Electronic Medication Management Research Articles

Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020.

This multicentre, retrospective medical record audit evaluated opioid analgesia prescribing within a Victorian metropolitan public hospital network. The study included all surgical patients discharged between January 2012 and December 2020 with one or more discharge prescriptions from three metropolitan hospitals (n = 117,989). The main outcome measures were mean oral morphine equivalent daily dose (OMEDD), mean number of opioid types and proportion of patients prescribed one or more slow-release opioids on discharge.Total opioid prescribing (mean OMEDD) peaked in 2013. Between 2017 and 2020 there was a trend towards prescribing fewer opioids on discharge. Over the study period, there was decreasing prescription of codeine and increasing prescription of oxycodone and tapentadol. The proportion of patients prescribed slow-release opioids increased in the earlier years of the study, reaching a peak of 20.6% in 2017. Since 2017 there has been a rapid reduction in the prescription of slow-release opioids.Subanalysis was undertaken to evaluate key changes in the opioid prescribing landscape in the health network. The removal of default opioid pack sizes in the electronic medication management system (December 2014) and the release of the Faculty of Pain Medicine-Australian and New Zealand College of Anaesthetists' statement regarding the use of opioid analgesics in patients with chronic non-cancer pain (March 2018) were associated with significant reductions in mean OMEDD prescribed on discharge (136 mg vs 122 mg and 120 mg vs 85.4 mg, respectively, P < 0.001).In conclusion, the quantity of opioids prescribed on discharge in this patient group peaked in 2013 and has been decreasing since.

Electronic Medical Records Management and Administration: Current Trends, Issues, Solutions, and Future Directions

Electronic Medical Records Management and Administration: Current Trends, Issues, Solutions, and Future Directions

An Analysis of Incident Reports Related to Electronic Medication Management: How They Change Over Time.

Electronic medication management (EMM) systems have been shown to introduce new patient safety risks that were not possible, or unlikely to occur, with the use of paper charts. Our aim was to examine the factors that contribute to EMM-related incidents and how these incidents change over time with ongoing EMM use. Incidents reported at 3 hospitals between January 1, 2010, and December 31, 2019, were extracted using a keyword search and then screened to identify EMM-related reports. Data contained in EMM-related incident reports were then classified as unsafe acts made by users and the latent conditions contributing to each incident. In our sample, 444 incident reports were determined to be EMM related. Commission errors were the most frequent unsafe act reported by users (n = 298), whereas workarounds were reported in only 13 reports. User latent conditions (n = 207) were described in the highest number of incident reports, followed by conditions related to the organization (n = 200) and EMM design (n = 184). Over time, user unfamiliarity with the system remained a key contributor to reported incidents. Although fewer articles to electronic transfer errors were reported over time, incident reports related to the transfer of information between different computerized systems increased as hospitals adopted more clinical information systems. Electronic medication management-related incidents continue to occur years after EMM implementation and are driven by design, user, and organizational conditions. Although factors contribute to reported incidents in varying degrees over time, some factors are persistent and highlight the importance of continuously improving the EMM system and its use.

Drug-Drug Interactions and Actual Harm to Hospitalized Patients: A Multicentre Study Examining the Prevalence Pre- and Post-Electronic Medication System Implementation.

Drug-drug interactions (DDIs) have potential to cause patient harm, including lowering therapeutic efficacy. This study aimed to (i) determine the prevalence of potential DDIs (pDDIs); clinically relevant DDIs (cDDIs), that is, DDIs that could lead to patient harm, taking into account a patient's individual clinical profile, drug effects and severity of potential harmful outcome; and subsequent actual harm among hospitalized patients and (ii) examine the impact of transitioning from paper-based medication charts to electronic medication management (eMM) on DDIs and patient harms. This was a secondary analysis of the control arm of a controlled pre-post study. Patients were randomly selected from three Australian hospitals. Retrospective chart review was conducted before and after the implementation of an eMM system, without accompanying clinical decision support alerts for DDIs. Harm was assessed by an expert panel. Of 1186 patient admissions, 70.1% (n = 831) experienced a pDDI, 42.6% (n = 505) a cDDI and 0.9% (n = 11) an actual harm in hospital. Of 15,860 pDDIs identified, 27.0% (n = 4285) were classified as cDDIs. The median number of pDDIs and cDDIs per 10 drugs were 6 [interquartile range (IQR) 2-13] and 0 (IQR 0-2), respectively. In cases where a cDDI was identified, both drugs were 44% less likely to be co-administered following eMM (adjusted odds ratio 0.56, 95% confidence interval 0.46-0.73). Although most patients experienced a pDDI during their hospital stay, less than one-third of pDDIs were clinically relevant. The low prevalence of harm identified raises questions about the value of incorporating DDI decision support into systems given the potential negative impacts of DDI alerts.

