C. Broverman

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Marcy Carty

Hope Biswas

Centers for Disease Control and Prevention

Harvard Medical School

Christopher Chute

Tammy Fraser

Abdul Kader Mohiuddin

University of Dhaka, Bangladesh

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Papers by C. Broverman

An unintended consequence of electronic prescriptions: prevalence and impact of internal discrepancies

Journal of the American Medical Informatics Association, 2010

Many e-prescribing systems allow for both structured and free-text fields in prescriptions, makin... more Many e-prescribing systems allow for both structured and free-text fields in prescriptions, making possible internal discrepancies. This study reviewed 2914 electronic prescriptions that contained free-text fields. Internal discrepancies were found in 16.1% of the prescriptions. Most (83.8%) of the discrepancies could potentially lead to adverse events and many (16.8%) to severe adverse events, involving a hospital admission or death. Discrepancies in doses, routes or complex regimens were most likely to have a potential for a severe event (p¼0.0001). Discrepancies between structured and freetext fields in electronic prescriptions are common and can cause patient harm. Improvements in electronic medical record design are necessary to minimize the risk of discrepancies and resulting adverse events.

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Evaluating standard terminologies for encoding allergy information

Journal of the American Medical Informatics Association, 2013

Objective Allergy documentation and exchange are vital to ensuring patient safety. This study aim... more Objective Allergy documentation and exchange are vital to ensuring patient safety. This study aims to analyze and compare various existing standard terminologies for representing allergy information. Methods Five terminologies were identified, including the Systemized Nomenclature of Medical Clinical Terms (SNOMED CT), National Drug File-Reference Terminology (NDF-RT), Medication Dictionary for Regulatory Activities (MedDRA), Unique Ingredient Identifier (UNII), and RxNorm. A qualitative analysis was conducted to compare desirable characteristics of each terminology, including content coverage, concept orientation, formal definitions, multiple granularities, vocabulary structure, subset capability, and maintainability. A quantitative analysis was also performed to compare the content coverage of each terminology for (1) common food, drug, and environmental allergens and (2) descriptive concepts for common drug allergies, adverse reactions (AR), and no known allergies. Results Our qualitative results show that SNOMED CT fulfilled the greatest number of desirable characteristics, followed by NDF-RT, RxNorm, UNII, and MedDRA. Our quantitative results demonstrate that RxNorm had the highest concept coverage for representing drug allergens, followed by UNII, SNOMED CT, NDF-RT, and MedDRA. For food and environmental allergens, UNII demonstrated the highest concept coverage, followed by SNOMED CT. For representing descriptive allergy concepts and adverse reactions, SNOMED CT and NDF-RT showed the highest coverage. Only SNOMED CT was capable of representing unique concepts for encoding no known allergies. Conclusions The proper terminology for encoding a patient's allergy is complex, as multiple elements need to be captured to form a fully structured clinical finding. Our results suggest that while gaps still exist, a combination of SNOMED CT and RxNorm can satisfy most criteria for encoding common allergies and provide sufficient content coverage.

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Evaluation of a proposed method for representing drug terminology

Proceedings. AMIA Symposium, 1999

In the absence of a single, standard, multipurpose terminology for representing medications, the ... more In the absence of a single, standard, multipurpose terminology for representing medications, the HL7 Vocabulary Technical Committee has sought to develop a model for such terms in a way that will provide a unified method for representing them and supporting interoperability among various terminology systems. We evaluated the preliminary model by obtaining terms, represented in our model, from three leading vendors of pharmacy system knowledge bases. A total of 2303 terms were obtained, and 3982 pair-wise comparisons were possible. We found that the components of the term descriptions matched 68-87% of the time and that the overall descriptions matched 53% of the time. The evaluation has identified a number of areas in the model where more rigorous definitions will be needed in order to improve the matching rate. This paper discusses the implications of these results.

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The need for a concept-based medication vocabulary as an enabling infrastructure in health informatics

Proceedings. AMIA Symposium, 1998

Users of drug information typically focus their attention at different levels of description in d... more Users of drug information typically focus their attention at different levels of description in different situations, such as medication ordering or dispensing. Computer systems utilizing drug information to support such activities must accommodate these multiple perspectives. This paper presents an approach to conceptualizing drug descriptions at multiple levels and outlines key features of an underlying information model that can serve as the basis for a concept-oriented medication vocabulary. These features include dose forms, routes of administration, as well as links to multiple drug classification schemes and medical problems. Implementation, standards, and maintenance issues related to the model are also discussed.

