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The ASTI project

The ASTI project. H. Falcoff - Société de Formation Thérapeutique du Généraliste (SFTG), A. Venot - Lim&Bio Paris XIII - B. Seroussi et J. Bouaud - Paris VI. The quality problem. Evidence about frequency of suboptimal or inappropriate drug prescriptions

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The ASTI project

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  1. The ASTI project H. Falcoff - Société de Formation Thérapeutique du Généraliste (SFTG), A. Venot - Lim&Bio Paris XIII - B. Seroussi et J. Bouaud - Paris VI

  2. The quality problem • Evidence about frequency of suboptimal or inappropriate drug prescriptions • Two main reasons : - explosion of therapeutic information - human errors • Computerized decision support systems (CDSS) for drug prescribing : is it a solution ?

  3. CDSS : 1st generation • They improve security- guide to choose de right dose - control of drug interactions et drug contra indications- generate reminders • They may save money • Doctors like them • They are based on structured drug databases • Exchanges with the EMR limited (age, weight,contra indications, allergies), data have to be coded • No help to choose the drug class

  4. CDSS : 2nd generation • They aim to help the GP to decide what is the best drug for each patient, taking account of all the health problems and the drugs received before • They are based on clinical practice guidelines • Developpment in progress : Prodigy (UK), ASTI (France) • Several problems to solve

  5. The ASTI project • ASTI : “Aide à la Stratégie Thérapeutique Informatisée” • Started in 1999 • Public funding • Consortium : - medical informatics academics : Pr Alain Venot - PARIS13, Dr Brigitte Seroussi et Mr Jacques Bouaud - PARIS VI, Dr Christine Riou - Rennes- software developers : Mr Gérard Simon - Banque Claude Bernard, Mr Christian Simon - Silk Informatique, “éO”- GPs : SFTG (“éO” users)

  6. Principles of ASTI • Two modes- “Critic mode” : operates as a background process to control the physician’s prescriptions ; it displays reminders when physician prescrpition differs from guidelines recommendations- “Guided mode” : operates on demand, has to be triggered by the GP when he needs support to establish the drug prescription • Knowledge base : built from the 1999 Canadian guidelines for hypertension

  7. Display of ASTI

  8. Critic mode : main functional components, knowledge ressources and data flow Patient categorisation rules Abstracted patient data EMR Reminder ! Critic mode Abstracted prescription Prescription Guideline based rules (if - then - else) Drug database Guideline

  9. Guided mode : main functional components, knowledge ressources and data flow Guideline Experts Patient categorisation rules Collection of scenarios Doctor Abstracted patient data EMR Guided mode Abstracted prescription Prescription Suggestion Drug database

  10. The two modes are complementary • Preliminary evaluation of ASTI (10 GPs confronted with clinical cases) • Reminder-based interaction seems to be appropriate for simple cases • GPs want to use on-demand system as clinical situations become more complex

  11. Some problems... • Quality of guidelines (complete, accurate, not ambiguous) • Updating guidelines • Quality of the EMR (well structured, coded data, updated) • “Therapeutic history” taking account of each drug prescribed in the past, the reason of its prescription and its effectiveness • How many guidelines can a GP cope with ?

  12. ASTI 2 - ASTI 3 • ASTI 2 : - based on French guidelines- hypertension + type 2 diabetes- assessment of the impact of the system on the quality of the prescriptions (RCT) • ASTI 3 : assessment of the “genericity” of the model : different guidelines and different EMR softwares

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