Abstract:
An electronic medical records system with computerized provider order entry includes error checking for duplicate or medically similar orders. In the system, similar medical orders are displayed on adjacent screens and are highlighted, thereby allowing medical personnel to easily identify and evaluate the orders. The user can therefore choose to modify or delete medically similar entries easily and quickly, thereby minimizing the occurrence of duplicate or repetitive orders, and increasing efficiency of the system.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. Provisional Application Ser. No. 61/753,161 filed Jan. 16, 2013, which is hereby incorporated by reference in its entirety. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    In recent years, rising health care costs have led to an increased emphasis on computerization of health care, and particularly the development and use of electronic medical records (EMR) and computerized provider order entry (CPOE). Electronic medical records and computerized provider order entry provide many advantages over prior art paper medical record documentation systems. Moving from paper to electronic records and orders can, for example, increase the efficiency of health care, as well as health and insurance payment systems. 
         [0003]    Electronic medical records and orders also provide an important advantage because they simplify both the storage and transfer of important medical history data, including prescribed drugs, blood type, allergies, and existing medical conditions, and enable electronic verification and checking of data. Electronic medical records are typically also more complete than the medical records of the past, which often relied on information retrieved directly from the patient. The patient data could be incomplete due to memory failure, or the failure to maintain complete personal records. Computerized medical systems, therefore, are an important improvement over prior art processes and lead to improved diagnosis and treatment decisions. 
         [0004]    While computerized medical systems and records provide important improvements in patient care and help to reduce health care costs the ease of entry of medical data in computerized systems can also lead to some problems. The online journal of the American Medical Informatics Association, for example, recently published an article evaluating the incidence of duplicate medication orders before and after computerized provider order entry. This study found that the ease of order entry actually increased the number of duplicative order errors at studied hospitals, and that the entry of duplicative orders had more than tripled after the introduction of CPOE—increasing from 2.6% to 8.1%. Because duplicate orders can lead to unnecessary and costly duplication of medical procedures, decrease efficiency by tying up resources that could be used elsewhere, and adversely impact inventory procedure in pharmacies and other areas of medical facilities, it is important to minimize duplicate, similar, and overlapping entries. 
         [0005]    Existing medical order systems often use pop-up windows to notify the medical practitioner that a duplicate or similar order exists. While these warnings can be effective in some cases, pop-up windows are often easy to disable, and are frequently ignored by computer users, who suffer from “fatigue” due to over-use of pop-up windows, or who associate pop-up windows with unwanted advertising. These systems, therefore, are often ineffective, and do not minimize duplicative order entry by medical personnel. 
         [0006]    The present invention addresses these and other issues. 
       SUMMARY OF THE INVENTION 
       [0007]    In one aspect, the present invention can provide a medical records computer system that includes a processor, a memory coupled to the processor and storing a patient database, a user interface device coupled to the processor, and a display communicatively coupled to the processor and the memory. The display includes an existing order portion displaying at least one existing medical order retrieved from the patient database, and a new order portion adjacent the existing order portion for displaying a new medical order entered by medical personnel using the user interface. The processor is programmed to receive and display the new medical order on the new order portion of the display, compare the new medical order to the existing medical orders in the patient database to determine whether the existing medical order is medically similar to the new medical order, and highlight at least one of the existing medical order and the new medical order on the display when the existing medical order is medically similar to the new medical order. A medical practitioner entering the new order, therefore, is provided with a warning in real time to prevent the entry of a medically similar order, and therefore to minimize the possibility of the entry of medically similar orders for the patient. 
         [0008]    The existing order portion of the display can display a plurality of existing medical orders categorized in medical order types. The processor can also be programmed to highlight the medical order type that contains the existing medical order that is medically similar to the new order. Again, the medical practitioner is therefore notified of the existing orders for quick analysis without the need for a pop-up window or display. 
         [0009]    The processor can also be programmed to highlight at least one of the existing medical order and the new medical order on the display by changing a font of at least one of the existing medical order and the new medical order, by changing a color of the font, or by applying a color highlight to at least one of the existing medical order and the new medical order on the display. The processor can also or alternatively be programmed to highlight at least one of the existing medical order and the new order on the display by visually enclosing the selected order within a line or box on the display. 
