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 2011 pediatric prescribing standards to 2016 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.
