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Writing Pharmacy Expert System Rules

Article  in  Journal of the American Medical Informatics Association · January 2001

Source: PubMed Central

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 Writing Pharmacy Expert System Rules
Robert J. Harrison, M.S. t, Laura A. Noirot, B.S.t, Ervina Resetar, B.S.t,
Thomas C. Bailey, M.D. t, Amy Blickensderfer, Pharm.D. §
t Medical Informatics, Washington University School of Medicine, St. Louis, Missouri
§Pharmacy Department, Barnes-Jewish Hospital, St. Louis, Missouri
Barnes-Jewish Health Care utilizes a custom
automated expert system to screen drug orders
at two of its health care facilities. This custom
automated expert system is referred to as the
Pharmacy Expert System (PES) and is currently
being used at Barnes-Jewish Hospital and
Christian Hospital, St. Louis, Missouri. The
Pharmacy Expert System is comp/sed of two
distinct components; Dosechecker' screens for
drug dosing errors, while PharmADETm screens
for serious drug contraindications. The
Pharmacy Expert System is based upon a
complex set of rules that have been developed
and refined by a group of pharmacists,
physicians and technicians at Barnes-Jewish
Health Care and Washington University School
ofMedicine. This paper discusses the process of
developing expert system rules for the Pharmacy
Expert System and the challenges associated
with developing these rules. In particular, this
paper discusses
1.) What is an expert system rule?
2) Resources to assist with developing
pharmacy expert system rules
3.) Expert system rule implementation.
An expert system is a computer system or
program that uses artificial intelligence
techniques to solve problems that ordinarily
require a knowledgeable human. The method
used to construct such systems, knowledge
engineering, extracts a set ofrules and data from
an expert or experts through extensive
questioning. This material is then organized in a
format suitable for representation in a computer
and a set of tools for inquiry, manipulation, and
response is applied. It is the design,
development, and deployment of a unique set of
rules that distinguishes one expert system from
another. In the case of the Pharmacy Expert
System deployed at Barnes-Jewish Hospital and
Christian Hospital, there are over 200 unique
rules designed to alert physicians and
pharmacists in the event a serious drug dosing
error or drug contraindication has been detected
in a patient currently admitted to the hospitaL
The Pharmacy Expert System rules are table-
based rules. That is, key rule components are
organized into separate, inter-related tables.
1067-5027/01/$5.00 © 2001 AMIA, Inc.
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Different tables are used depending upon
whether the rule is a Dosechecker or PharmADE
rule.
There is a variety of information available to
guide and influence the development of
pharmacy expert system rules. Some ofthe most
recognized sources are FDA labeling, Black-Box
warnings, "Dear Health Care Professional"
letters, the FDA's "Medwatch" system, and
proprietary drug information software. These
sources provide important information about a
drug including drug name, description of the
drug, indications and usage, clinical study
results, contraindications, general warnings,
precautions, adverse reactions, dosage and
administration.
While these resources may be sufficient to
generate a set of pharmacy rules, true expert
system rules still require the direct involvement
of "experts ". These experts are required during
the design, development and integration of
expert rules in order to insure the rules and their
proper intent are successfully deployed. It is not
just rules, but also "exceptions to the rule" that
need to be considered when designing an expert
system.
Pharmacy expert system rules should be based
upon traditionally recognized sources of drug
information; FDA labeling, Black-Box warnings,
"Dear Health Care Professional" letters. These
sources provide important information about the
drug. However, guidance and assistance from a
group of local pharmacy experts who use the
expert system and understand its intent is also
important to the deployment of a pharmacy
expert system that is both successful and
accepted among its local pharmacy community.
It is the guidance and close supervision of this
group of experts that transforms a set of
pharmacy rules into a true set of expert system
rules capable of being deployed successfully
within an enterprise.
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