Table 3 Important features of EHRs with embedded CDSSs on which consensus was achieved in this study
Round 02 | Round 03 | Importance weight (%) | Source of the item | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
# | Items | M | IQR | %A | M | IQR | %A | M | SD | |
Demographic characteristics of the patient | ||||||||||
1 | The body weight of the patient | 8 | 2 | 88 | NA | 11.2 | 3.8 | B | ||
2 | The measure units of weight (gm, kg, pounds) | 8 | 2 | 92 | NA | 10.6 | 2.9 | L | ||
3 | The working weight of the patient that was used for dose calculations (for example, 5 kg instead of 5.1 kg) | 7 | 2 | 84 | NA | 9.3 | 3.0 | L | ||
4 | Date on which the weight of the patient was measured | 7 | 2 | 79 | NA | 8.6 | 3.2 | B | ||
5 | The height of the patient | 6 | 5 | 53 | 8 | 2 | 75 | 8.1 | 2.8 | B |
6 | The measure units for height (cm, m, in) | 5 | 4 | 51 | 7 | 2 | 76 | 7.6 | 2.4 | L |
7 | The date on which the height of the patient was measured | 4 | 4 | 48 | 7 | 2 | 75 | 7.2 | 2.5 | B |
8 | The body surface area of the pediatric patient | 7 | 2 | 79 | NA | 6.8 | 2.3 | L | ||
9 | The measure units of the body surface area | 7 | 2 | 82 | NA | 6.0 | 2.1 | L | ||
10 | The date on which the body surface area was measured | 7 | 1 | 85 | NA | 5.4 | 3.1 | L | ||
11 | The body mass index of the patient | 7 | 2 | 76 | NA | 4.8 | 3.2 | L | ||
12 | The date on which the body mass index of the patient was measured | 7 | 2 | 75 | NA | 3.9 | 2.9 | L | ||
13 | Time on which the weight of the patient was measured | 7 | 4 | 71 | 7 | 2 | 82 | 2.9 | 2.6 | L |
14 | The time on which the height of the patient was measured | 4 | 5 | 46 | 7 | 2 | 76 | 2.7 | 2.4 | L |
15 | The time on which the body surface area was measured | 7 | 2 | 84 | NA | 2.6 | 2.0 | L | ||
16 | The time on which the body mass index of the patient was measured | 6 | 4 | 61 | 7 | 2 | 75 | 2.3 | 1.7 | L |
Prescribing medications | ||||||||||
1 | Prompting a mode of selection for specifying the dose (for example mg, μg, mL, … etc.) of the medication prescribed | 9 | 1 | 100 | NA | 11.8 | 2.6 | B | ||
2 | Prompting a mode of selection for specifying the frequency (number of times) the medication needs to be administered (for example, once daily, twice daily, three times daily, ...etc.) | 9 | 1 | 100 | NA | 9.4 | 3.2 | B | ||
3 | Prompting a mode of selection for specifying the route by which the medication would be administered (for example, oral, intravenous, intramuscular, … etc.) | 8 | 1 | 99 | NA | 8.8 | 3.6 | B | ||
4 | Prompting a mode of selection for specifying the dosage form “formulation” (for example, tablet, capsule, syrup, ...etc.) of the medication prescribed | 8 | 2 | 91 | NA | 8.2 | 2.9 | B | ||
5 | Prompting a mode of selection for specifying the number of dosing units to be administered each time (for example, one tablet, two tablets, … etc.) | 9 | 1 | 93 | NA | 7.5 | 2.6 | L | ||
6 | Allowing search and/or providing a mode of selection (for example a drop-down menu) for all medications available on the hospital’s formulary including their non-proprietary names and brand (branded-generic) names | 7 | 2 | 79 | NA | 6.9 | 2.4 | L | ||
7 | Prompting a mode of selection for specifying the date on which the medication was prescribed | 9 | 1 | 95 | NA | 6.4 | 2.1 | L | ||
8 | Prompting a mode of selection for specifying the duration for which the medication administration should be continued | 8 | 1 | 97 | NA | 6.2 | 2.8 | L | ||
9 | Prompting a mode of selection for specifying the date on which the medication administration should be started | 7 | 2 | 93 | NA | 5.8 | 2.7 | L | ||
10 | Prompting a mode of selection for specifying the times at which the medication doses should be administered (for example, at 8:00 am, 2:00 pm, … etc.) | 8 | 1 | 92 | NA | 5.3 | 2.4 | L | ||
