Part 1 of a Series:
Solving the Med Wreck Challenge
Learning from communities making a difference...
Prescriptions can help you or harm you. Adverse drug events (ADEs) in the outpatient/ambulatory setting alone cost more than $76 billion annually in the U.S. Many Americans have suffered an ADE for themselves or a family member. Yet medication safety seems to get less attention today as we tackle other significant healthcare challenges. The free eBook, Med Wreck..., discusses the problem and calls for a "single source of truth" to combat the problem. This article discusses the first of three communities making a difference. This is just a small sample of clinicians and researches across North America tackling the problem of "med wreck."
Medication Harmony at Harvard
Dr. Frank Pandolfe states that as a hospitalist he has "first-hand experience with the struggles patients encounter managing their medications. Most patients do not have a system for keeping track of the medications they take or a way to coordinate that list among their many providers.
In the paper Medication Harmony: A framework to save time, improve accuracy and increase patient activation (reference below), Drs. Pandolfe, Bradley Crotty and Charles Safran remind readers of the importance of obtaining "the best possible medication history" as a foundational activity to reduce medication errors. They acknowledge "Medication managers through mobile applications and institution-based systems currently exist, however, under fractured infrastructure."
In their paper, they envision using health information exchanges (HIE) to retrieve multiple sources of patient-centered medication information, combining them into a "single source of truth (SSOT)." Then this "federated data" would be available to both physicians, hospitals, and the patients. This would greatly reduce the time needed to perform medication reconciliation and improve accuracy. Mobile access would encourage patients to engage in the process to help maintain quality of the data. Hopefully such applications would also strive to improve medication adherence.
Of course HIEs are limited to those physician offices, hospitals and pharmacies that are contributing data it. HIE participation does vary across the country. Thus Med Wreck... recommends we establish a more universal SSOT. However, the Medication Harmony... paper lays out a detailed proposal of how to use existing technology in our migration to a single source of truth.
"The process of collecting an accurate medication list from several sources such as, doctors’ offices, pharmacies and hospitals is a frustrating and time-consuming process. Many patients do not understand why they take particular medications. (We know) that errors on the home medication list on admission to the hospital can lead to adverse events while in the hospital and at home."
Dr. Pandolfe envisioned a framework he coined "medication harmony" and set out to design a new kind of medication list. The electronic medication manager is designed with patients in mind, encouraging them to take an active role in their medication management. It is also designed to be sharable with family members and other providers, so keeping an accurate medication list is not such an arduous task.
Harvard has put these principles to practice in an active study. The InfoSAGE study is connecting senior citizens and their family members into an online community. Information about their project can be found at the InfoSage website. Dr. Safran is the lead physician researcher overseeing the InfoSAGE study. We look forward to the results of the InfoSAGE study and the impact on improving medication management and adherence through family connections. Thus Harvard is one of the communities making a difference in tackling Med Wreck.
Dr. Pandolfe completed a fellowship in clinical informatics at Beth Israel Deaconess Medical Center in May of 2017 and has joined South Shore Health System as Physician Lead in informatics while he continues to practice clinical medicine.
Managing Meds in Montreal
Next time we will feature a recent study completed at McGill University as another example of communities making a difference to solve the Med Wreck problem.
Pandolfe F, Crotty BH, Safran C. Medication Harmony: A Framework to Save Time, Improve Accuracy and Increase Patient Activation. AMIA Annu Symp Proc. 2017 Feb 10;2016:1959-1966. eCollection 2016 [Abstract with link to Full Article]