         [0010]    The processor can also be programmed to scroll the display to position the existing medical order and the new medical order adjacent one another in the first and second portions of the display, or to sort the existing medical orders to position an identified existing medical order at a position adjacent the medically similar new medical order. 
         [0011]    The medical records computer system can also include a database storing a plurality of known medical orders and similar medical orders, and the processor can be programmed to compare the known medical orders to the new medical order to identify a match, retrieve the corresponding similar medical orders from the database, compare the similar medical orders to the existing medical order to determine whether the new medical order is similar to the existing medical order, and highlight the existing medical order when it is similar to the new medical order. The database can also correlate the known medical orders with categories of medical order types, and the existing medical orders can be correlated with corresponding medical order types on the display. The processor can be further programmed to highlight the medical order type corresponding to the new medical order on the existing order portion of the display. 
         [0012]    The medical records system can include a memory storing a medical orders database comprising a plurality of known medical orders grouped in a plurality of categories based on a medical order type, and a patient database comprising at least one existing medical order initiated for a selected patient which is also categorized in a medical order type and can compare the new medical order to the orders database to determine a medical order type. The processor can also compare the new medical order to the existing medical orders of the same medical order type in the patient database to determine whether the existing medical order is medically similar to the new medical order, and highlight at least one of the existing medical order type corresponding to the new medical order, the existing medical order that is medically similar to the new medical order, and the new medical order on the display when the existing medical order is medically similar to the new medical order. Again, the medical practitioner entering the new order is provided with a warning in real time to prevent the entry of a medically similar order. 
         [0013]    The existing order portion of the display can display a plurality of existing medical orders categorized in medical order types, and the processor can be programmed to highlight at least one of the predetermined medical order types that contains the existing medical order that is medically similar to the new order. 
         [0014]    The processor can also be programmed to group the existing medical order with other existing medical orders of the same medical order type on the display, and to highlight the medical order type that corresponds to the new medical order in the existing order portion of the display when a similar or duplicate order is found. In some applications, the processor can also be programmed to scroll the medical order type corresponding to the new medical order to a top portion of the existing order portion of the display to highlight the duplicate or similar entry. 
         [0015]    The processor can also be programmed to visually group the existing medical orders corresponding to a medical order type by enclosing the existing medical orders in a box in the existing order portion of the display or to highlight at least one of the existing medical order and the new medical order on the display by scrolling the display to position the existing medical order and the new medical order adjacent one another in the first and second portions of the display, or by sorting the existing medical orders to position the existing medical order at a position adjacent the new medical order, or to highlight existing medical orders of the same medical order type to the new order to allow a medical practitioner to compare the new medical order to existing medical orders. 
         [0016]    In another aspect, the present invention can comprise a method for minimizing entries of duplicate medical orders by medical personnel in a computerized medical records system. The method comprises the steps of storing at least one existing medical order initiated by medical personnel for a specific patient, and displaying the existing medical order on a first portion of a display screen, receiving a new medical order for the patient through a user interface, and displaying the new medical order on a second portion of a display screen. A processor compares the new medical order to the existing medical order, and highlights at least one of the existing medical order and the new medical order to provide a real time notification that at least one of a similar and a duplicate order has been entered. 
         [0017]    To identify similar orders, the method can also include storing a plurality of known medical orders and similar medical orders in a database for comparison, comparing the known medical orders to the new medical order to identify a match, retrieving the corresponding similar medical orders, comparing the similar medical orders to the existing medical order to determine whether the new medical order is similar to the existing medical order, and highlighting the existing medical order when it is similar to the new medical order. 
         [0018]    The method can also include categorizing each of the existing medical orders as a predetermined medical order type, determining the medical order type of the new medical order, and highlighting the corresponding medical order type in the first portion of the display to enable a user to identify a duplicate or similar order. The method can further comprise the steps of comparing the new medical order to a database of known medical orders, and providing a warning to the user when a spelling error is detected. The user can also be provided with one or more alternatives for the user to select when the new medical order does not match any of the known medical orders. 
