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A. Motulsky

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  • OS23 - Labs, Drugs and Rock & Roll (ID 42)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 2
      • Abstract
      • Slides

      Purpose/Objectives: Since 2013, Quebec is operating a centralized e-prescribing network allowing for the electronic transmission of prescriptions between prescribers and pharmacies in primary care. The objective of this study is to describe the system, its utilization and the experience of users.

      Methodology/Approach: Longitudinal analysis of usage data between Jan 2016 and April 2017 was performed. Interviews and observation sessions were conducted with frequent users on the prescriber side and the pharmacy - the receiver - side to compare usage patterns and experience of users with different commercial systems (2 EMR systems and 4 PMS). E-prescribing strings were analyzed from the receiver side to determine the quality of data being transmitted electronically.

      Finding/Results: The e-prescribing network is a centralized pull model providing for a paperless process. So far, only the patients are outside the loop. They are still receiving a paper copy of the prescription when it is electronically sent to the central warehouse. Pharmacists have to wait for the paper copy of the prescription to retrieve it from the warehouse. No alert is sent to their system when a new prescription is available for one of their patient. In April 2017, more than 2 800 prescribers were using the system (while at least 5 000 could technically do it with their EMR). Of all the e-prescriptions sent, only 16% were retrieved electronically in pharmacies (Table 1, Figure 1). The experience of users was heterogeneous depending on the commercial system they were using. In pharmacies, the most problematic feature was the absence of a view of the original e-prescription to be able to compare with what the local PMS was generating. All e-prescribing strings needed to be manually corrected in the PMS to be dispensed. The main factor influencing the completeness of the e-prescribing string was the pharmaceutical form of the medication (solid oral forms, creams, inhalers, drops, etc.). The fields with the most frequent corrections were the “instruction” field, followed by the quantity, the duration, and the prescriber ID. Table 1. Number of prescribers, prescriptions and retrieved up to April 2017 Details n(%) Number of prescribers (in the month) 2 851 Number of e-prescriptions sent (cumulative) 10 703 194 Number of prescriptions retrieved (cumulative) 1 767 138 (16%) Figure 1. Cumulative number of electronic prescriptions sent and retrieved through the e-prescribing network by month

      Conclusion/Implications/Recommendations: For the promises of e-prescribing to be realized, additional work is needed to improve the standardization of interoperable data exchanged between EMR and PMS.

      140 Character Summary: This study analyzed utilization and experience of users with the e-prescribing network implemented in Quebec since 2013.

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    • OS23.05 - Development and Adoption of an Electronic Medication Reconciliation Tool: RightRx (ID 56)

      A. Motulsky, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, University of Montreal; Montreal/CA

      • Abstract

      Purpose/Objectives: To improve patient safety, medication reconciliation is required at admission, transfer, and discharge for hospital accreditation in several countries. Medication reconciliation is expected to improve patient safety by preventing inadvertent discrepancies between community and hospital medications that lead to medication errors, and avoidable morbidity. However, the process is resource-intensive, resulting in poor adherence. We developed an e-medication reconciliation application (RightRx), and report on the impact of using population- and hospital-based drug information systems to pre-populate and align community and hospital drug lists and thus reduce workloads and enhance adoption and completion of medication reconciliation.

      Methodology/Approach: We developed a web-based e-medical-reconciliation software and are evaluating it in a cluster-randomized trial at an academic hospital network. We used agile development processes and user-centered design to develop features aimed at enhancing adoption, safety, and efficiency. We implemented RightRx in medical and surgical wards, where field staff and unit champions provided training and support. Using data retrieved from provincial health administrative databases, RightRx pre-populates the patient’s community drug list with all drugs dispensed in the 3 months preceding admission as well as all drugs dispensed, stopped, or placed on hold during hospitalization. The two lists are aligned, sorted by pharmacologic class, and displayed to physicians to enable reconciliation at admission, transfer, and discharge. Physicians reconcile and review the lists to generate the discharge prescription, which displays all changes, additions, and discontinuations, along with the reasons for those changes. Rates of medication reconciliation completion rates were measured using chart review and data retrieved from the RightRx application in the intervention and control units. In the intervention unit we also measured the time professionals spent using the application. figure.gif

