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Linking Laboratory and Pharmacy
Opportunities for Reducing Errors and Improving Care
Gordon D. Schiff, MD;
David Klass, MD;
Josh Peterson, MD;
Gaurav Shah, MD;
David W. Bates, MD, MSc
Arch Intern Med. 2003;163:893-900.
A myriad of errors and lost improvement opportunities result from failure of clinical laboratory and pharmacy information systems to effectively communicate. Pharmacotherapy could benefit from enhanced laboratory-pharmacy linkage with respect to (1) drug choice (laboratory-based indications and contraindications), (2) drug dosing (renal or hepatic, blood level–guided adjustments), (3) laboratory monitoring (laboratory signals of toxicity, baseline and ongoing monitoring), (4) laboratory result interpretation (drug interfering with test), and (5) broader quality improvement (surveillance for unrecognized toxicity, monitoring clinician response delays). Linkages can be retrospective or real-time. Many organizations could benefit now by linking existing pharmacy and laboratory data. Greater improvement is possible through implementation of electronic order entry with real-time decision support incorporating linked laboratory and pharmacy data. While many guidelines, admonitions, and rules exist regarding drugs and the laboratory, substantial new knowledge and evidence in this area are needed. Focusing on these unmet needs and accompanying logistical challenges is a priority.
From the Department of Medicine, Cook County Hospital (Drs Schiff and Shah), Rush Medical College (Dr Schiff), Chicago, Ill; State of Illinois Department of Mental Health, University of Chicago Medical School (Dr Klass); Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tenn (Dr Peterson); and Division of General Internal Medicine, Brigham and Women's Hospital and Partners Healthcare Information Systems, Boston, Mass (Dr Bates). Dr Klass is now with VigiLanz Corporation, St Paul, Minn. Dr Bates has received honoraria for speaking from the Eclipsys Corporation, Boca Raton, Fla, and from Automated Healthcare; is a coinventor on patent No. 6029138 held by Brigham and Women's Hospital on the use of decision support software for medical management, licensed to the Medicalis Corporation, Waterloo, Ontario; holds a minority equity position in Medicalis Corporation; is a consultant and serves on the advisory board for McKesson MedManagement, Brooklyn Park, Minn; is on the clinical advisory boards for Zynx Inc, Beverly Hills, Calif, and SoCurious Inc, San Francisco, Calif; and is a consultant for Alaris, San Diego, Calif. Drs Schiff, Peterson, and Shah have no relevant financial interest in this article.
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