluation of different medication safety measures for the emergency department: physicians’ usage and acceptance of training, poster, checklist and computerized decision support. BMC Med Inform Decis Mak 2013; 13: 79
    CrossrefPubMedGoogle Scholar
  • 34 Wipfli R, Betrancourt M, Guardia A, Lovis C. A qualitative analysis of prescription activity and alert usage in a computerized physician order entry system. Stud Health Technol Inform 2011; 169: 940-944.
    PubMedGoogle Scholar
  • 35 Ehrler F, Lovis C. Supporting drug prescription through autocompletion. Stud Health Technol Inform 2013; 186: 120-124.
    PubMedGoogle Scholar
  • 36 Oertle M. Frequency and nature of drug-drug interactions in a Swiss primary and secondary acute care hospital. Swiss Med Wkly 2012; 142: w13522
    PubMedGoogle Scholar
  • 37 Beindl W, Berger K, Mutzenbach J, Schuler J, Prinz E, Fellhofer G, Hofer-Dueckelmann C. Software zur elektronischen Verordnungsunterstützung - Praktische Erfahrungen an den Salzburger Landeskliniken. Krankenhauspharmazie 2012; 33: 73-80.
    PubMedGoogle Scholar
  • 38 BMG Aktionsplan 2013-2015 des Bundesministeriums für Gesundheit zur Ver- besserung der Arzneimitteltherapiesicherheit in Deutschland. Available from: www.bundesgesundheitsministerium.de/fileadmin/dateien/Publikationen/Gesundheit/Broschueren/Aktionsplan-Arzneimitteltherapiesicherheit_ 2013-2015.pdf Last access: April 30 2014
    PubMedGoogle Scholar
  • 39 Podtschaske B, Fuchs D, Friesdorf W. Integrated Therapy Safety Management System. A medico-ergonomic approach to providing resilient patient treatment systems. British Journal of Clinical Pharmacology 2013; 76 (Suppl. 01) 5-13.
    CrossrefPubMedGoogle Scholar
  • 40 Bates DW, Leape LL, Petrycki S. Incidence and preventability of adverse drug events in hospitalized adults. J Gen Intern Med 1993; 8 (06) 289-294.
    CrossrefPubMedGoogle Scholar
  • 41 Benkirane RR, Abouqal R, Haimeur CCSSSECEK, Azzouzi AA, M’Daghri Alaoui AA, Thimou AA, Nejmi MM, Maazouzi WW, Madani NNIRE, Soulaymani RR. Incidence of adverse drug events and medication errors in intensive care units: a prospective multicenter study. J Patient Saf 2009; 5 (01) 16-22.
    CrossrefPubMedGoogle Scholar
  • 42 Stark RG, John J, Leidl R. Health care use and costs of adverse drug events emerging from outpatient treatment in Germany: a modelling approach. BMC Health Serv Res 2011; 11: 9
    CrossrefPubMedGoogle Scholar
  • 43 von Laue NC, Schwappach DL, Koeck CM. The epidemiology of preventable adverse drug events: a review of the literature. Wien Klin Wochenschr 2003; 115 (12) 407-415.
    CrossrefPubMedGoogle Scholar
  • 44 Schnurrer J, Frölich J. Zur Häufigkeit und Vermeidbarkeit von tödlichen unerwünschten Arzneimittelwirkungen. Internist 2003; 44: 889-895.
    CrossrefPubMedGoogle Scholar
  • 45 Hart D, Claßen M, Wille H, Becker-Schwarze R. Risikomanagement in pädiatrischen Kliniken. Monatsschr Kinderheilkd 2008; 156: 1104-1113.
    CrossrefPubMedGoogle Scholar
  • 46 Brinkrolf P, Prien T, van Aken H. Medication errors - A systematic analysis of CIRS-AINS reports. Anästh Intensivmed 2013; 54: 126-132.
    PubMedGoogle Scholar
  • 47 Pfistermeister B, Schenk C, Kornhuber J, Burkle T, Fromm MF, Maas R. Different indications, warnings and precautions, and contraindications for the same drug--an international comparison of prescribing information for commonly used psychiatric drugs. Pharmacoepidemiol Drug Saf 2013; 22 (03) 329-333.
    CrossrefPubMedGoogle Scholar
  • 48 van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006; 13 (02) 138-147.
    CrossrefPubMedGoogle Scholar
  • 49 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14 (04) 415-423.
    CrossrefPubMedGoogle Scholar
  • 50 Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc 2007: 26-30.
    Google Scholar
  • 51 Loh A, Simon D, Bieber C, Eich W, Harter M. Patient and citizen participation in German health care--current state and future perspectives. Zeitschrift fur ärztliche Fortbildung und Qualitätssicherung 2007; 101 (04) 229-235.
    PubMedGoogle Scholar
  • 52 Dayer L, Heldenbrand S, Anderson P, Gubbins PO, Martin BC. Smartphone medication adherence apps: potential benefits to patients and providers. Journal of the American Pharmacists Association (JAPhA) 2013; 53 (02) 172-181.
    CrossrefPubMedGoogle Scholar
  • 53 Stegemann S, Baeyens J, Cerreta F, Chanie E, Loefgren A, Maio M, Schreier G, Thesing-Bleck E. Adherence measurement systems and technology for medications in older patient populations. European Geriatric Medicine 2012; 3: 254-260.
    CrossrefPubMedGoogle Scholar
  • 54 Aly A, Menges K, Haas C, Zimmermann L, Kaltschmidt J, Criegee-Rieck M. Voraussetzungen für elektronische Systeme zur Prüfung auf Arzneimitteltherapiesicherheit (AMTS). Bundesgesundheitsblatt 2011; 54: 1170-1178.
    PubMedGoogle Scholar
  • 55 ISO. International Standardization Organization Ergonomics of human system interaction - Part 210: Human centred design for interactive systems (Rep N° 9241-210). Genf: ISO; 2010
    Google Scholar
  • 56 Potylycki MJ, Kimmel SR, Ritter M, Capuano T, Gross L, Riegel-Gross K, Panik A. Nonpunitive medication error reporting: 3-year findings from one hospital’s Primum Non Nocere initiative. The Journal of nursing administration 2006; 36 (7-8) 370-376.
    PubMedGoogle Scholar
  • 57 MPG Gesetz über Medizinprodukte (Medizinproduktegesetz - MPG). 2012. Available from: www.gesetze-im-internet.de/bundesrecht/mpg/gesamt.pdf Last access: April 30 2014
    PubMedGoogle Scholar
  • 58 Communication from the Commission to the European Parliament and the Council on Patient Safety, Including the Prevention and Control of Healthcare-Associated Infections www.ec.europa.eu/health/ph_systems/docs/patient_com2008_en.pdf Last access: April 30 2014
    PubMed