         [0019]    These and other aspects of the invention will become apparent from the following description. In the description, reference is made to the accompanying drawings which form a part hereof, and in which there is shown a preferred embodiment of the invention. Such embodiment does not necessarily represent the full scope of the invention and reference is made therefore, to the claims herein for interpreting the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]      FIG. 1  is block diagram of a computerized health care information system for use with the present invention; 
           [0021]      FIG. 2  is a block diagram of a computer or other computerized device for providing access to the computerized health care information system of  FIG. 1 ; 
           [0022]      FIG. 3  is an illustration of an exemplary patient records database for use in accordance with the system of the present invention; 
           [0023]      FIG. 4  is an illustration of an exemplary medical orders database for use in accordance with the system of the present invention; 
           [0024]      FIG. 5  is an illustration of an exemplary screen for medical order data entry and comparison prior to entry of a new medical order; 
           [0025]      FIG. 6  is an illustration of an exemplary screen for medical order data entry and comparison during entry of a new medical order; 
           [0026]      FIG. 7  is an illustration of an exemplary screen for medical order data entry and comparison after entry of a new medical order; 
           [0027]      FIG. 8  is an illustration of an exemplary screen for medical order data entry and comparison illustrating highlighting of two medically similar orders; 
           [0028]      FIG. 9  is a flow chart illustrating one embodiment of a comparative analysis for identifying medically similar medical orders in accordance with the present invention; and 
           [0029]      FIG. 10  is a sequence diagram illustrating the process of identifying and highlighting medically similar orders. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0030]    Referring now to the figures, and more particularly to  FIG. 1 , a typical computerized medical records system  10  on which the present invention can be used is shown. The medical records computer system  10 , as shown here, comprises a central computer or server  16 , and a memory storage device  18  which stores databases of electronic medical records  30  (EMR) and medical orders  40 . The server  16  can be accessed by medical personnel through terminals or computers  12  and  14  in communication with the server  16  at an inpatient facility, such as a hospital, clinic, or rehabilitation center, or at an outpatient facility. During an examination or patient visit, medical personnel access the electronic medical record for the patient by accessing the database  30  through the computer  12  or  14 . The data retrieved includes existing orders for the patient. When a new medical order is initiated by medical personnel, the system compares the new order against existing medical orders and data in the medical orders database  40 , and provides an indicator to the medical personnel if a medically similar order exists, thereby minimizing occurrences of medically similar orders, as described below. As used herein, the term “medically similar” means an order that is either duplicative of, therapeutically or diagnostically overlapping of, or therapeutically and/or diagnostically similar to an existing order. Medically similar orders can include, for example, different medications that are commonly ordered as a treatment for the same condition, or to treat the same symptoms, and which may therefore be effective duplicates. Similar medications can be identified as therapeutically or diagnostically similar, for example, based on their current procedural terminology (CPT) codes, including ICD-9 and ICD-10 coding. Here, medications in the same therapeutic class, and orders that are numerically similar in CPT code may overlap in treatment. Also, in some cases, a single lab order includes results that can also be obtained by taking a number of individual lab tests. A complete blood count (CBC), for example, includes a white blood cell (WBC) count. A WBC, therefore, overlaps an existing CBC order, as well as CBC with differential, CBC without differential, and CBC manual differential tests. Imaging procedures which acquire duplicate images of the same sector of the patient can also be duplicative. 
         [0031]    Referring still to  FIG. 1  and also to  FIG. 2 , each of the computers  12  and  14  comprises a user interface  22  for entry of data by medical personnel, and a display  24 . The computing devices  12  and  14  can comprise any number of known devices that are connectable to a network, and can include, without limitation, personal computing devices, cellular phones, tablets, notebooks, laptops, desktop computers, all-in-one computers, and other types of computer configurations. The computing devices  12  and  14  can be connected to the server  16  through the internet, or through other public or private networks including wide area networks, local area networks, wireless interfaces, cellular communication links, satellite communications, and various other types of communication links which will be known to those of ordinary skill in the art. Although the computer is shown here in a network configuration, stand alone computer devices capable of maintaining or connecting to appropriate databases can also be used without the need for a server or network. 
