Why Health or Medicine 2.0?

“At The Deloitte Center, you will find even more details about the web usage of health consumers. Yes, there will be much more patients who seek health-related information on the web and who want to communicate with their doctors via e-mail or Skype.”
Article
Bertalan Meskó, ScienceRoll, 14 July 2008

CRF: Patient Compliance Triples with e-Diaries

“Electronic patient diaries, relative to the paper variety, improve patient compliance by a factor of three, according to research recently released by Waltham, MA-based CRF Inc. The finding emerged from a review of clinical trials involving more than 30,000 subjects across 23 different indications from 42 countries.”
Article
Deborah Borfitz, BIO-IT World, 7 July 2008

e-Medication History?

Announced yesterday: Groundbreaking E-Medication History Pilot Program to Improve Patient Safety:

“The impressive and valuable part of this program is that when patients check into a hospital or emergency room their medication histories will be known in real time,” said Doctor Richard Popiel, Vice President & Chief Medical Officer, Horizon BCBSNJ. “Physicians will have immediate access to medications the patient is currently taking or may have taken in the past. This will make hospital visits safer, more efficient and reduce the chance of adverse drug reactions to medications administered to patients. The program will be 100% private and secure.”
The program will be administered through RcopiaAC MedHx by DrFirst which connects to the largest and most comprehensive medication history data sources available in the market. RcopiaAC collects, displays, and documents patient medication history information at the time of admission and connects directly to hospitals taking part in the program. When a patient is admitted into the hospital, RcopiaAC will send an electronic medical history request to multiple sources including RxHub, Surescripts, DrFirst’s nationwide network of Rcopia e-prescribing users, and DrFirst’s EMR Open Borders partners. When medication history information is found, it will be submitted back to the hospital. The system will be completely automated and the information will be relayed in real time.

It took my breath away and for a number of reasons. First of all because of the false security this offers. Only data from associated partners will be used and only when e-prescribed. So all other medication history is not included, nor are over-the-counter drugs.

But in all my innocence I believed that one of the major goals of creating EHRs was to establish these kinds of overviews and histories. So why develop this new technology?

And why call it “groundbreaking”?  Because of the fact that the software searches various sources, from what I understand. But as I have said time and again, that should be the essence of an EHR.

Lodewijk Bos

Building an inter-organizational communication network and challenges for preserving interoperability

“Abstract
Background: The ideal scenario for information technology to bridge information gaps between primary and secondary healthcare and to improve the quality of healthcare in the medication process is to build an interoperable communication network. This type of undertaking requires diverse information systems to be integrated, and central to this are the preservation of data integrity and the integration of different pieces of patient data.
Objectives and methodology: In this study, we focused on sources of challenges to the integration process and to the building of an interoperable communication network. Interviews, document analysis, and observations were conducted to evaluate the integration process in a project that involved medication data communication between primary healthcare providers (i.e., general practitioners and community pharmacists) and secondary healthcare providers (i.e., hospital pharmacists and specialist physicians).
Results: The project encountered numerous integration problems, many of which persisted even after extensive technical intervention. An analysis of the problems revealed that they were mostly rooted either in problematic integration of work processes or in the way the system was used. Despite the project’s ideal technical condition, the integration could be accomplished only by applying human interfaces.
Conclusion: The main challenge to building interoperable communication network does not lie in technical integration. The real problem occurs when the technical linkage is implemented without the work processes being aligned and integrated.”
Abstract
H. Pirnejad, R. Bal and M. Berg, International Journal of Medical Informatics, In Press, Corrected Proof, Available online 25 June 2008, doi:10.1016/j.ijmedinf.2008.05.001

Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety

Abstract:
We develop a typology of clinicians’ workarounds when using barcoded medication administration (BCMA) systems. We then identify the causes and possible consequences of each workaround. BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic medication administration records. Ideally, BCMAs help confirm the “five-rights of medication administration:” right patient, drug, dose, route, and time. BCMAs are reported to reduce medication administration errors-the least likely medication error to be intercepted–although these claims have not been clearly demonstrated. We studied BCMA use at five hospitals by: 1-observing and shadowing nurses using BCMAs at two hospitals; 2-interviewing staff and hospital leaders at five hospitals; 3-participating in BCMA staff meetings; 4-participating in one hospital’s failure-mode-and-effects analyses; 5-analyzing BCMA override log data. We identified 15 types of workarounds, including, for example, affixing patient-ID-barcodes to computer carts, scanners, doorjambs, or nurses’ belt-rings; carrying several patients’ pre-scanned medications on carts. We identified 31 types of causes of workarounds, such as, unreadable medication-barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient-ID-wristbands (chewed, soaked, missing); non-barcoded-medications; failing batteries; uncertain wireless connectivity; emergencies. We found nurses overrode BCMA-alerts for 4.2% of patients charted and for 10.3% of medications charted. Consequences of the workarounds include administration of wrong medications, doses, times, and formulations. Shortcomings in BCMAs’ design, implementation and workflow integration encourage workarounds. Integrating BCMAs within real-world clinical workflows requires attention to use in situ to ensure safety features correct use.
Article
Ross Koppel, Tosha Wetterneck, Joel Leon Telles, and Ben-Tzion Karsh, Journal of the American Medical Informatics Association, April 24, 2008 as JAMIA PrePrint; doi:10.1197/jamia.M2616

Trans-Atlantic data harmonization in the classification of medicines and dietary supplements: A challenge for epidemiologic study and clinical research

“Objectives
As international scientific collaboration increases, there is a growing requirement for research data to be comparable among countries. Despite the importance of medication and dietary supplement data in research, there are no international standards for the collection and storage of these data. In the absence of such standards, we needed to adopt a strategy for classification and coding of medications and dietary supplements to meet demands of our multi-national study.
Methods
Given the inter-country variations in nomenclature that characterize prescription, over-the-counter (OTC) medications, traditional herbal medicines, and dietary supplements, we adopted RxNorm as a data standard for medication data, and developed an independent system that extends this standard and allows for flexible and scalable data collection for dietary supplements.
Results
RxNorm was implemented in May 2005 and as of July 2006, coverage has been 99%, at the level of active ingredients, of all the medications reported in our study. Development of a dietary supplement database began in August 2005, and has thus far coded some 1200 dietary supplements and 650 infant formula products and forms from the four countries in our study.
Conclusion
The methods we have used to collect, store, and manage medication and dietary supplement data serve as interim solutions until international standards are developed. It is hoped that such standards will ultimately emerge, and that our strategy and data model will be of value in other research environments in the immediate future.”
Article
Susan Moyers, Rachel Richesson and Jeffrey Krischer, International Journal of Medical Informatics
Volume 77, Issue 1, January 2008, Pages 58-67, doi:10.1016/j.ijmedinf.2006.12.003