Risk Factors Associated with Medication Administration Errors in Children: A Prospective Direct Observational Study of Paediatric Inpatients.

Limited evidence exists regarding medication administration errors (MAEs) on general paediatric wards or associated risk factors exists. The aim of this study was to identify nurse, medication, and work-environment factors associated with MAEs among paediatric inpatients. This was a prospective, direct observational study of 298 nurses in a paediatric referral hospital in Sydney, Australia. Trained observers recorded details of 5137 doses prepared and administered to 1530 children between 07:00h and 22:00h on weekdays and weekends. Observation data were compared with medication charts to identify errors. Clinical errors, potential severity and actual harm were assessed. Nurse characteristics (e.g. age, sex, experience), medication type (route, high-risk medications, use of solvent/diluent), and work variables (e.g. time of administration, weekday/weekend, use of an electronic medication management system [eMM], presence of a parent/carer) were collected. Multivariable models assessed MAE risk factors for any error, errors by route, potentially serious errors, and errors involving high-risk medication or causing actual harm. Errors occurred in 37.0% (n=1899; 95% confidence interval [CI] 35.7-38.3) of administrations, 25.8% (n=489; 95% CI 23.8-27.9) of which were rated as potentially serious. Intravenous infusions and injections had high error rates (64.7% [n=514], 95% CI 61.3-68.0; and 77.4% [n=188], 95% CI 71.7-82.2, respectively). For intravenous injections, 59.7% (95% CI 53.4-65.6) had potentially serious errors. No nurse characteristics were associated with MAEs. Intravenous route, early morning and weekend administrations, patient age ≥ 11 years, oral medications requiring solvents/diluents and eMM use were all significant risk factors. MAEs causing actual harm were 45% lower using an eMM compared with paper charts. Medication error prevention strategies should target intravenous administrations and not neglect older children in hospital. Attention to nurses' work environments, including improved design and integration of medication technologies, is warranted.

A Digitally Enabled, Pharmacist service to detecT medicine harms in residential aged care (nursing home) (ADEPT): protocol for a feasibility study

IntroductionThis feasibility study aims to develop and test a new model of practice in Australia using digital technologies to enable pharmacists to monitor early signs and symptoms of medicine-induced harms...

Professional Ethics, Challenges and Opportunities for Blockchain Technology in Healthcare Sector: A Systematic Review

Background:: The healthcare sector faces numerous issues, such as insurance fraud, electronic medical record management, interoperability, insecure dissemination of information, etc. The novel Blockchain technology holds tremendous potential to transform the healthcare sector by addressing these rising challenges in the industry. It provides a secure platform for storing, disseminating, and retrieving sensitive patient data and health records while preserving the ethical principles of the healthcare sector. Method:: In this study, we systematically reviewed the literature on blockchain technology in healthcare using PRISMA and highlighted how blockchain technology might promote innovation and deliver major improvements in the healthcare sector. Result:: Our goal is to examine the present status of this discipline, focusing on limits and potential advances. Queries were used to gather Scopus, PubMed, SpringerLink, IEEE Xplore, and Web of Science publications that met the criteria for the selection of papers. Conclusion:: This article, thus, analyses the potential for blockchain in the healthcare industry and outlines blockchain-based products in healthcare. Our study enhances and complements prior healthcare blockchain research.