11 | Prompting a mode of selection for specifying the date on which the medication administration should be discontinued | 9 | 1 | 92 | NA | 5.1 | 1.9 | B | ||
12 | Prompting a mode of selection for specifying the time on which the medication administration should be discontinued | 9 | 1 | 94 | NA | 4.8 | 1.8 | L | ||
13 | Prompting a mode of selection for specifying the medication administration in relation to meals | 8 | 1 | 92 | NA | 4.3 | 1.6 | B | ||
14 | Prompting a mode of selection for specifying the maximal number of doses to be administered in 24 h for medication prescribed as “when needed” (PRN) | 8 | 1 | 89 | NA | 3.8 | 1.2 | B | ||
15 | Prompting a mode of selection for specifying the name of the physician who prescribed the medication | 9 | 1 | 96 | NA | 3.2 | 1.1 | L | ||
16 | Ability to suggest other suitable substitutes (other medications from the same pharmacological class) | 6 | 4 | 54 | 7 | 2 | 76 | 2.5 | 1.4 | I |
Checking prescriptions and alerts | ||||||||||
1 | Ability to assess suitability of the dose in view of the patient’s conditions like renal and/or hepatic functions | 8 | 1 | 92 | NA | 13.6 | 3.6 | B | ||
2 | Clear instructions to guide prescribers on the procedures to follow when a medication order to be discontinued or changed | 9 | 2 | 92 | NA | 12.8 | 3.1 | B | ||
3 | Ability to check for and provide warnings on potential drug-drug interactions | 8 | 2 | 92 | NA | 11.3 | 3.5 | L | ||
4 | Ability to check for and provide warnings on potentially contraindicated medications for the patient | 7 | 2 | 89 | NA | 10.2 | 3.2 | B | ||
5 | Ability to check for and provide warnings on potential drug-food interactions | 5 | 3 | 61 | 7 | 2 | 75 | 9.6 | 3.3 | L |
6 | Ability to check for and provide warnings on potential drug-herb interactions | 6 | 3 | 68 | 7 | 1 | 78 | 8.5 | 2.9 | L |
7 | Ability to provide warnings regarding any potential medication adverse reactions in view of the patient’s conditions | 6 | 3 | 59 | 7 | 2 | 76 | 7.3 | 2.6 | B |
8 | Ability to recommend evidence-based dose suitable for the patient | 7 | 3 | 69 | 7 | 1 | 79 | 6.4 | 2.8 | B |
9 | Ability to check for and provide warning when another medication from the same pharmacological class (duplication) is prescribed | 7 | 4 | 69 | 7 | 2 | 76 | 5.2 | 2.9 | L |
10 | Ability to provide prompts on special precautions or procedures to administer the prescribed medication (if any) | 7 | 3 | 74 | 7 | 2 | 77 | 3.8 | 2.3 | L |
11 | Ability to alert the prescriber if the dosage form(s) prescribed was (were) of slow or modified release | 6 | 3 | 69 | 7 | 2 | 76 | 2.6 | 1.8 | L |
12 | Ability to enter reason(s) (justification) why another medication from the same pharmacological class (duplication) is prescribed | 7 | 2 | 79 | NA | 2.4 | 1.6 | L | ||
13 | Ability to add reasons (justification) for not changing the medication or dose in the event of an adverse medication reaction | 5 | 3 | 46 | 7 | 2 | 75 | 2.1 | 1.9 | L |
14 | Ability to enter reason(s) (justification) why the dose was different from the evidence-based recommended one | 7 | 2 | 78 | NA | 1.7 | 1.2 | L | ||
15 | Ability to enter reason(s) (justification) why the dosing frequency was different from the evidence-based recommended one | 6 | 4 | 58 | 7 | 2 | 75 | 1.4 | 1.3 | L |
16 | Ability to enter reason(s) (justification) why the duration of medication administration was different from the evidence-based recommended one | 5 | 4 | 56 | 7 | 2 | 76 | 1.1 | 0.9 | L |
Patient’s identity | ||||||||||
1 | The first name of the patient | 9 | 1 | 100 | NA | 12.2 | 3.7 | B | ||
2 | The father’s name of the patient | 9 | 1 | 100 | NA | 11.3 | 3.2 | B | ||
3 | The grandfather’s name of the patient | 9 | 1 | 100 | NA | 10.7 | 4.1 | B | ||
4 | The family name (surname) of the patient | 9 | 1 | 100 | NA | 9.2 | 3.6 | B | ||