         [0032]    Referring now to  FIG. 2 , an exemplary computer system  12  or  14  is shown. The computers  12  and  14 , as described above, include a display  24  and a user interface  22 , which are communicatively coupled to an internal processor  20 , memory  26 , and a communications or input/output (I/O) device  28  which can, as described above, link the computing device  12  to a server  16  or other external devices. As shown in  FIG. 1 , the user interface  22  can be or include a keyboard, mouse, joystick, pen, or other devices capable of providing input to the computer  12 . Alternatively, the display  24  can be provided with a touch screen, and the user interface  22  can be configured as a portion of the display function. The user interface  22  or the I/O device  28  can also include cameras and scanning devices, including magnetic, optical, or barcode scanners, and data ports such as universal serial bus (USB), RS-232, or other types of wired and wireless data links. Selective access can be provided to the system using password protection, biometric data, retinal scanners, fingerprint scanners, vascular biometrics analyzing the back of the hand or finger vein scans, RFID readers, encoded digital symbols such as bar codes, and other types of identifiers and reader devices. The computers  12  and  14  may also include audio generation systems and speakers, which are not shown. 
         [0033]    Referring now to  FIG. 3 , an exemplary EMR database  30  includes electronic medical records for patients, as described above. The database can include a patient identifier  32 , patient medical data  34 , medical order types  36 , and corresponding data related to existing medical orders  38  that have been entered for the patient. As shown here, the patient identification data can include a name and address of a patient, and may also include alternative identifiers such as social security number, insurance information and/or finger print, retinal scan, or other types of personal identification data or codes. Also as shown here, the patient medical data  34  can include information that can be used by medical personnel to identify drugs which are not appropriate for a given patient, including information about the patient&#39;s allergies (latex, bee venom, and penicillin) and information about medication orders the patient is already taking 
         [0034]    Medical order types  36  can include for instance, a request from medical personnel for an inpatient or outpatient procedure, a medication, a laboratory test, an evaluation, a treatment, or a nursing task to be performed. As used herein, medical order types can also include, for example, laboratory orders, imaging orders, diet, consults, and other types of orders made by medical personnel for a patient. Medication orders can also include, for example, medications taken at home by a patient including take-home medications, discharge medications, prescriptions, and facility administered medications including persistent facility-administered medications and prescriptions. For purposes of identifying similar or duplicate orders, medication orders can be divided into specified sub-types of Medical Orders  36  such as, for example, medication order—pro re nata (PRN or “as needed” medication orders), medication order—continuous, and medication order—scheduled pharmaceutical delivery. 
         [0035]    Referring still to  FIG. 3 , existing medical orders  38  are correlated with medical order types  36 , and can be categorized to correspond to one or more medical order type  36 . In applications where CPT coding is used, for example, medical orders  38  within a predetermined numerical range of the CPT code assigned to the medical order  38  can be presumed to be medically similar. In these applications, the medical order type can correspond to a numerical range of CPT codes, and can be provided in the database  30  corresponding to the medical order  38  to provide a range for searching for medically similar orders. More generally, a medical order  38  may require a patient to take a medication prior to a blood test or other laboratory analysis. Here, the medical order  38  therefore can be appropriately categorized as both a lab order and a medication order for purposes of identifying a medical order type  36  and medically similar orders. The degree or level of similarity can be used to prioritize medical orders  36  with the corresponding medical order types  38  in database  30  and for comparison purposes. 
         [0036]    Referring still to  FIGS. 2 and 3 , when a medical practitioner evaluates the patient to initiate additional orders, new orders for the patient can be entered into a window on display  22  as described more fully below. The entered data can be evaluated to determine whether the newly initiated order is medically similar to an existing order  38 . 
         [0037]    Referring now to  FIG. 4 , one method of providing this function is by comparison to a medical orders database  40 . The medical orders database  40  can include a listing of known medical orders, including a standardized listing of medical order types  42 , specific medical orders  44  that correlate to the medical order type, and also, a list of medically similar orders  46  that are pre-determined to be sufficiently medically similar to the corresponding order to require a notification to medical personnel that the order may be unnecessary or unduly repetitive. The medical orders database  40  can be constructed specifically for a hospital, clinic, or other facility, or can be based on standards from public databases. Standard medical data can, for example, be retrieved through the internet or other networks and can be, as described above, CPT coding. Also as described above, the medical orders  44  can correspond to one or more medical order type  42 . Again, the corresponding medical order types  42  can be prioritized, or a degree of similarity to the corresponding medical order types  42  can be stored in memory with the medical orders  44 . Also as discussed above, where CPT coding is used, it can be assumed that CPT codes that are within a predetermined numerical range of the CPT code corresponding to the medical order  44  may be medically similar. Although a specialized medical orders database is shown here, standardized CPT codes and IC-9 and IC-10 databases can be accessed to provide similar types of data, 
         [0038]    Referring now to  FIG. 5 , an exemplary display screen  49  for use by a medical practitioner is shown. The display screen  49  is provided on display  22  of computer  12  ( FIG. 1 ) and can include a plurality of sections or windows, including an existing order section  50  for displaying existing orders  38  for the patient from database  30 , and a new order entry section  52  for entering or editing medical orders. A patient data section  51  can also be included. In one embodiment, as shown here, the patient data section  51  can be provided along an upper portion of the screen  49 , and the existing order section  50  and new order entry section  52  adjacent one another, where the existing order data can be viewed by a medical practitioner simultaneously with the new order data, as the data is entered into the order entry section  52  of the screen  49 . As shown here, the existing order section  50  and order entry section  52  can be in two adjacent columns. 