      Finding/Results: User feedback identified required adjustments to RightRx, including addition of dose-based prescribing, clarification of discharging physicians’ roles in prescribing community-based medication, and providing access to the clinical reasoning behind medication decisions made during hospitalization. In intervention units, pharmacists and physicians were involved in reconciliation at discharge for 71.9% and 96.1% of patients, respectively. Pharmacists spent a mean time of 10.9 min (SD 10.9 min) per RightRx session, compared to 5.8 min (SD 7.8 min) spent by physicians. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in intervention units, and 0.7% (surgery) to 82.7% (medicine) of patients in control units. After adjusting for differences in patient characteristics, the odds of medication reconciliation completion were 9 times higher in intervention versus control units (OR 9.0, 95% CI 7.4-10.9).

      Conclusion/Implications/Recommendations: Automated prepopulation and alignment of community and hospital medication lists helped achieve high medication reconciliation completion rates.

      140 Character Summary: Right-Rx increased the efficiency and completion rate of medication reconciliation by automating the retrieval and alignment of community and hospital drug data.

  • PS06 - Digital Health Engagement Through Benefits and Data (ID 45)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Panel Session
    • Track: Executive
    • Presentations: 1
    • PS06.01 - Connected Health Information in Canada: A Benefits Evaluation Study (ID 611)

      A. Motulsky, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, University of Montreal; Montreal/CA

      • Abstract
      • Slides

      Purpose/Objectives: Effective, timely sharing of patient health information among care providers is central to quality of care. Important progress has been made in the implementation, adoption, and use of electronic systems that are connecting health care providers with the information they need to provide care. In Canada, jurisdictions have created connected health information through interoperable electronic health records (iEHRs) which provide access to drug, lab, diagnostic imaging, immunization information, as well as clinical reports from multiple care settings. The objective of this panel is to discuss how connected health information is transforming health care in Canada. More specifically panel members will discuss: 1) the current landscape of connected health information; 2) impact of connected health information against expected benefits; 3) jurisdictional experiences with use and optimization of systems; and 4) how to sustain and spread the value of connected health information to transform healthcare.

      Methodology/Approach: In 2017, Canada Health Infoway undertook a study to understand the adoption, use and impact of connected health information across Canada. This study, based on national clinician studies, project research and evaluation, valued the effects of the foundational iEHR infrastructure as accessed through different point of care solutions in different care settings. Panelists will address a number of key activities that were undertaken as part of the study: measurement of the adoption of the iEHR; assessment of the benefits accruing from connected health information through review of available evidence; and key informant interviews with provincial/territorial stakeholders to understand the current and future use of connected health information nationwide.

      Finding/Results: The pan-Canadian Study on Connected Health Information calculated benefits accruing to health care system stakeholders (patients, providers, health system). Benefits substantiated by evidence include reducing duplication of lab and diagnostic imaging tests, enhancing timeliness of care, more effective ambulatory care and emergency department interactions, optimizing scope of practice for clinicians and improving equity in care through the availability of health information. Financially quantifiable benefits were driven by improvements in clinician and clinical practice productivity; avoided health system utilization due to improved patient safety; reduced patient time and expense, and reduced duplication of diagnostic tests. Equally as important but difficult to quantify are benefits related to improved access to information for clinicians. A majority of clinicians now have access to connected patient information either through integrated point-of-care systems or through separate web-based viewers. In some jurisdictions integrated iEHR viewers are available where clinicians are accessing connected patient information through a single solution such as their main clinical record system. Over 300,000 health care providers across Canada are currently accessing the iEHR through one of these methods, compared to 170,000 two years ago.

      Conclusion/Implications/Recommendations: Panelists will provide clinical and health system leadership perspectives on what has contributed to the impact seen to date and how health leaders can move forward to sustain, spread and achieve further value through the use of iEHRs. Discussion will focus on priority focus areas such as interoperability, advanced functionalities that enable e-referral, e-consults, and the use of the foundational iEHR infrastructure to support patient portals and analytics.

      140 Character Summary: Connected health information is transforming care in Canada. More than 300,000 health care professionals and their patients are realizing widespread benefits.

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