Adverse drug interactions and toxicities are common in elderly patients. SmartChart is a program that allows nurses and physicians to enter real-time clinical data into PC's from the bedside. The paper chart is generated through a microcomputer rather than by pen or dictation. During Phase I, SmartChart will be modified so that the therapy entries of all patients refer to a central list that will automatically expand as new drugs are used and entered. A drug-monitoring program (SmartDose) will be developed to use the complete, accurate, and timely clinical information to estimate proper drug dosages and to monitor for potential drug interactions. Each time a therapy is changed or entered, a program will calculate the proper dosage according to a number of formulas, determine whether there are interactions with other drugs, and display messages if the drug prescription could cause clinical problems.The database will be created by simplifying the Stanford drug interaction database and adding generally accepted drug dosing and kinetic formulas for each drug title. The accuracy and utility of messages will be tested using clinical information from a dialysis patient population.In Phase II, neural network simulation programs will be tested to see whether physicians and nurses could eventually "train" a computer to monitor drug use in their own specialty units and hospitals. Bayesian methods of drug-dose calculation and prediction will also be tested.
Anticipated Results:Computers will be used someday to enter and review clinical data, and computer algorithms will monitor and assure quality of care. With the SmartDose program, SmartChart comes closer to filling these needs and creating a standard for computerized clinical information. Developers of such a computerized system will have an opportunity for a large percentage of the outpatient and hospital market, which exceeds $200 million per year.National Institute Of Diabetes And Digestive And Kidney Diseases (NIDDK)