         [0039]    Referring still to  FIG. 5 , the patient data section  51  displays information from patient database  30  and can include patient identification data  32 , such as a name, address, physical description, and a picture of the patient for verification by medical practitioners, and other data drawn from the database  30 , to allow a medical practitioner easy access to verify identification of the patient. The display screen  49  can also illustrate patient medical data  34  derived from database  30  for use by medical personnel in evaluating whether a specific type of order may be appropriate for the patient. This data can include, as described above, blood type information, patient allergy data, and important medical history data. The patient data can also include a list of identified medical problems for analysis and diagnosis. 
         [0040]    Referring still to  FIG. 5  and also to  FIG. 3 , the existing medical order section  50  displays each of the existing orders  38  that have been previously entered for the patient, which can be retrieved from the database  30 , along with icons that can be selectively activated by a medical practitioner to modify or discontinue the order. The existing orders are categorized by medical order type  36 , and all of the existing orders  38  of a particular type are grouped together on the screen  49  in the existing order section  50 . The grouped medical orders can include a visual indicator grouping all of the existing medical orders  38  of the same medical order type  42  together, as discussed below. 
         [0041]    Referring still to  FIG. 5 , after examining the patient, the medical practitioner can enter new medical orders into the order entry section  52  of the screen  49 . As shown here, the new order section  52  can include, for example, a text box section or window  54  that accepts input from the user interface  22 . A medical practitioner enters the new medical order into the text box  54 . As described below, as and after the text is entered into the text box  54 , the processor  20  takes a series of steps to evaluate whether medically similar orders have already been entered for the patient, and highlights any identified similar orders to notify the medical practitioner of a potential problem. A sequence diagram illustrating these steps is shown at  FIG. 10 . Generally, the process begins by clearing the old highlights (step  69 ). After new orders are entered (step  70 ), the new orders are highlighted in a sidebar or window, the new order section  52  (step  76 ). As described more fully below with reference to  FIG. 9 , corresponding groups of existing medical orders  38  having the same medical order type  36  are highlighted (step  79 ) in the existing order section  50  and then the existing orders  36  that are medically similar to the new order are highlighted (step  82 ). 
         [0042]    Referring still to  FIG. 5 , and now also to  FIGS. 4 and 9 , in the first step of the process, any existing highlighting is cleared (step  69 ). As the new order is entered into text box  54  (step  70 ), the processor  20  compares the entered text to known orders  44  in a medical order database  40  (step  72 ) until all possible matching orders are identified (step  74 ). The processor  20  can, for example, parse the entered text string and compare either the entire text string or portions of the text string to known orders  44 . Rules can be provided specifying the degree of similarity between the text string or text string portion and a known order  44  to trigger identification as a possible match. The processor  20  can then display possible matches (step  74 ) to the medical practitioner. Referring now also to  FIG. 6 , the matches can be displayed in a pop-up window or screen  55 . The medical practitioner can use a mouse, arrow keys, or other user input device to highlight and select an entry  61 . As shown here in  FIGS. 5 and 6 , for example, when a medical practitioner enters the letters TYL ( FIG. 5 ), a series of orders generated by the rules and including these letters is provided in window  55  for selection by the user ( FIG. 6 ). 
