Electronic Decision Support for Medications

The AAP announced this week the launch of Delta-Exchange, a professional networking site developed to support primary care physicians and their staff by providing a means to communicate and collaborate during implementation of a patient-centered medical home model (PCMH) of care. There’s a modest fee associated with Delta-Exchange use, and it will be interesting to see how many practices take advantage of the offering.

The current issue of Therapeutic Drug Monitoring includes a study that has found a higher level of common household pesticides in the urine of children with acute lymphoblastic leukemia (ALL), suggesting an association.

In the study, urine samples were collected from 41 child-mother pairs and analyzed by the Centers for Disease Control and Prevention, which found organophosphates in the urine of more than half of the participants. Two common metabolites—diethylthiophosphate (DETP) and diethyldithiophosphate (DEDTP)&mdash;were higher in ALL patients as compared to controls (p< 0.03 and p< 0.05, respectively). Obviously, the finding is significant and the researchers recommend further investigation.

This finding is probably not a huge surprise to anyone, but it caught my eye because, as someone who lives in southeastern US, I regularly use a variety of pesticides to keep my family from being eaten alive by insects during the spring, summer, and fall months. I did a quick search to see if I could find information on the incidence and prevalence of ALL by region, and didn’t find much… if you know of an online resource that offers this information, please drop me a line.

And speaking of oncology, I also read a press release this week regarding electronic decision support for pain medication developed at Heidelberg University Hospital. The software module, called AiDPainCare, is an add-on to AiDKlinik, a pharmaceutical guide available to German hospitals and private practices by subscription service. AiDPainCare was developed to address inadequate pain therapy in oncology patients.

Unfortunately, the specifics with respect to AiDKlinik functionality are discussed online in German. However, given the issues inherent in the use of pain medication, a module such as AiDPainCare could be a blessing regardless of the usefulness of the rest of the software.

Overall, my impression is that the reaction of physicians to electronic decision support has been mixed. A study by the Dana-Farber Cancer Institute released just this year found that physicians frequently rely on their own judgment with respect to prescribing practices, overriding safety alerts built into computer-based systems. While this study was limited to the use of one electronic prescribing system, I think it speaks volumes with respect to the level of sophistication that physicians need from computerized decision support.