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The PrescIT platform: An interoperable Clinical Decision Support System for ePrescription to Prevent Adverse Drug Reactions and Drug-Drug Interactions

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Abstract

Introduction

Preventable medication errors have been proven to cause significant public health burden, and ePrescription is a key part of the process where medication errors and adverse effects could be prevented. Information systems and “intelligent” computational approaches could provide a valuable tool to prevent such errors with profound impact in clinical practice.

Objectives

The PrescIT platform is a Clinical Decision Support System (CDSS) that aims to facilitate the prevention of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in the phase of ePrescription in Greece. The proposed platform could be relatively easily localized for use in other contexts too.

Methods

The PrescIT platform is based on the use of Knowledge Engineering (ΚΕ) approaches, i.e., the use of Ontologies and Knowledge Graphs (KGs) developed upon openly available data sources. Open standards (i.e., RDF, OWL, SPARQL) are used for the development of the platform enabling the integration with already existing IT systems or for standalone use. The main KG is based on the use of DrugBank, MedDRA, SemMedDB and OpenPVSignal. In addition, the Business Process Management Notation (BPMN) has been used to model long-term therapeutic protocols used during the ePrescription process. Finally, the produced software has been pilot tested in three hospitals by 18 clinical professionals via in-person think-aloud sessions.

Results

The PrescIT platform has been successfully integrated in a transparent fashion in a proprietary Hospital Information System (HIS), and it has also been used as a standalone application. Furthermore, it has been successfully integrated with the Greek National ePrescription system. During the pilot phase, one psychiatric therapeutic protocol was used as a testbed to collect end-users’ feedback. Summarizing the feedback from the end-users, they have generally acknowledged the usefulness of such a system while also identifying some challenges in terms of usability and the overall user experience.

Conclusions

The PrescIT platform has been successfully deployed and piloted in real-world environments to evaluate its ability to support safer medication prescriptions.

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Notes

  1. https://www.prescit.com/.

  2. The dataset generated and analyzed during the current study is available in the Zenodo repository (https://zenodo.org/record/8096705).

  3. https://www.opengroup.org/togaf.

  4. https://virtuoso.openlinksw.com/.

  5. https://graphdb.ontotext.com/.

  6. https://rdf4j.org/.

  7. Galinos.gr website URL (the website is in Greek): https://www.galinos.gr/.

  8. https://www.java.com/en/.

  9. https://www.osgi.org/.

  10. https://hibernate.org/.

  11. https://lucene.apache.org/.

  12. https://eclipse.dev/jetty/.

  13. https://qooxdoo.org/.

  14. https://camunda.com/.

  15. The system’s source code is not available as a whole due to complex legal issues. However, parts of the code used are available in github at: https://github.com/ergobyte/prescit.

  16. Screenshots of the system are provided in the Appendix in the Online Supplementary Material. In addition, an explanatory video demonstrating the stand-alone system’s functionality can be found at https://youtu.be/Cv9xM_VRZqE (in Greek).

  17. https://ec.europa.eu/research/participants/data/ref/h2020/wp/2014_2015/annexes/h2020-wp1415-annex-g-trl_en.pdf.

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Acknowledgements

It should be acknowledged that Thanos G. Stavropoulos and the late Vassilis Koutkias had significant contributions regarding the original design of the project (proposal phase). Thanos G. Stavropoulos also acted as a coordinator for the first year of the project.

The authors would also like to acknowledge the support of the Papanikolaou General Hospital (Thessaloniki, Greece), the Interbalkan Medical Center (Thessaloniki, Greece) and the “Asklipios” private clinic (Veroia, Greece) during the pilot study.

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Author notes

  1. Pantelis Natsiavas and George Nikolaidis share first authorship.

Authors and Affiliations

  1. Institute of Applied Biosciences, Centre for Research and Technology Hellas, 6th Km. Charilaou, Thermi Road, Thermi, PO Box 60361, 57001, Thessaloniki, Greece

    Pantelis Natsiavas, Achilles Chytas & Vlasios Dimitriadis

  2. Ergobyte SA, Aristotelous 21, 54624, Thessaloniki, Greece

    George Nikolaidis, Jenny Pliatsika & Martha Zachariadou

  3. Information Technologies Institute, Centre for Research and Technology Hellas, 6th Km. Charilaou, Thermi Road, Thermi, PO Box 60361, 57001, Thessaloniki, Greece

    George Giannios, Margarita Grammatikopoulou, Spiros Nikolopoulos & Ioannis Kompatsiaris

  4. Department of Computer Science and Biomedical Informatics, University of Thessaly, Papasiopoulou 2-4, Postal code 35131, Lamia, Greece

    Haralampos Karanikas

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Corresponding authors

Correspondence to Pantelis Natsiavas or George Nikolaidis.

Ethics declarations

Funding

This research has been co-financed by the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the title RESEARCH–CREATE–INNOVATE (project code: Τ2EDK-00640).

Conflict of interest

Some of the authors (GN, JP, MZ) work for ErgoByte SA, which is a commercial company and Galinos.gr is one of its commercial products. PN is an Editorial Board member of Drug Safety. PN was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions.

Availability of data and materials

The detailed data regarding the conclusions of this paper could be available upon reasonable request. Please contact Pantelis Natsiavas (pnatsiavas@certh.gr) for such requests.

Availability of code

The system’s source code is not available as a whole due to complex legal issues. However, parts of the code used are available in github at: https://github.com/ergobyte/prescit. Furthermore, a demonstration of the system and the relevant code could be arranged upon reasonable request. Please contact George Nikolaidis (gnikolaidis@ergobyte.gr) for relevant requests.

Ethics approval

The Ethics Committee of the Centre for Research and Technology Hellas was informed on all activities and approved the study protocol (reference number 015577).

Consent to participate

All methods presented were carried out in accordance with relevant guidelines and regulations. All participants were provided with adequate information on the project, its goals and the evaluation phases and participated voluntarily, while informed consent was obtained from all participants.

Consent to publish

Written consent was acquired from all the study participants, who agreed to the publication of the results of this study.

Author contributions

PN, GN, HK, and IK had significant contribution in the original design of the project. PN and GN designed the knowledge base and the architecture of the system. GN was the lead software developer of the PrescIT platform. JP contributed in code authoring. AC and GG constructed the Knowledge Graphs. HK supported the therapeutic prescription protocols’ integration. MG and MZ supported project management activities and the pilot testing processes. VD contributed in terms of software development. SN was the project coordinator and IK was the principal investigator. PN led the manuscript authoring process. All the authors contributed to authoring and approved the final version of the manuscript.

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Natsiavas, P., Nikolaidis, G., Pliatsika, J. et al. The PrescIT platform: An interoperable Clinical Decision Support System for ePrescription to Prevent Adverse Drug Reactions and Drug-Drug Interactions. Drug Saf 47, 1051–1059 (2024). https://doi.org/10.1007/s40264-024-01455-z

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