Week 4: EHR II, Database Management Systems Flashcards
What is computerized prescriber order entry (CPOE)?
feature in EHR systems that allows care providers to electronically submit orders themselves (ie. for medications, labs, consults, etc.)
How is CPOE connected with different sets of data and information systems as part of an electronic health record?
- integration with decision-support tools
- links to interaction checkers
- adverse drug event reporting systems
- relies on correct coding in data entry process
How is CPOE different than ePrescribing?
- CPOE includes all electronic ordering
- ePrescribing is specific to submitting medication orders only
Why can the use of CPOE lead to more problems? What are 3 possible problems with the use of CPOE?
poor implementation can cause more problems:
- case reports of increase in mortality
- increased risk of alert fatigue
- can increase time taken to deliver care
What is the evidence for CPOE?
- significant reduction in med ordering errors – between 54-92% relative risk reduction
- significant reduction in adverse drug events – 35-53% RRR
- mortality NSS or small benefit for ICU only
- length of hospital stay NSS
Which provinces have ePrescribing?
in every province except BC and NWT
What are the benefits of ePrescribing?
- secure electronic transmission of Rx’s
- 2-way messaging between prescriber-pharmacy
- integration with costs/coverage info
- can include controlled/narcotic medications
- other benefits
What is ePrescribing?
paper-based, including faxed and verbal orders
What is eFax?
combines faxing and digitization all-in-one step
What are the two options for using ePrescribing?
- directed (push)
- deferred (pull)
What is directed (push) ePrescribing?
‘mail man’
- transaction hub – routing of eRx between prescribers and pharmacies
prescriber side:
- select pharmacy – patient has to decide, know it, and then prescriber has to find it
dispenser side:
- transaction costs
- pending prescriptions in the pharmacy system – prepare them all or call patient (30% of new prescriptions are never filled), print e-Prescription (UK, USA)
- patient confusion
What is deferred (pull) ePrescribing?
‘mail box’
prescriber side:
- authorized paper copy of Rx is printed
- Rx is sent to a virtual, central repository
- paper copy has a unique barcode that can be scanned by pharmacies
pharmacy side:
- if pharmacy is PrescribeIT enabled, barcode is scanned, Rx info retrieved (pulling Rx info)
- if pharmacy is not PrescribeIT enabled, can use paper Rx as-is
What is transactional data?
- have time component
- automate business processes
- data that is created and updated by operational systems
- designed for integrity and long-term persistence
- ie. billing, sales, prescriptions, clinic notes
What is analytical data?
- metrics that provide business or clinical intelligence
- support decision making
- defined as numerical measurements rather than being the describing data
- ie. number of Rx in the last month, number of patients with A1C >7% in the past 3 months, number of patients requiring 6 month MRS, most commonly prescribed medication in the last month, number of reduced emergency visits following pharmacist CV mediation counselling
Transactional vs. Analytical Data
Priority
- transactional: capture and input of data
- analytical: extraction and utilizaton of data
Transactional vs. Analytical Data
Goal
- transactional: record individual data from transactions, interactions, or facts of importance
- analytical: collate data from multiple records to provide information for decision making
Transactional vs. Analytical Data
DMS Focus
- transactional: 1-5 linked records – INSERT, UPDATE, DELETE*
- analytical: combination of multiple tables into one – SELECT, READ
What are databases?
compilation of data of various forms
- includes clinic notes, lab tests, documents, clinical measurements, medications, any data created as a byproduct of providing care
- organized into tables that store information
- use primary keys to identify data records
- use foreign keys to link tables and prevent redundancy
- store transactional data
- used as a means to create analytical data
What are the 3 core components of databases?
- table (various types)
- primary key
- foreign key
What are tables (various types)?
collection of similar data with a common meaningful purpose
- database can have one or more tables that store information
- name: each table has a name (ie. Pharmacists, Prescriptions)
- columns: data points of interest (ie. Name, DOB, Age)
- rows: collection of data points
- fields: single data points
What are primary keys?
value that identifies a specific record within the same table
- all tables have a primary key
What are foreign keys?
value that identifies a specific record in a different table
- only some tables have a foreign key
- used to link tables and prevent redundancy
What are the 4 reasons why primary and foreign keys are necessary?
- prevents duplication of data
- allows for better organization
- preserves fields and discrete data
- useful in generating different types of analytical data from transactional data
What are database management systems (DMS)?
computer code that organizes a database and facilitates access to the data stored in the database
What is SQL?
language of database management systems that allows access and manipulations of database tables
- SELECT [Column Name]
- FROM [Table Name]
- WHERE [Condition – greater than, less than, equals, etc.]
- AND [both are true]
- OR [one or both are true]
- LIMIT
What is required to select data from multiple tables? (4)
- primary key
- foreign key
- transactional data
- analytical data
What are aliases?
when using more than one table with the same column name, you need to define an alias to tell the computer which table you are talking about