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A concept-based medication vocabulary: an essential requirement for pharmacy decision support

Pharmacy practice management quarterly, 1998

The impact of adverse drug events (ADEs) on the cost and quality of health care today is indisput... more The impact of adverse drug events (ADEs) on the cost and quality of health care today is indisputable. A significant portion of these events can be detected and prevented with computerized pharmacy decision support systems. Challenges to the successful implementation of decision support systems include availability and quality of patient data and the accessibility of drug information that can be integrated programmatically on a patient-specific basis. An additional related challenge is establishing the vocabulary (i.e., codes, terms, and meanings) to be used for the representation, exchange, and automation of drug information and clinical functions. A central argument of this article is that a concept-based medication vocabulary needs to be created in order to facilitate the development of pharmacy decision support. We address the medication vocabulary challenge by defining a specific concept-based model of drugs as the basis for a standardized medication terminology.

The future of knowledge-based components in the electronic health record

Studies in Health Technology and Informatics, 1998

Traditional monolithic healthcare information systems (HIS) no longer meet the requirements of to... more Traditional monolithic healthcare information systems (HIS) no longer meet the requirements of today's distributed enterprises and the rapidly changing healthcare environment. The ability of applications to communicate, interpret, and act intelligently upon complex healthcare information has assumed paramount importance. The future lies in the development of flexible component-based architectures that can operate seamlessly within the workflow of a healthcare environment. A key design goal is "graceful degradation," i.e., providing the best decision support possible within the context of available patient data. The First DataBank Drug Toolkit is used as a case study. Several technical challenges associated with building truly plug and play components are discussed.

Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries

Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium, 1997

Because clinical databases vary in structure, access methods and vocabulary used to represent dat... more Because clinical databases vary in structure, access methods and vocabulary used to represent data, the Arden Syntax does not define a standard model for querying databases. Consequently, database queries are encoded in ad hoc ways and enclosed in "curly braces" in Medical Logic Modules (MLMs). However, the nonstandard representation of queries impairs sharing of MLMs, an impediment that has come to be known as the "curly braces problem." As a first step in solving this problem, we evaluated the proposed HL7 Reference Information Model (RIM) as a foundation for a standard query model for the Arden Syntax. Specifically, we analyzed the MLM knowledge base at the Columbia-Presbyterian Medical Center and compared the queries in these MLMs to the RIM. We studied 488 queries in 104 MLMs, identifying 674 total query data elements. Laboratory tests accounted for 45.8% of these elements, while demographic and ADT data accounted for 37.6%. Pharmacy orders accounted for 10....

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Component architecture in HIS: a drug order entry case study

Studies in Health Technology and Informatics, 1997

Historically, many healthcare information systems (HIS) have been designed around monolithic arch... more Historically, many healthcare information systems (HIS) have been designed around monolithic architectures that rely upon a single organization to provide most, if not all, of the system's business logic. Recent advances in distributed systems technology and healthcare standards make a component-based architecture feasible in building today's HIS. The First DataBank Drug Toolkit is used as a case study for the role of components in the design of a HIS. Several technical challenges associated with building truly plug and play components are discussed.

Clinical decision support for physician order-entry: design challenges

Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium, 1996

We report on a joint development effort between ALLTEL Information Services Health Care Division ... more We report on a joint development effort between ALLTEL Information Services Health Care Division and IBM Worldwide Healthcare Industry to demonstrate concurrent clinical decision support using Arden Syntax at order-entry time. The goal of the partnership is to build a high performance CDS toolkit that may be easily customized for multiple health care enterprises. Our work uses and promotes open technologies and health care standards while building a generalizable interface to a legacy patient-care system and clinical database. This paper identifies four areas of design challenges and solutions unique to a concurrent order-entry environment: the clinical information model, the currency of the patient virtual chart, the granularity of event triggers and rule evaluation context, and performance.

