History and Future of KALIS: Towards Computer-assisted Decision Making in Prescriptive Medicine

With an increasing older population in Germany and the need for polypharmacy to treat multimorbid patients computer-assisted decision making on an individual level is increasingly important to reduce prescription errors and adverse drug reactions. While current systems focus on guidelines and prescribing information, molecular information is equally important for explanation and discovery of drug-related problems. Based on the existing KALIS system and newer projects like PIMBase, a new concept for the KALIS-2 system is presented. Improvements to the modularisation of components enable future extension and greater maintainability. Interoperability with available electronic health records standards and protocols allows the integration and communication with existing workflows for healthcare professionals. Finally, new visualisation modes empower the user to explore and analyze the patient situation in an individual patient subgraph. For offline use and dialogue between patient and general practitioner, the results can be printed out using a new reporting tool. The adherence to findings from previous decision support systems and reasons for their failed adoption is an important task in the development of KALIS-2.

Psychopharmacological treatments strategies in consultation-liaison psychiatry: Clinical vignette and pros and cons

IntroductionMultimorbidity and polipharmacotherapy are crucial features influencing the psychiatrist's prescription in the consultation-liaison psychiatry (CLP) setting.Aimsto provide an example of computer-assisted decision-making in psychotropic prescriptions and to provide hints for developing pharmacological treatment strategies in the CLP setting.MethodsCase report. A clinical vignette is presented, followed by a review of available online computer-assisted prescription software.ResultsA woman in her seventies was repeatedly referred for psychiatric consultation. Eleven different medications were administered daily, because of multimorbidity. A diagnosis of distymia was established, with comorbid mixed pain (partly fulfilling the criteria of somatic symptom disorder) and substance use disorder (opioids). After the first assessment, six follow-up visits were needed during hospitalization. Mirtazapine and benzodiazepines were introduced. Beside the pharmacological intervention, conflict mediation was performed in the relationship with the patient, her relatives, the ward personnel and the GP, to develop a long-term rehabilitation project. Pros and cons of online computer-assisted prescription software were discussed together with the ward personnel, as well.ConclusionsComputer-assisted decision-making in psychotropic prescription is becoming more common and feasible. The use of available software may contribute to safety, effectiveness and cost-effectiveness of clinical decision-making. Risks are also possible: depending for example from regional differences in prescription indications, different guidelines, pharmacogenomics, frequency with which databases are updated, sponsorships, possible conflicts of interest, and real clinical significance of highlighted interactions – all issues the clinician willing to benefit from this modern tools should pay attention to.Disclosure of interestThe authors have not supplied their declaration of competing interest.