5 | The unique national identification number of the patient | 6 | 4 | 62 | 7 | 2 | 76 | 8.7 | 2.9 | B |
6 | The gender of the patient | 9 | 1 | 100 | NA | 8.1 | 3.1 | B | ||
7 | The date of birth of the patient | 9 | 1 | 100 | NA | 7.5 | 2.9 | B | ||
8 | The age of the patient | 7 | 2 | 89 | NA | 7.1 | 3.1 | L | ||
9 | The measure units of age (years, months, or days) | 8 | 2 | 91 | NA | 6.8 | 2.8 | L | ||
10 | The gestational age of the pediatric patient (for neonates) | 7 | 4 | 71 | 7 | 2 | 77 | 6.1 | 1.9 | L |
11 | The corrected gestational age of the pediatric patient (if the neonate was a preterm) | 6 | 4 | 68 | 7 | 2 | 76 | 5.3 | 2.8 | L |
12 | The date on which the age of the patient was calculated | 7 | 2 | 88 | NA | 3.5 | 2.6 | L | ||
13 | The telephone number of the patient/their parent(s)/guardian(s) in case of a pediatric patient | 7 | 3 | 74 | 7 | 2 | 79 | 2.1 | 1.2 | B |
14 | The home address of the patient | 7 | 3 | 72 | 7 | 2 | 78 | 1.4 | 1.1 | B |
Patient assessment | ||||||||||
1 | Prompts to enter the presenting symptoms of the patient | 8 | 1 | 99 | NA | 12.6 | 3.2 | B | ||
2 | Prompts to enter the vital signs of the patient | 9 | 1 | 99 | NA | 11.3 | 3.5 | B | ||
3 | Ability to enter and/or automatically import results of laboratory tests ordered for the patient | 9 | 1 | 99 | NA | 10.2 | 2.8 | L | ||
4 | Ability to enter and/or automatically import results of medical images ordered for the patient | 9 | 1 | 99 | NA | 9.3 | 2.6 | L | ||
5 | Ability to enter other co-morbidities the patient might be suffering from | 8 | 1 | 97 | NA | 8.9 | 2.3 | B | ||
6 | Ability to enter all relevant information on prescription medications the patient is/was taking | 8 | 1 | 96 | NA | 8.2 | 2.9 | B | ||
7 | Ability to enter all relevant information on other non-prescription medications the patient is/was taking | 8 | 2 | 94 | NA | 7.3 | 3.1 | I | ||
8 | Ability to enter all relevant information on allergies to medications the patient suffered from | 9 | 1 | 100 | NA | 7.0 | 2.2 | B | ||
9 | Ability to enter all relevant information on adverse medication reactions the patient suffered from | 9 | 1 | 100 | NA | 6.3 | 1.9 | L | ||
10 | Ability to update patient’s data and integrating new laboratory, imaging, and vital sign measurements | 9 | 1 | 98 | NA | 6.0 | 1.8 | L | ||
11 | Ability to transfer patient’s data into the patient’s electronic medical record | 8 | 1 | 96 | NA | 4.8 | 2.0 | L | ||
12 | Ability to enter information on congenital defects of the patient | 8 | 1 | 94 | NA | 4.6 | 1.8 | I | ||
13 | Ability to enter all relevant information on herbal medicines used by the patient | 7 | 3 | 74 | 7 | 2 | 81 | 3.5 | 1.6 | L |
Quality of alerts | ||||||||||
1 | Suggestions and alerts should be evidence-based, provide a reference or references, and level of evidence | 6 | 4 | 52 | 7 | 2 | 75 | 16.9 | 3.2 | L |
2 | Suggesting evidence-based and up-to-date recommendations, guidelines, and/or protocols to prescribe medications | 6 | 3 | 74 | 7 | 2 | 79 | 14.2 | 2.6 | B |
3 | Alerts regarding allergy should distinguish between a serious potential allergy and minor side effect of the medication | 7 | 2 | 76 | NA | 12.9 | 3.8 | L | ||
4 | Alerts and suggestions should provide clear information on relative risk of harm for the given patient | 6 | 4 | 51 | 7 | 2 | 76 | 11.3 | 3.5 | L |
5 | Ability to give warning when the prescribed dose differed from the recommended dose | 6 | 4 | 61 | 7 | 2 | 76 | 8.6 | 2.9 | B |
6 | Ability to recommend evidence-based dosing frequency suitable for the patient | 7 | 4 | 62 | 7 | 2 | 76 | 7.3 | 3.1 | B |
7 | Ability to recommend evidence-based duration of medication administration | 7 | 3 | 60 | 7 | 1 | 75 | 6.8 | 2.8 | L |