         [0043]    Alternatively, the medical practitioner can continue to enter data directly into the text box  54 , using the window  55  as a guide, for example. If the practitioner chooses to enter the medical order into the new order entry text box  54  rather than selecting an order from the window  55 , and the order is not found, the process can be stopped and, for example, an error notice can be communicated to the medical practitioner on the display  22 , indicating that the new order entry was not found in the database  40  (step  73 ). In some applications, a spell check can be performed on the new entry, and alternative choices offered to the medical practitioner. 
         [0044]    In either case, the processor  20  waits (step  75 ;  FIG. 9 ) until the user selects an order from the list, or completely types the order into the text box  54 . When the entry is complete, the user can activate a “new” button, key or icon  53 , activate the enter key, or use a mouse or other device from user interface  22  to indicate acceptance of the entry, or otherwise provide an indication to the processor that an order entry has been identified and is ready for review and comparison for medically similar orders (step  76 ). 
         [0045]    Referring now to  FIG. 7 , when an order is selected, the selected new medical order  56  is displayed and highlighted in the new order section  52 . Referring again to  FIG. 9 , the processor  20  in computer  12  takes a series of steps to evaluate the new medical order  56  to determine whether the new medical order  56  is medically similar to any of the existing medical orders  38  for the patient in database  30 , and to provide an indicator to the medical practitioner when a medically similar order may have been made. After the processor  26  receives the indicator that the new order  56  has been selected (step  76 ), the processor  20  first identifies the medical order type attribute (step  77 ). 
         [0046]    The processor  20  then compares the medical order type or types  42  identified in database  40  as corresponding to the new order  56  to each of the medical order types  36  corresponding to the existing orders  38  in the patient database  30  ( FIG. 3 ) (step  78 ). As described above, where CPT codes are used, this analysis can include a comparison to medical orders that have a CPT code within a predetermined numerical range of the CPT code corresponding to the new medical order  56 . If no match is found, no medical orders of the corresponding medical order type have been previously made, and the order can be entered when the medical practitioner indicates entry by, for example, activating the “sign” button  57 . (Step  80 ) In some applications, the highlighting of the new medical order  56  could be changed or adjusted to indicate that no similar orders or duplicates have been found, providing an indicator to the medical practitioner that the order can be completed without overlap or duplication. 
         [0047]    If the database  30  includes existing medical orders  38  of the same medical order type  36  as the new medical order  56 , the processor  20  highlights the order type  36  in the existing order section  50  of the display  22  (step  79 ). As shown in  FIG. 7 , the existing orders  38  of the same or closest medical order type  36  are scrolled to the top of the existing order section  50  of the display  22  and highlighted, drawing the attention of the medical practitioner to the relevant group of existing orders in existing order section  50 . The processor  20  compares the new medical order  56  to the existing medical orders  38  corresponding to the identified medical order type, initially to determine whether an exact match, or duplicate, exists in the existing order database  30 . (step  81 ). If a match is found, the processor  20  can highlight the corresponding medical order type in existing order section  50  of the screen  49  (step  82 ) to provide a visual indicator to the medical practitioner that a duplicate exists. The new medical order  56  can also be highlighted. As shown here, for example, a line or box  64  can be drawn around the orders corresponding to each of the medication order—PRN medical orders, allowing the medical practitioner to easily identify the existing orders of this type. 
         [0048]    Referring still to  FIG. 7 , if no identical match is found, the processor  20  retrieves similar orders from the medical orders database (step  83 ) and compares the similar medical orders  46  corresponding to the new medical order  56  in database  40  to the existing orders  38  of the same medical order type or types in database  30  (step  84 ). As described above, the similar medical orders  46  are orders that may be medically similar to the new medical order, rendering the new order unnecessary or repetitive. If a match is found, the processor  20  can, again, highlight the corresponding existing medical order  38  in existing order section  50  of the screen  49  (step  82 ), and also the new medical order  56  in order entry section  52 , to provide a visual indicator to the medical practitioner that further analysis is required before completing the order. Since more than one medical order may be similar to the existing order, this process can be repeated until all of the similar medical orders are identified, and can also be provided after a duplicate medical order is identified. Additionally, the medical order database  40  can store a probability or confidence factor, indicating a degree of similarity between corresponding similar types of medical orders, and this confidence factor can be used in providing feedback to the medical practitioners initiating the order, as described below. 