The Impact of Health Informatics on Radiologist, Laboratory Technician, Pharmacist-Physician Collaboration, and Patient Outcomes

Health informatics has revolutionized the way healthcare professionals collaborate and deliver care, with significant implications for patient outcomes. This abstract explores the impact of health informatics on the collaboration between radiologists, laboratory technicians, pharmacists, and physicians, and its influence on patient outcomes. The abstract provides an overview of the role of health informatics in facilitating communication, information sharing, and decision-making among these healthcare professionals. It also discusses the potential benefits and challenges associated with integration of health informatics in collaborative care, and highlight the importance of leveraging technology to improve patient safety, treatment efficacy, and overall healthcare quality. The review concludes that, the professions of radiologists, laboratory technicians, chemists, doctors, and patient outcomes have all been significantly impacted by health informatics. Healthcare practitioners are now able to make better decisions thanks to the increased efficiency and accuracy of diagnostic imaging and laboratory tests brought about by the integration of technology and data management systems. Electronic prescribing and medication management systems have improved collaboration between chemists and doctors, guaranteeing safe and efficient pharmaceutical use. The application of health informatics has also helped patients receive more individualized care, better communication, and access to health information. All things considered, the use of health informatics has changed the way that healthcare is delivered and may continue to enhance patient outcomes in the future.

Evaluating the Impact of a Tailored Electronic Medication Management System on Anemia Management in Outpatient Hemodialysis Patients

Evaluating the Impact of a Tailored Electronic Medication Management System on Anemia Management in Outpatient Hemodialysis Patients

Outpatients satisfaction and perceptions toward pharmaceutical services in public and private hospitals in Palestine: a cross-sectional study

BackgroundPharmaceutical care is an essential component of healthcare services, and patient satisfaction with these services is crucial for improving overall health outcomes. We aimed to evaluate patient satisfaction and perception with pharmaceutical care services provided at public and private hospitals for outpatient pharmacies. This study can provide insights into the quality of pharmaceutical services provided in both settings and identify areas for improvement.Materials and methodsA cross-sectional 1-month study was conducted in three hospitals in Nablus city in the Northern District of West Bank, Palestine. Participants were a convenience sample of outpatients who attended the study-selected hospitals (two public and one private). A sample of 30 patients from each hospital was selected with a total of 90 patients. A self-administered questionnaire was used to assess socio-demographics pharmacist-related issues, waiting and working time, and medication availability.ResultsA total of 90 patients were recruited. The overall level of patient satisfaction with pharmaceutical health services was moderate with a mean of 3.24 out of 5. Females represented 58.9%. The most prevalent age was (30–39) years (30%). There was a statistically significant difference in patient satisfaction with pharmaceutical services regarding working time between the morning and evening shifts (p value = 0.009) in favor of morning shift. No statistically significant differences in satisfaction with pharmaceutical treatments based on socio-demographics (age, gender, marital status, education level, family income, employment status, and living place), were found. Nearly, 70% of patients indicated having problems getting the medicine on their last visit to the hospital pharmacy. Only 66.7% of patients expressed satisfaction with the pharmacies’ operating (working) hours.ConclusionsPatient satisfaction with pharmaceutical care services could be enhanced by involving pharmacists in patient-oriented training and informing patients about the role of pharmacists. Patient satisfaction in the evening shift might be improved by establishing a system for continuous evaluation and improvement of pharmaceutical care services in hospitals to ensure the highest quality of care for patients in addition to implementing technology such as electronic prescribing and medication management systems that can improve the accuracy and efficiency of pharmaceutical services in hospitals.

