Addressing Gaps in Pediatric Prescribing Using Scalable and Interoperable Prescription Decision Support

ABSTRACT Significance Electronic prescribing is now widely adopted by US healthcare systems but clinical functionality of e prescribing falls short in the realm of pediatrics Medication prescribing is intrinsically more complex for pediatric patients due to weight based dosing the lack of widely adopted medication formulation recipes inconsistent off label usage of drugs appropriate drugs for given conditions and appropriate dose rounding percentages that will still make the drug treatment clinically useful Clinical decision support CDS tools can improve shortcomings in electronic health records EHR yet many focus on adult only patient populations are limited in drug and condition coverage exist as web services external to the native EHR environment and generate excessive pop up alerts that contribute to provider alert fatigue Safety Through E Prescribing Systems Tools STEPSTools is a web service that was designed to be a comprehensive pediatric dosing knowledge dissemination platform that fills the void of condition based medication usage expert consensus based dosage rounding and extemporaneous drug formulation recipes currently missing in EHR functionality RxCheck is a Prescription Decision Support PDS platform built by RxREVU that is surfaced directly in the provider s native Epic EHR workflow to ensure the accuracy of information utilization by providers drive operational best practices surface information that may or may not natively exist in the EHR and improve the clinical window Hypothesis By combining the strengths and expertise of STEPSTools pediatric prescribing technology with RxREVU s RxCheck Prescription Decision Support platform a comprehensive pediatric prescribing product will be developed that is scalable interoperable and utilized directly at the point of prescribing in order to drive consistent evidence based prescribing patterns for pediatricians and improve clinical outcomes for pediatric patients Specific Aims By the investigators own admission a pediatric prescribing technology will not be useful if it is not comprehensive and up to date This proposal aims to update STEPSTools technology from pediatric prescribing standards to standards as new evidence and innovative approaches to pediatric prescribing have occurred Rapid and effective communication between STEPSTools RxCheck and Vanderbilt s Epic EHR is critical for the accuracy and safety of the prescribing module These data handshakes will be rigorously tested for accuracy in the second aim Provider adoption and clinical utility of an RxCheck pediatric prescribing module is critical to test the feasibility of widespread scalability of the tool The number of times RxCheck is accessed compared to total prescriptions written as well as provider acceptance rates of the recommendations surfaced by RxCheck in Epic will be measured and success of this Phase I SBIR proposal will be determined here PROJECT NARRATIVE The primary goal of this Phase I SBIR proposal is to prove feasibility of a pediatric electronic prescribing module built in the RxCheck Prescription Decision Support platform and surfaced directly within the native electronic health record EHR Our solution leverages an expert based dosing and formulation framework developed by researchers at Vanderbilt University Medical Center Importantly RxCheck is HL compliant and fully compatible with the emerging Fast Healthcare Interoperability Resources FHIR standard helping to ensure the developed prescribing framework can be easily deployed to any modern EHR supporting the emerging interoperability standards