         [0049]    If no match is found, the new order  56  is not medically similar to any existing orders, and the new order  56  can be entered into the patient database  30 . (Step  80 ) In one embodiment of the invention, the medical practitioner can save the order entries by activating the “save work” button  58 , and sign the order by activating the “sign” button  57 . When the new order is saved, and the order is signed, the order is stored in the patient database  30 , with the corresponding medical order type. If the medical practitioner instead decides not to enter the order, the medical practitioner can activate the “remove” button  59 , removing the order from screen. If no match is found, the processor may also perform a spell check to determine if the order was entered correctly, or provide the medical practitioner with a number of alternate entries that the user may have intended to type. Alternatively, the processor  20  may provide a pop-up window, highlight the entry, or provide another indicator to the medical practitioner that no matches were found, or that the order entry may be incorrect. The user can then delete the order, save the order, or change the order and re-start the process. 
         [0050]    Referring again to  FIG. 7 , an example of the application of the order entry steps and review process described above can be seen by reference to the display  49 . As shown here, a medical practitioner has entered a new order  56  for acetaminophen in the new order section  52  of the display screen  49 . In response to this entry, the system  10  evaluates the new order entry  56  to determine the corresponding medical order type or types  42 , as discussed above with reference to  FIG. 7 . When a match is found, the system can scroll or sort the existing order section  50  of the display  49  to align the medical order type  36  at the existing entry  38  corresponding to the new entry adjacent the new order entry  56  at the top of the screen  49 , thereby allowing medical personnel to easily view the possible medically similar order. In the example shown here, the corresponding entry corresponds to the medication order—PRN medical order type  42 , and this category is scrolled to the top of the existing order section  50  near the new order entry  56 . The corresponding medical order type  42  is visually highlighted on the screen  49  by, for example, drawing a highlighting line  64  around the identified order type and each of the corresponding orders in that particular portion of the screen  49 . A highlight, here shown as cross-hatching, can also be provided on the existing medical order  38  for acetaminophen which has already been initiated for the patient. The new order entry  56  in new order entry section  52  can also be similarly highlighted. The medical practitioner is therefore visually notified that a duplicate order exists in the medical order type selected. Because the duplicate order is scrolled to a location where it can be easily seen, the person entering the order can view the information easily and determine whether to change the existing order, delete the new order, or make a different recommendation, thereby minimizing the possibility of a duplicate or similar entry. Although cross-hatching and dotted lines are shown here for highlighting, changes in color, bold fonts, italics, and other types of highlighting can be used as described more fully below. 
         [0051]    Referring now to  FIG. 8 , either in addition to the steps described above, or as an alternative to the steps described above, the processor  20  can also search for medically similar orders  46  of any medical order type  42 . Using similar methodology to that described above, the processor  20  can, for example, search all existing medical orders  38  for orders that are medically similar to the new medical order  56 . Here, for example, the new medical order  56  includes “acetaminophen.” Acetaminophen level testing has been ordered for the patient as part of the “lab” medical order type group. Here, the processor identifies the use of the term “acetaminophen” in the lab type, and flags this order as medically similar. As shown in  FIG. 8 , the “labs” medical order type containing the medically similar order can be scrolled up on the screen  49 , and the term “acetaminophen” highlighted to indicate to the medical practitioner that the acetaminophen level test is a medically similar or overlapping order. The “labs” medical order type can be highlighted, as described above, or, since this order type does not match the order type attribute of the new medical order  56 , may be left un-highlighted. Multiple medically similar orders can therefore be highlighted in the existing medical order section  50  of the display  22 . A count of the number of medically similar orders can be provided in, for example, a text box  60  for the medical practitioner. These medically similar orders also can be organized based on degree of similarity. Here, for example, the first highlighted order includes both the same medical order type attribute and a medically similar order. The next group includes a medically similar order, but does not have the same medical order type attribute. Various methods for determining degree of similarity can be used in ordering the display. The degree of similarity can be indicated by order of display, as shown here, by the color of text, or using other variations in the highlighting options. 
         [0052]    Although a specific method of highlighting duplicate entries has been described, various highlighting methods can be used that would fall under the scope of the invention. For example, in some applications, the duplicate or similar entries could be emphasized by changing the font and displaying either the duplicate entry or both the newly entered and duplicate entries in an emphasized font, such as italics, bold, or underline. Alternatively, the size or color of the font of the entries could be adjusted to emphasize the match. In other alternatives, an icon or other visual indicator could be provided near the duplicate or medically similar entry, near the new medical order, or both. 