A Systematic Research of The Internet Hospital in China: Breakthroughs and Challenges in the Development of Internet Hospital under the Influence of COVID-19

In the age of advanced digital technology, the traditional medical industry is gradually expanding its Inter-net medical business. Internet hospitals are gradually coming to the public. Internet Healthcare refers to a new type of medical and health service industry that uses the Internet and information technology to collaborate with traditional healthcare. Its main functions include remote diagnosis, online e-prescription, online medicine purchase, home delivery of medicines, medical condition tracking, patient electronic medical record formation management and disease management, etc. Because the Internet hospital is still in the initial stage of development, many functions are not available, and many relevant regulations are not detailed enough. However, the covid-19 outbreak has to some extent driven the sudden progress of Internet hospitals. This article analyzes the progress and breakthroughs made by Internet hospitals during the outbreak and the development prospects of Internet hospitals in the post-pandemic era in a macroscopic manner through known data and reports. In addition, this article analyzes the problems that Internet hospitals may encounter, and more importantly, this article will suggest corresponding solutions. Ultimately, this article concludes that Internet hospitals have good prospects for development, which will not be possible without technological breakthroughs, government policy support, user perceptions, and Internet hospitals innovation.

Closed-Loop Medication Management with an Electronic Health Record System in U.S. and Finnish Hospitals.

Many medication errors in the hospital setting are due to manual, error-prone processes in the medication management system. Closed-loop Electronic Medication Management Systems (EMMSs) use technology to prevent medication errors by replacing manual steps with automated, electronic ones. As Finnish Helsinki University Hospital (HUS) establishes its first closed-loop EMMS with the new Epic-based Electronic Health Record system (APOTTI), it is helpful to consider the history of a more mature system: that of the United States. The U.S. approach evolved over time under unique policy, economic, and legal circumstances. Closed-loop EMMSs have arrived in many U.S. hospital locations, with myriad market-by-market manifestations typical of the U.S. healthcare system. This review describes and compares U.S. and Finnish hospitals' EMMS approaches and their impact on medication workflows and safety. Specifically, commonalities and nuanced differences in closed-loop EMMSs are explored from the perspectives of the care/nursing unit and hospital pharmacy operations perspectives. As the technologies are now fully implemented and destined for evolution in both countries, perhaps closed-loop EMMSs can be a topic of continued collaboration between the two countries. This review can also be used for benchmarking in other countries developing closed-loop EMMSs.

Electronic Medical Record Management in Monitoring Loan and Return of Medical Records at Majalaya Hospital

This study aims to develop an electronic-based governance system for monitoring borrowing and returning medical record files at Majalaya Hospital. The Waterfall method was chosen as the main approach because the detailed and structured nature of this method allows planned and scheduled development. This approach also guarantees the quality of the resulting system, as each phase is completed in stages, avoiding over-reliance on a single stage. System development documentation is well organized, where each phase must be completed comprehensively before the next step can be carried out. One of the problems identified related to borrowing medical record files is the absence of an expedition book to record borrowing and returning. The existence of this expedition book is critical in monitoring the distribution of medical record files. Therefore, the authors designed a management system in accordance with the procedures for borrowing and returning medical record files. This system is expected to be able to efficiently monitor the distribution of medical records and organize borrowing and return processes more smoothly. With the existence of an effective monitoring mechanism, it is hoped that it can reduce potential problems that may occur when borrowing and returning medical records, even being able to deal with them proactively

Complexity: Tending to the Medication-Related Needs of Older People.

The solutions to reduce the prevalence of medication-related harm in aged care are just as multifaceted as those that can be used in other industries where processes are complicated and complex. Designing safe systems is a key element of these efforts, with factors such as automation, electronic medication management systems, and the emergence of artificial intelligence all supplementing other aspects of safe health delivery such as appropriate environmental design and safe staffing levels. Nevertheless, as any experienced health practitioner will readily confirm, there is both art and science involved in the processes of safely delivering care for patients, particularly people of advanced age.

A repeated cross-sectional study on the implementation of electronic medication management system

Many IS studies focus on initial user perceptions as drivers of initial IS success, but these perceptions may change over time. This study aims to examine whether there is any difference in the drivers of IS success between the initial adoption and the initial assimilation stages. With the Expectation Confirmation Model as the theoretical lens, a repeated cross-sectional study was conducted regarding clinicians’ perceptions of the implementation of electronic medication management systems (eMMS) in an Australian hospital, one at the time of implementation and another one at one year after the implementation. The results indicated that the means of perceived usefulness, perceived ease of use, social influence, clinician satisfaction, and organizational benefits are significantly higher in the initial assimilation stage than in the initial adoption stage, which means that expectations have been positively confirmed in the initial assimilation stage. More importantly, while perceived usefulness and social influence remain important one year after the implementation, perceived ease of use and facilitating conditions are moving toward a decrease in importance to the success of eMMS. This study provides a better understanding of how the importance of the factors influencing eMMS success changes over time.