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Clinical decision support for physician order-entry: design challenges

Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium, 1996

Component architecture in HIS: a drug order entry case study

Studies in health technology and informatics, 1997

A concept-based medication vocabulary: an essential requirement for pharmacy decision support

Case-based hypermedia access of 'lessons learned' to accomplish technology transfer

IEEE/SEMI Advanced Semiconductor Manufacturing Conference and Workshop - ASMC '92 Proceedings, 1992

Page 1. Case-based Hypermedia Access of Lessons Learned to Accomplish Technology Transfer Carol... more

The 'Offset Effect' of Mental Health Treatment on Ambulatory Medical Care Utilization and Charges

Archives of General Psychiatry, 1985

The five-year ambulatory medical care experience of 400 patients with mental disorders was studie... more The five-year ambulatory medical care experience of 400 patients with mental disorders was studied to test the &quot;offset&quot; hypothesis that patients receiving timely mental health specialist treatment have lower subsequent utilization of, and charges for, care than patients not receiving such specialist treatment. Specialist treatment was associated with significant offset savings in utilization and charges for the non-psychiatric medical care of treated patients with either severe or less severe mental disorders. However, the visits and charges for such specialist treatment boosted the overall (nonpsychiatric plus mental health specialist) care utilization and charges of the specialist-treated patients above those of patients treated solely by their nonpsychiatric physicians; this overall increase was especially pronounced for patients with severe mental disorders. The findings suggest the need for randomized prospective offset studies comparing utilization, cost, and clinical outcomes.

Case-based hypermedia access oflessons learned'to accomplish technology transfer

… and Workshop, 1992. …, 1992

Page 1. Case-based Hypermedia Access of Lessons Learned to Accomplish Technology Transfer Carol... more

Case-based hypermedia access oflessons learned'to accomplish technology transfer

… and Workshop, 1992. …, 1992

Page 1. Case-based Hypermedia Access of Lessons Learned to Accomplish Technology Transfer Carol... more

The role of plan recognition in design of an intelligent user interface

A model-based method for improving protocol quality

Report of Experiences Using the Beta Version of SNOMED-RT

Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries

Proceedings : a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium, 1997

An unintended consequence of electronic prescriptions: prevalence and impact of internal discrepancies

Journal of the American Medical Informatics Association, 2010

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Evaluating standard terminologies for encoding allergy information

Journal of the American Medical Informatics Association, 2013

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Evaluation of a proposed method for representing drug terminology

Proceedings. AMIA Symposium, 1999

Download

The need for a concept-based medication vocabulary as an enabling infrastructure in health informatics

Proceedings. AMIA Symposium, 1998

Download

A concept-based medication vocabulary: an essential requirement for pharmacy decision support

Pharmacy practice management quarterly, 1998

The future of knowledge-based components in the electronic health record

Studies in Health Technology and Informatics, 1998

Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries

Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium, 1997

Download

Component architecture in HIS: a drug order entry case study

Studies in Health Technology and Informatics, 1997

Clinical decision support for physician order-entry: design challenges

Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium, 1996

Download

Clinical decision support for physician order-entry: design challenges

Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium, 1996

Component architecture in HIS: a drug order entry case study

Studies in health technology and informatics, 1997

A concept-based medication vocabulary: an essential requirement for pharmacy decision support

Case-based hypermedia access of 'lessons learned' to accomplish technology transfer

IEEE/SEMI Advanced Semiconductor Manufacturing Conference and Workshop - ASMC '92 Proceedings, 1992

Page 1. Case-based Hypermedia Access of Lessons Learned to Accomplish Technology Transfer Carol... more

The 'Offset Effect' of Mental Health Treatment on Ambulatory Medical Care Utilization and Charges

Archives of General Psychiatry, 1985

Case-based hypermedia access oflessons learned'to accomplish technology transfer

… and Workshop, 1992. …, 1992

Page 1. Case-based Hypermedia Access of Lessons Learned to Accomplish Technology Transfer Carol... more

Case-based hypermedia access oflessons learned'to accomplish technology transfer

… and Workshop, 1992. …, 1992

Page 1. Case-based Hypermedia Access of Lessons Learned to Accomplish Technology Transfer Carol... more

The role of plan recognition in design of an intelligent user interface

A model-based method for improving protocol quality

Report of Experiences Using the Beta Version of SNOMED-RT

Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries

Proceedings : a conference of the American Medical Informatics Association / ... AMIA Annual Fall Symposium. AMIA Fall Symposium, 1997

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