leonie abbott, barwon health: how are electronic medication management systems communicating with...
DESCRIPTION
Leonie Abbott, NPDR Project Co-ordinator Barwon Health, VIC delivered this presentation at the 2013 Electronic Medication Management conference. It is Australia’s only conference to look solely at electronic prescribing and electronic medication management systems. For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/emedmanagementTRANSCRIPT
A Medication RepositoryThe MedView Pilot & NPDRLeonie Abbott
• 12 Federally funded PCEHR trial sites (Wave I and II)
• To develop, deploy and test eHealth infrastructure in a practical setting
• Fred IT Group was engaged to build a national medications repository
• MedView worked in partnership with 8 software vendors:
• Barwon Health was the only public organisation and hospital involved
MedView: The Pilot
MedView: The Pilot
• The Commonwealth Government provided funding for the development and implementation of MedView, as part of the National eHealth Program.
• The pilot was conducted over 12 months.
• Deployed March 2012 in the Barwon Region.
• Completed June 2012.
• At completion of the trial lessons learnt were shared with the Commonwealth.
What was MedView
The MedView pilot was a Medications Repository developed to demonstrate the ability of healthcare professionals to view consenting patient’s prescribed and dispensed medication information across hospital, community, and aged care settings.
To facilitate the sharing of, and access to more comprehensive and better quality medications information in a timely manner between health professionals and organisations.
• Reduce duplication
• Reduce system-wide inefficiency
• Reduced health risks
• Improved healthcare through more visible medication history
MedView Evaluation
• Monash University conducted an independent evaluation of the pilot.
• Triangulation was utilised through a combination of methods including interviews and surveys.
• Interviews included Barwon Health practitioners and pharmacists, community pharmacists, consumers and General practitioners.
• The pre-implementation phase involved qualitative interviews and a quantitative survey with end-users (pharmacists and doctors)
• The post-implementation phase employed qualitative interviews of end-users and consumers. Excluding GPs.
The next phase: NPDR
• Following pilot completion integration with the Personally Controlled Electronic Health Record (PCEHR) system began.
• This will be known as the National Prescription and Dispense Repository (NPDR)
• The Prescription and Dispense view is intended to be an electronic summary of the prescription and dispense record information contained in a consumers PCEHR.
Information Sources for MedView
MedView – The Systems Involved
Change Management
AWARENESS of the need for change
DESIRE to support the change
KNOWLEDGE on how to change
ABILITY to implement skills and behaviour
REINFORCEMENT to sustain the change
Change management - development
Evaluation
July 2011
Communications
Change management - deploy
Change – Implementation and Adoption
Change management - design
31 June
Detailed Business Impact Assessment
Validate High Level Business Impact
Assessment
Communication Plan
Training AssessmentStakeholder Matrix
Develop training and comms materials
Update &
review process
documents
Training
Change Readiness
/ Adjustment
• Changes / enhancements
to high level BIA
• Stakeholder matrix for
review by relevant areas
• Stake in the changes
• Agree with Stakeholders
• Changes, impacted users and
impacts to be compiled
• What, how, when,
where, who
• Reviewed by stakeholders
•Channels and activities
validated
• Socialise with key stakeholders
Detailed Training Plan
Training
March 2011
APPROACH
Due to the geographical expanse, different change management
strategies will be employed.
This creates value in the evaluation phase, by providing comparators
on the success of implementation, engagement and uptake.
• Intensive – hands on change management support
• Mixed – reduced hands-on change management support
• Remote – limited hands on change management support
Regions Involved
Target Site was the Barwon Region
This involved
• Pharmacies
• GPs
• Barwon Health
• One aged care facility
Additional Sites - 10% nationally
• Tasmania
• Brisbane South
• East Melbourne
Medication Activity Record
Medication Activity Record
Medication Profile
Easy Access through CIS
Prior to implementation: Current State
2–3 % of hospital admissions are medication related.
10% of patients attending GP experience adverse drug events.
Medication error rates are:
• high in elderly patients
• high during transfer of care between hospital and community
• estimated that 52 – 88% of transfer documents contain an
error
Monash Evaluation Reported
• Greater than 70% of GPs, hospital doctors and pharmacists
had difficulty accessing accurate medication information
Practitioner Perceived Benefits of MedView
Provide seamless continuity of care between healthcare settings
Reduced medication misadventure
Improve communication between healthcare professionals
Save time in obtaining a medication history
MedView was expected to be used for
• New patients
• After hours
• Emergency admissions
• Accessing hospital discharge information
Hospital pharmacists indicating they would be most frequent users
Pre-implementation attitudes
o GPs and community pharmacists saw most benefit in having
access to hospital discharge information.
o Prescribing and dispensing information was expected to be
useful in assessing adherence and facilitating patient
education.
o Central benefit of having accurate hospital prescribing and
discharge medication history
o Medication safety
o Facilitate decision making
Implementation Outcomes
Early adoption for Barwon Health - March 5th 2012
Community pharmacies had a rolling implementation
from 1st of April 2012
Within the Barwon region there were
• 43 community pharmacies
• 2 general practice sites
Significant issues with release of upgraded general
practice prescribing software within the time frame
Barwon Health Functionality (March 5th – June 30th)
Frequency
MedView Profiles with Hospital Prescriptions 7522
Prescribed items 34189
Dispensed items 34366
Hospital Doctors 200
Hospital Pharmacy Users 49
Views of MedView 697
Overall Project Functionality
Frequency
Total Number of MedView Records 196032
Number of Patients with a MedView Record 13173
Number of Pharmacies Uploading 192
Number of Doctors Uploading 225
Number of Prescribed items Uploaded 81002
Number of Dispense items uploaded 84263
Number of Views 1488
Number of consumers who withdrew consent 1
Post-implementation user attitudes
Interviews occurred 3-5 weeks following release of MedView
• GPs were excluded
• 38 consumers
Themes
• Generally user-friendly and easily accessible
• Majority perceived it to be beneficial
• Concerns regarding potential incompleteness of information.
• Perception by hospital doctors that the system wasn’t useful to them
• Some stated they had issues with the training offered
• Issues with misuse of information
Challenges
Change adoption throughout the region for a pilot
• Timeline making this difficult
Timing of training and communications
• Junior doctors new to Barwon Health
Co-operation between numerous private vendors and the constraints of a pilot project
Training time poor healthcare practitioners in a new concept
• understanding of MedView differed significantly.
Delays in vendor software release
Length of pilot
Ensuring interaction with CIS was going to display information in a clinically meaningful way
Issues Raised: Hospital Healthcare practitioners
MedView would still contain information that was out of date
• The healthcare practitioner still needed to use their own judgement
• Similar to lists now which quickly become out of date
• A repository is not a list
• More an event record
Incomplete
• No information from Melbourne specialists
• Handwritten prescriptions not included
• Not 100% of GPs and pharmacies involved
That the patient gives consent
Pharmacist Use of MedView
Hospital Pharmacist
A patient who had recently been discharged was readmitted used
MedView. This contained both the information from the prescribing CIS
and dispensing system.
Hospital Pharmacist
Found information on a patient’s MedView profile that the patient hadn’t
mentioned, which assisted in collating an accurate medicines reconciliation
record.
Community Pharmacist
Was able to “correct a medication error from the hospital”
and to check the dose of a medication.
In both examples the information was available on MedView.
Conclusion
Achieved objectives
Demonstrated that a repository could receive information from
• Community pharmacy
• General Practitioners
• Hospital prescribing and dispensing systems
Facilitated the sharing of health information across a broad range of providers.
Feedback indicated
• Access to this information is highly valuable
Questions