Chances are your clinical information systems are starved for data. Consider adding EMBASE, Micromedix, and other sources.
How good is the information going into your healthcare database? If your organization is compiling its own knowledge base from which to make diagnostic and treatment decisions, you need the most up-to-date, evidence-based sources to improve patient outcomes and compete with other providers. And many organizations aren't doing enough in this area.
As I mentioned in my last column, if you rely solely on Medline, you're missing a lot of useful data to feed your e-prescribing and clinical decision support systems. Although Medline covers most of the important healthcare journals, the process it uses to qualify journals for its database can exclude some valuable publications.
Medline, the main online bibliographic citation database of the National Library of Medicine, is used internationally for access to much of the world's biomedical journal literature. The database indexes about 5,000 titles and uses a selection committee that meets three times a year to consider adding about 140 other titles. The review process considers a journal's objectivity, credibility, and the quality of its contents, as well as the quality of its layout, graphics, and illustrations--and much more. Over the years, I've spoken with several medical editors who think the process is subjective and arbitrary.
With those shortcomings in mind, a comprehensive clinical information system should tap into additional sources. EMBASE, for instance, indexes more than 7,600 peer-reviewed journals, including those cited in Medline. But EMBASE is much more thorough, including more than 5 million records not covered in the NLM database. EMBASE's forte is adverse drug reactions, systematic reviews, and the development and use of medical devices.
Like EMBASE, Micromedix goes beyond Medline, tapping into 7,000 professional journals. It's especially famous for its comprehensive poisons database. In fact, Poisindex is used in every poison control center in the U.S.
Other useful data sources include Micromedix's Diseasedex Emergency Medicine, which offers detailed information on patient presentation, lab and radiology reports, and pharmacologic and nonpharmacologic therapies. Drugdex, also from Micromedix, covers dosage, pharmacokinetics, cautions, interactions, comparative efficacy, labeled and off-label indications, and nonprescription products.
One of the less appreciated data sources is the FDA's Adverse Event Reporting System (AERS). It's a collection of raw data from clinicians and patients, essentially a complaint service listing adverse reactions that providers and patients suspect have been caused by specific medications after they've been approved by the FDA--what's referred to as the post-marketing period.
One of AERS's limitations is the fact that there's no way to know for sure if the adverse reaction was caused by the drug in question, because the FDA doesn't require that a causal relationship between a product and event be proven. But then again, many of the reports of adverse drug reactions in the peer-reviewed journals are likewise anecdotal. Although it's not the strongest type of evidence, oftentimes it's the best we can hope for.
The other problem with AERS is the data presentation isn't very user friendly. The fact that the FDA provides the information as quarterly reports, rather than in one comprehensive database, makes it difficult to get a full picture of how many adverse events were reported over the entire post-marketing period. The lack of a search function is just one more stumbling block.
Adverseevents.com is worth considering because its data-refinement algorithm, RxFilter, has extracted and organized the FDA data so that it's of practical use at the bedside. It also provides a search engine for its database.
Thinking outside the Medline box might cost your organization more in dollars and cents, but it's an investment that should improve patient care and reduce healthcare costs over the long term.
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