Article
Validation of CPOE systems by contextualized test cases: Report from a European Project
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Authors
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Elske Ammenwerth
- Institute for Health Information Systems, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol
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Werner Hackl
- Institute for Health Information Systems, UMIT – University for Health Sciences, Medical Informatics and Technology, Hall in Tirol
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Christoph Pechlaner
- Dept. Internal Medicine, Innsbruck Medical University, Innsbruck
| Published: | September 2, 2009 |
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Outline
Text
Introduction: Medication errors seem to be frequent in health care [1]. Several reports recommend to implement electronic prescribing to reduce the number of medication errors [2], [3]. In the U.S., only 5% of hospitals have fully implemented computerized physician order entry (CPOE) [4]. In Europe, this number is probably even lower. One reason for this seems to be “alert overload” [5]: Clinicians may ignore alerts if they seem not relevant for the particular patient and context. The EU-PF7 project PSIP [6], develops a CPOE prototype that supports contextualized alerts. The prototype will be validated for correctness and adequacy of the alerts. The objective of this presentation is to discuss the challenges in developing contextualized test cases.
Materials and Methods: In a literature review, no openly available CPOE test protocol were identified (e.g. the Leapfrog protocol [7] is not openly available at the moment). We therefore organized a team of experts from three countries to develop and reciprocally validate contextualized test cases, following established standards [8]. The first group of test cases concentrates on anticoagulant therapy, as this is a major source of medication errors [9].
Results: A template for test case description comprising around 20 items has been agreed upon and is now implemented in a web-based tool. At the moment, 12 test cases have been developed and are just being validated. Further test cases are in development. To identify the context of the test case, the template contains information e.g. on the process of care of the respective patient, and on the experience of the prescriber.
Discussion / Conclusion: Contextualized CPOE needs complex contextualized test cases describing the process of care and the experience of the physician. This makes test case development quite work intensive. After final validation, we plan to make our test case battery available for other researchers.
Acknowledgement: The project received fundings from the European Community’s 7th Framework Programme (FP7 / 2007–2013) unter grant agreement no 216130 – PSIP project.
References
- 1.
- Kohn L, Corrigan J, Donaldson M, editors. To err is Human: Building a Safer Health System. Washington: National Academy Press; 2000.
- 2.
- The Leapfrog Group. Computerized Physician Order Entry; 2009. Available from: http://www.leapfroggroup.org/
- 3.
- Smith J. Building a Safer National Health System for Patients: Improving Medication Safety. London: Department of Health; 2004.
- 4.
- Cutler DM, Feldman NE, Horwitz JR. US adoption of computerized physician order entry systems. Health Aff (Millwood). 2005;24(6):1654-63.
- 5.
- Shah NR, Seger AC, Seger DL, Fiskio JM, Kuperman GJ, Blumenfeld B, et al. Improving acceptance of computerized prescribing alerts in ambulatory care. J Am Med Inform Assoc. 2006;13(1):5-11.
- 6.
- Patient Safety through Intelligent Procedures in Medication (PSIP). 2009. Available from: http://www.psip-project.eu/
- 7.
- Classen DC, Avery AJ, Bates DW. Evaluation and certification of computerized provider order entry systems. J Am Med Inform Assoc. 2007;14(1):48-55.
- 8.
- Friedman C, Wyatt JC. Evaluation Methods in Medical Informatics. 2nd ed. New York: Springer; 2006.
- 9.
- AHQR. Adverse Drug Events in US Hospitals, 2004; Statistical Brief #29. 2007. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb29.pdf
