Pediatric Informatics: Computer Applications in Child Health (Health ...

26 Prescribing/Ordering: Computerized Order Entry and Decision Support 341
26.8 Case Studies
26.8.1 Study 1: Incorporating Inline Calculators
into Commercial CPOE/CDS 8,9
At the Johns Hopkins Children’s Center (JHCC), a commercial CPOE/CDS
product was adopted as part of an institution-wide implementation of the product
at a multidisciplinary tertiary care center of which JHCC is a part. In turn, JHCC
is a multidisciplinary pediatric tertiary care center, including services for pediatric
and neonatal critical care, pediatric oncology and numerous surgical services.
Deployment of the commercial product was conceived in stages, beginning with
general pediatric floors followed by the neonatal intensive care unit and the pediatric
critical care unit.
Fitting the CPOE/CDS product to the different sectors of the JHCC required a
prolonged concerted effort that required development of:
Pediatric-specific drug dictionary with over 13,000 manually checked rules for
pediatric dosing
Disease-specific evidence-based order sets, reviewed by clinical faculty from
each division in JHCC
Prior to the introduction of the commercial system, clinical calculators had been
developed to facilitate the ordering and writing of total parenteral nutrition (TPN)
and continuous intravenous infusions. These tools had been developed and made
available on public workstations throughout the JHCC and had been in use.
As these functions were not present in the commercial system, a project was
undertaken to incorporate the calculators into the functionality of the commercial
system. Through cooperation of programmers of the clinical calculators and the
CPOE system, a procedure where orders for TPN or infusions were translated
into messages to the respective calculators, which returned necessary values to the
CPOE system. The benefits of this bidirectional communication between applications
which: allowed continued use of the calculators (which had been demonstrated
to decrease prescribing errors dramatically) and avoided the need and cost for development
and testing of new CDS functionality (by reusing proven technology).
26.8.2 Study 2: CPOE in Pediatric Intensive Care
(See Chapter 7)
The publication of two studies on the implementation of the same commercial
CPOE system into pediatric critical care units at two different academic medical
centers 10,11 demonstrated the importance of anticipating clinical workflow needs, considering
implementation and deployment including policy changes. The question of