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This project investigated the feasibility and impact of novel approaches to clinical decision support in multidisciplinary ambulatory care, emphasizing high-risk transitions of care.
The project developed technology to support shared medication management for persons with chronic conditions. The health IT system, RxSafe, was used to facilitate clinician decisionmaking and improve outcomes for patients and providers in the management of chronic conditions.
Ultimately, the project aimed to show improvements in medication management by: 1 providing the means to effectively share medication information; 2 making any corrections or improvements made by one team member to the regimen visible to all team members; and 3 providing clinicians using the system with access to evidence-based information at the time and place it is needed.
This project is a collaboration between community-based nurses and physicians providing ambulatory services in an Oregon coastal community, a multidisciplinary team of university-based investigators with expertise in medicine, nursing, medical informatics, and computer science, and the Oregon Rural Practice-based Research Network, which provided the infrastructure, coordination, and support.
Clinical settings for the project were independent clinic practices in two coastal communities, local home health services, and transitions in care into and out of the sole community hospital and its emergency room.
The patient focus was on community-dwelling persons with chronic conditions on multiple medications.
The choice of these specific innovations was informed by experience with development and early deployment of RxSafe, a system that consolidates medication lists of patients in long-term care to integrate information for providers involved in prescribing, dispensing, administering, or monitoring medications.
The team configured these clients to interact through the versioning system SyncRx and explored the usefulness of this technology in prototype testing to determine the requirements and challenges to its development and deployment.
The team completed the "pipeline" prototype, demonstrating the Web-based clinical decision support model that would allow composition of independent medication information related services.
The demonstration included services for parsing, identification using RxNorm, and classification using the National Drug File Reference Terminology of medication information, and a software harness to allow composition of these and other medication management services.
The project was completed in August Impact and Findings: The project found that arrangement of information is important to clinicians and may be an important form of cognitive support.
Recall of medication list items corresponded to experience level, with attending physicians recalling a median of 14 of 20 medications overall, residents a median of Student recall was greater with an organized medication list, but resident and attending physician recall was not affected by order, which contrasted with the teams' expectation that the organization of medication information would improve recall yet found data to support this for novices only.
However, it may be that processing of the list by the clinician is the more important factor. Recall by experts was high in either case, but subjectively they reported it was easier to recall the list items when they had to reorganize the lists themselves.
Medication reconciliation may occur as an isolated procedure designed to document compliance with regulations.
However, medication management in long-term care was a richer, more robust, and more complex process, which is distributed, dynamic, collaborative, and continuous, involving multiple health professionals separately performing complementary tasks in different settings over time.
To address this issue, a cross-sector initiative, RxSafe Marin, has been established with the following goal: Marin County will reduce prescription drug misuse and abuse through measurable strategies and month action plans that address factors across the continuum.
Matt Willis. Opioids — either prescription medications or an illicit drug — present the most serious drug crisis the US has ever experienced.
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