         [0053]    In another example, a color coded system can also be used to identify various grades of similarity. For example, if a known duplicate order is found, the duplicate orders can be displayed in red, indicating a very likely need to stop and re-evaluate the situation before completing the order. Where a similar order is substantially medically similar to an existing order, such as, for example, where a generic drug is ordered at the same time as a brand name drug, these entries can be highlighted in orange. As discussed above, a confidence factor indicating a likelihood that two orders are similar can also be provided in the medical orders database  40 , and this data can be used to vary the colors of the highlighting, varying, for example, from yellow to orange, to red, depending on the degree of confidence. Similarly, a “green” highlight could be used to indicate that no duplicate or similar order has been found, and the entry of the order can proceed. In situations where more than one duplicate or similar order has been identified, the identified existing orders could be color-coded depending on the degree of similarity. Similarly, the size of the font could be varied, with the largest font being used to display the closest similar order, and less similar orders can be displayed using a smaller, but still emphasized, font. The similar orders could also be sorted based on degree of confidence, and displayed in the sorted order, displayed with a numerical ranking, or displayed with a confidence factor rating. 
         [0054]    Various other types of visual indicators could also be used. For example, the duplicate orders could be highlighted by causing the corresponding orders to “blink” on and off. Icons can be used to identify duplicate and similar orders, and can be positioned adjacent the entries for analysis. The icons could also be used to provide selective access to information about the highlighted order, and information about why the highlighted order is considered to be similar to the new order entry. This information could be used by the medical practitioners to make a determination regarding whether to proceed with an order. 
         [0055]    In addition to visual highlighting, an audible warning could be used to indicate that a duplicate or similar entry has been identified. Again, the audible warnings could be varied depending on the degree of confidence that an order needs to be re-evaluated before entry, and range in intensity or volume depending on the correlation factor. 
         [0056]    Although a specific method and series of steps for identifying duplicate or similar orders has been described above, this method is exemplary. Various other methods can be also be used. For example, in some applications, such as the process described above with reference to  FIG. 8 , the processor can identify and highlight all of the orders of the same medical order type in the existing medical order section of the display without searching for an exact duplicate or similar order, and thereby allow the medical practitioner to evaluate all of the corresponding orders. In some applications, all orders having a similar spelling could be highlighted, and preferably sorted to the top of the screen, thereby allowing a medical practitioner to easily review the data for possible errors. 
         [0057]    Additionally, although the system is described as providing medical orders categorized in medical order types, the comparison could be made to each medical order rather than the medical order types. Various other methods of evaluating medically similar orders and methods for categorizing medical orders and medical order types can also be used. Further, although the medical practitioner enters the medical order into the system in the method described above, and the system automatically determines the medical order type, in alternate embodiments the medical practitioner could enter both the new medical order type and the new medical order. 
         [0058]    In some applications, the amount and type of feedback provided to the user can be varied based on, for example, the identity of the medical practitioner accessing the system. For example, selective access can be provided to the system using password protection, biometric data, RFID codes, barcodes, or other types of identification systems, and the amount of feedback provided could be varied based on the identity of the medical practitioner accessing the system. A first user could, for example, request that feedback be provided only when an exact duplicate is found. A second user could request that all similar orders be identified. A third user could request that all orders of the corresponding medical order type be highlighted. In some applications, a facility could implement a policy that various categories of employees be provided with selected types of feedback. For example, a facility could provide a certain level of feedback to all physicians, and a different level of feedback to physician assistants or nurse practitioners. 
         [0059]    Furthermore, although the duplicate identification process is described as controlled by processor  20  of computer  12 , it will be apparent to one of ordinary skill in the art that the process could be performed by other computer devices in the network as well. Additionally, although data entry is described by keyboard entry through a text box, it will be apparent that data can be entered using a pen-based system, through voice commands, through drop down boxes, by scanning data into the computer, or through other methods known to those of skill in the art. 
         [0060]    It should be understood that the methods and apparatuses described above are only exemplary and do not limit the scope of the invention, and that various modifications could be made by those skilled in the art that would fall under the scope of the invention. To apprise the public of the scope of this invention, the following claims are made: