Module 6, electronic medication management records

Question 1

What have electronic patient records?

Answer 1

• patient centered clinical decision making & care coordination
  
  • connectivity, integration, interoperability
  • access to more complete data, reducing fragmentation of care
• efficiency; evolution towards paperless systems with ubiquitous access
• cost saving (eventually): huge investment, but ultiately reduced duplication (or over-servicing), prevention of under servicing and more timely care
• data security, despite privacy concerns and hacking threats
• capacity for ‘big data’ research via data linkage between patient records and medicare date, hospitalisations, PBS data, disabilities services etc

Question 2

What is MHR?

Answer 2

• a secure online summary of an individuals health info, available to all Australians from birth to death
• accessible to authorised healthcare providers to view and add to
• supplements existing health records with a high value, shared source of patient info that can improve care planning & decision making

Question 3

What are some potential uses of the MHR at different stages of life?

Answer 3

• antenatal records
• health checks, immunisations
• mental health
• allergy checks
• prescribed medicines (any age)
• diagnostic & monitoring results
• advance care directives
• discharge summaries; medical info integrated between hospital and GP

Question 4

What are some limitations of the MHR?

Answer 4

• incomplete/ inadequate quality of data
  
  • cant tell if patient has hidden any history
  • time required to build a usable volume of data for a complete picture of the patient–> need a critical mass of contents to make the MHR attractive & comprehensive enough to use, yet this relies on practitioners to build up this critical mass
  • “obligations relating to uploading of records, the allocation of liability between the parties, and the processes for notifying key events & changes”
  • media reports of GPs seeking legal advice about liability for incomplete and inaccurate data in a patients MHR

Question 5

What are some limitations of the MHR?
-integration with other systems

Answer 5

• integration with other systems
  
  • sits externally to most dispensing software, requiring switching of platforms and login to MHR, cf true integration
  • once exceptions is dispense works, designed from the ‘ground up’ for full integration with the MHR
  • –> MHR data are automatically analysed using artifical intelligence and MIMS, compared to the records in the dispensing software, and anomalies are highlighted to the pharmacist e.g. triple whammy drug interactions, new discharge prescriptions, dose changes
• patients may view lab test results uploaded before their next GP appointment
• need for integration with dispensing workflow, especially if technicians enter data and alerts are raised
• additional administrative tasks on burdned health professionals- largely clerical documentation, impeding workflow and communication with the patient
• requires standardised terminilogy and coding of medicines
• information transfer does not constitute communication and vice versa

Question 6

What are some limitations of the MHR?
-privacy concerns

Answer 6

• privacy concerns
  
  • access to MHR is data logged, so ensure only authorised access for the purposes of direct patient care (patients can receive SMS or email notifications of each access)
  • patients may sue for breaches $126k for individuals and $630k for bodies corporate
  • pharmacies need a protocol/ procedure relating to security and access for MHR and other patient data
  • close patient files after use
  • check privacy if accessing in the front shop or semi private counselling booth

Question 7

What is teh pharmacists role in the use of My Health Record?

Answer 7

• obtain timely access to valuable clinical information and to patient- entered information
• reduce time spent gathering information from multiple sources–> more complete picture
• provide tailored advice based on relevant and recent info
• enhance delivery of MedsChecks, HMR, RMMR, QUM, medication reconciliation
• improve continuity of care

Question 8

Describe the principles of electronic medication management systems in hospital pharmacy…

Answer 8

• BOSSnet
• it integrates with the pharmacy management system and supports PBS prescribing, while enabling information quality
• similar appearance to National Inpatient Medication Chart
• faciliatates investigation of incidents and system failures using root cause analysis, why-because and cause-and-effect analysis

Question 9

What are some challenges of use with EMM- electronic medication management systems?

Answer 9

• need for constant switchig between screens or tabs–> fragmented cognitive images of a ptient case cf single tangible chart
• potential inflexibility in charting medication
  
  • one dose of a day already administered before discontinution- can this be appropriately recorded?
  • delays in med administration due to late delivery from pharmacy
  • can urgent medication orders be administered and documented before the medicine is charted in the system
• need for workarounds e.g. temporary text storage, copy and paste
• management of missing or wrongly entered date
• user identity/ access
• approach to alerts
• workflow in hybrid paper/ electronic environments e.g. medication orders on paper charts but electronic alerts
• perceived imapct on time available for patient care
• errors in data entry and retrieval
• juxtaposition errors
• communication & coordination process
• “data quality is about more than fixing data errors”- need a culture of continuous quality improvement

Question 10

Risk management

Answer 10