Abstract 2068: MCAP Explore: A self-service data exploration and cohort building tool for oncologists

Abstract The goal of the described work was to create a self-service tool for data exploration and cohort creation, facilitating feasibility assessments for research studies and providing insights into the primary clinical and demographic characteristics of the Moffitt patient population. The Moffitt Cancer Analytics Platform (MCAP) was designed to enable seamless end-to-end data lifecycle management, promote data democratization, and reduce data duplication by feeding diverse, typically siloed local data streams into a central data repository. Eight distinct sources including the Moffitt electronic medical record, cancer registry, billing systems and clinical trial management system feed into an Amazon S3-based data lake. Raw data are cleaned, standardized for research use, and stored in the enterprise data warehouse in Snowflake. To date, over 80 distinct tables and 2,200 data elements are captured, representing over 500,000 patients. To provide transparency into these data assets, Moffitt partnered with phData to create a custom tool for data self-service, MCAP Explore. Built on the Sigma cloud analytic platform, Explore is a highly customized interactive workbook that allows the user to filter the total patient population on a broad range of clinical and demographic characteristics to identify cohorts of interest, with applications ranging from research study feasibility assessments to operational oversight of the composition of the patient population and where disparities may exist in disease characteristics, treatment or outcomes. In addition, the user is able to view a broad range of visualizations summarizing the resulting cohort and deep-dive into the specific records available. The features that distinguish Explore from similar tools include: a) the broad range of data domains covered by the available filters (demographics, diagnoses, appointments, labs/vitals, treatment, study enrollment/consent, patient-reported, biospecimens, molecular); b) the ability to apply any number of filters in an arbitrary order, on data that is both one-to-one and many-to-one with the patient, while maintaining important linkages between record types; c) full customization of the product for our oncology-specific use cases, facilitating transparency into the underlying data model and flexibility for future expansion; d) no data being required to leave the Moffitt environment, and de-identification processes governed at an institutional level and applied within Snowflake being automatically inherited within Explore by connection to our institutional Active Directory accounts and Snowflake user roles. We will present detailed examples of tool functionality and describe the underlying data model and design decisions required to accommodate a broad range of complex oncology-specific use cases. In addition, we will present early usage metrics and next steps for expansion into new data domains including imaging. Citation Format: Rachel Howard, Phillip Reisman, Patricia Lewis, Rodrigo Carvajal, Chandan Challa, Mark Ruesink, Joe McFarren, Katrina Johnson, Mukund Sridhar, Kedar Kulkarni, Dana E. Rollison. MCAP Explore: A self-service data exploration and cohort building tool for oncologists [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2068.

Dampak Era Society 5.0 Terhadap Kompetensi Perekam Medis dan Informasi Kesehatan (PMIK)

The era of society 5.0 creates new challenges in various sectors of life, one of which is the health sector. Health development is directed at realizing optimal health degrees. To achieve this goal, it is necessary to manage various resources so that efficient, quality, and affordable health services can be available. At this point, a quality medical recorder is needed. In the era of society 5.0 every individual must have knowledge and skills. This relates to the PMIK competency field at number 2, namely Self-Introspection and Self-Development. The influence of the era of society 5.0 on PMIK's competence has led to changes and improvements in knowledge that require PMIK to be able to develop, apply and use technology, one example of its use is Electronic Medical Records (RME) and Hospital Management Information Systems (SIMRS). The purpose of this study was to determine the influence and relationship of the era of society 5.0 on PMIK competence. This study uses a qualitative data interpretation method. This type of method is used to analyze data in qualitative research or also called categorical data. The subject of this research is PMIK and the object is PMIK competence in the era of society 5.0. The potential result of applying the influence of the era of society 5.0 to PMIK competence is a change in competence in line with the demands of the times. This change led to renewal of competencies taught to PMIK candidates.

