Single Source of Truth Combats Med Wreck
Since publishing Med Wreck: Proposing a Solution for the Nightmare of Medication Reconciliation [(c)2017] I have been keeping my eye on the various efforts for using a single source of truth (SSOT) for combating Med Wreck. I introduced readers to the Medication Harmony at Harvard and the work by Drs. Frank Pandolfe, Charles Safran and their team in November 2017. They have updated their work in an August 2018 article published in the Journal of the American Medical Informatics Association (JAMIA).*
Combating Med Wreck: Recognizing the Patient Challenges
The authors summarize the various challenges that work against the patient and their healthcare team achieving a complete and accurate medication list:
- Multiple prescribers,
- Multiple pharmacies and medication sources,
- Frequent transitions of care (doctor visits, hospitalization, operations, ED visits, home and etc.)
- Tracking potential side effects of prescribed medications,
- Retaining and sharing knowledge of past medication adverse effects,
- Disconnect between what has been prescribed, who prescribed it, and for what indication(s),
- Confusion between Trade and generic names,
- Dosing information, frequency and other administration instructions (e.g. before food, after food, do not crush, etc.), and
- Patient adherence to the medication management plan.
All these factors, combined with the sheer number and complexities of modern medications, make it very difficult for physicians, providers and pharmacists to have a true and accurate medication list when making treatment decisions, adjustments and other interventions. It is difficult to perform medication reconciliation without the foundation of an accurate med list. Thus we remain in environments that run counter to medication safety - a state of "Med Wreck."
Combating Med Wreck: Solving the Data Challenges
The authors' vision of "Medication Harmony" states that:
"the complete and accurate medication list is available at all times to all the appropriate people, and involves patient-centered medication list management with the ability for synchronization across providers."*
That state four fundamental tenets in the design and development of a solution:
- Data federation
- Patient activation*
Ultimately, combating Med Wreck comes down to a common core principle - establishing a central, interactive and up-to-date medication list that serves as the "single source of truth."
Combating Med Wreck: Leveraging Existing Platforms and Nomenclatures
The team has built and piloted a medication management platform both on the web and as a mobile application - InfoSAGE. They have leveraged the following data sources in their development:
- RxNorm (which includes interactions)
- The Dietary Supplement Label Database (DSLD)
- The National Drug File - Reference Terminology (NDF-RT)
- The Consumer Health Vocabulary (CHV)
The U.S. government supports these platforms and provide them as a free source to users. The authors themselves are supported by a grant through the Agency for Healthcare Research and Quality (AHRQ) in addition to a National Library of Medicine training grant.
Combating Med Wreck is in our Sights
Those interested in overcoming the medication safety challenges of our population should read the abstract linked below and consider reading the full JAMIA article.* Our current state of Med Wreck is costing lives through unnecessary complications, disabilities and even death... from failing to address the problem.
We encourage every American to ensure that they have a complete and accurate medication list. We also encourage you to read the free Med Wreck e-book available only through our secure store at HealthITAccelerator.com.
*Pandolfe F, Wright A, Slack WV, Safran C, Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation, J Am Med Inform Assoc. 2018 Aug 1;25(8):1027-1053. Abstract available on PubMed.gov