8 | Clear instructions to guide prescribers on writing the reason for discontinuing or changing a medication order | 8 | 2 | 87 | NA | 5.3 | 3.1 | L | ||
9 | Prompts to indicate if additional charts other than the medication chart was used for the patient (for example other charts for intravenous fluids, nutrition, … etc.) | 8 | 1 | 89 | NA | 4.8 | 2.1 | B | ||
10 | Clear instructions to obtain parent/guardian authorization to allow for immunization as per the national program, in case, immunization was due for a pediatric patient | 7 | 4 | 71 | 7 | 1 | 82 | 4.3 | 1.8 | L |
11 | The system should not allow the use of non-standard abbreviations/nomenclature | 8 | 2 | 94 | NA | 4.1 | 1.6 | B | ||
12 | Compulsory review of medications prescribed before saving and validating orders | 7 | 3 | 73 | 7 | 1 | 85 | 3.5 | 1.8 | L |
Admission and discharge of the patient | ||||||||||
1 | The hospital’s admission number assigned to the patient at the time of admission | 7 | 2 | 90 | NA | 20.2 | 2.3 | B | ||
2 | The date on which the patient was admitted to the hospital | 8 | 2 | 97 | NA | 15.8 | 2.1 | B | ||
3 | Name(s) of the ward(s) to which the patient was (were) admitted | 9 | 2 | 94 | NA | 13.1 | 3.2 | B | ||
4 | The name of the physician under whose care the patient was admitted to the hospital | 8 | 2 | 94 | NA | 11.9 | 4.1 | L | ||
5 | The date on which the patient was discharged from the hospital | 8 | 2 | 93 | NA | 11.1 | 2.6 | B | ||
6 | The name of the physician who decided to discharge the patient | 9 | 1 | 95 | NA | 9.1 | 3.1 | B | ||
7 | Bed(s) number(s) that was (were) assigned to the patient during their admission to the hospital | 9 | 1 | 98 | NA | 8.0 | 2.9 | B | ||
8 | Name of the hospital to which the patient was admitted | 9 | 2 | 93 | NA | 4.9 | 2.5 | I | ||
9 | Name of the physician who entered the patient information and verified that all details were correct | 7 | 2 | 88 | NA | 2.9 | 2.1 | L | ||
10 | The time on which the patient was discharged from the hospital | 7 | 2 | 91 | NA | 1.9 | 1.7 | B | ||
11 | The time on which the patient was admitted to the hospital | 7 | 2 | 93 | NA | 1.1 | 1.2 | B | ||
General features | ||||||||||
1 | The system should be as user friendly as practically possible providing easy to use interfaces | 9 | 1 | 96 | NA | 21.1 | 4.2 | I | ||
2 | Alerts should be clear and specify exactly why they were displayed | 8 | 2 | 91 | NA | 17.3 | 3.6 | B | ||
3 | The system should provide a prepackaged entry forms allowing accurate and comprehensive patient assessment | 8 | 2 | 94 | NA | 15.6 | 4.3 | L | ||
4 | The system should allow retrieval and viewing of all and/or selected patient’s specific information as the user desires | 7 | 2 | 88 | NA | 13.1 | 3.9 | B | ||
5 | Users should provide reasons when opting to over-ride system recommendations | 7 | 2 | 88 | NA | 10.2 | 2.8 | L | ||
6 | Provided entries should be customizable in case the user needed to modify some of them | 7 | 2 | 88 | NA | 8.6 | 2.7 | B | ||
7 | Ability to remind the user to complete tasks and activities that were not completed or selected for follow up | 7 | 2 | 77 | NA | 5.6 | 2.1 | B | ||
8 | Users should be able to decline suggested recommendations | 6 | 4 | 63 | 7 | 2 | 78 | 4.9 | 1.9 | I |
9 | Alerts and suggestions should pop-up when really necessary to avoid prescriber alert desensitization | 6 | 3 | 48 | 7 | 1 | 77 | 3.6 | 1.7 | B |
Diseases and making diagnosis | ||||||||||
1 | Ability to enter diagnosis | 8 | 1 | 98 | NA | 39.7 | 10.3 | B | ||
2 | Ability to access to offline, online, and searchable databases and references related to diseases and differential diagnosis | 8 | 2 | 91 | NA | 32.1 | 6.2 | B | ||
3 | Ability to provide hints for potential diagnosis based on the data entered into the assessment section | 7 | 2 | 87 | NA | 28.2 | 4.6 | L | ||