The electronic medical record management systems may improve monitoring and control of disease activity in patients with ankylosing spondylitis

To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. The number of annual outpatient visits increased after ASDAS assessment (4.0 (4.0, 7.0) vs. 4.0 (4.0, 8.0), p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (6.4 (8.5, 11.2) vs. 6.3 (8.3, 10.8) min, p = 0.073), especially among patients whose with an inactive disease activity was < 1.3 (ASDAS C-reactive protein (CRP) 6.7 (8.8, 11.1) vs. 6.1 (8.0, 10.3) min, p = 0.033; ASDAS erythrocyte sedimentation rate (ESR) 6.4 (8.7, 11.1) vs. 6.1 (8.1, 10.0) min, p = 0.027). Among patients who received at least three ASDAS assessments, the third ASDAS-CRP tended to be lower than the first (1.5 (0.9, 2.1) vs. 1.4 (0.8, 1.9), p = 0.058). The use of an EMRMS increased the frequency of ambulatory visits among AS patients with high and very high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS.

Missed Opportunities to Diagnose and Treat Tertiary Hyperparathyroidism After Transplant

IntroductionTertiary hyperparathyroidism (3HPT) is common after renal transplant. However, guidelines for diagnosis are not clear and few patients are treated surgically. This study aims to determine rates of diagnosis and treatment of 3HPT in renal transplant patients with hypercalcemia. Materials and methodsThis retrospective chart review identified all renal transplant recipients at a single tertiary care institution between 2011 and 2021. Patients with post-transplant hypercalcemia (> 10.2 mg/dL) were identified. The time in months of index hypercalcemia was noted. Measurement of parathyroid hormone (PTH) levels after index hypercalcemia was determined and noted as elevated if > 64 pg/mL at least 6 mo after transplant. Documentation of symptoms of hyperparathyroidism, a diagnosis of hyperparathyroidism in the electronic medical record, and medical or surgical management of patients with classic 3HPT (elevated calcium and PTH) were determined. ResultsOf 383 renal transplant recipients, hypercalcemia was identified in 132 patients. The majority of hypercalcemic patients had PTH levels measured (127, 96.2%). PTH was elevated in 109 (82.6%). Among the 109 patients with classic 3HPT, 54 (49.5%) had a documented diagnosis of hyperparathyroidism in the electronic medical record (P = 0.01). Kidney stones or abnormal DEXA scan were present in 16 (14.7%) and 18 (16.5%), respectively. Most patients were managed non-surgically (101, 92.6%); calcimimetics were prescribed for 42 (38.5%, P = 0.01). Eight (7.3%) patients with classic 3HPT were referred to a surgeon (P = 0.35); all were initially prescribed calcimimetics (P = 0.001). Conclusions3HPT is underdiagnosed in patients with elevated calcium and PTH levels post-transplant. A significant percentage of these patients go without surgical referral and curative treatment.

Formulary & benefit and real-time pharmacy Benefit: Electronic standards delivering value to prescribers and pharmacists

The use of standard transactions in the electronic sharing of prescription-related information among payers, prescribers and pharmacists aids in the delivery of effective, safe, and affordable medication therapy to patients. Integral to electronic medication management (eMM) in this environment is the availability of data to aid in the determination of the most appropriate medication for a patient considering benefits coverage restrictions, therapeutic effectiveness, and cost. Key elements of this formulary decision support are the National Council for Prescription Drug Programs Formulary & Benefit (F&B) standard and the related Real-time Pharmacy Benefit (RTPB) standard. In this article, we review the foundational role of F&B in the electronic prescribing of medications, the value it delivers to prescribers, and dispensing pharmacists. The combination of F&B and RTPB to enhance the quality of information available in eMM is also discussed with evidence presented on how these standards help to minimize manual tasks and rework in the pharmacy, optimize time to therapy, lower patient out-of-pocket costs, and result in the dispensing of prescriptions less likely to be abandoned. We conclude with a view of the future of F&B to support new eMM requirements.