Statistics in healthcare newer cease to amaze me. Unfortunately in a negative way. According to the Institute of Medicine’s Preventing Medication Errors report, the average hospitalized patient is subject to at least one medication error per day. This confirms previous research findings that medication errors represent the most common patient safety error. And to make matters worse research also shows that most of the errors are preventable. *1
So how come most hospitals around the world are not using electronic medication management systems?
As I am talking and working with clinicians, nurses and pharmacists from different care providers in Slovenia, UK and other countries I was surprised that they all welcome the rich feature set of our medication management system, but they never really shared the same level of enthusiasm with me. For me and my team it is a 6 year project and endless hours spent shadowing care teams to first learn about all the different scenarios around medication management and then even more hours spent brainstorming and developing a comprehensive and easy to use medication management system. But for care teams all the scenarios and modules our product supports are self-evident and in current paper world already available - so nothing really new for them, hence no enthusiasm.
So I was caught in exactly the same situation that I described in my previous blog post. We “just" developed a comprehensive medication management system with all scenarios that paper world already fully covers. Anyone who tried to develop a medication management system would of-course recognise the complexity and hard work that went into developing such a solution. But to clinicians it is obvious that if they are to start using the electronic version of medication management all these scenarios should be readily available and covered in full. They do appreciate that with electronic medication management the process becomes safer and a lot of medication related errors are prevented, however, at the same time they expect that the product offers all features that are not possible in the paper version. And it is these features that currently represent their actual pain in the process of medication management:
- Smart clinical decision support at the time of prescribing (interactions, contra indications, dietary warnings, lactation, pregnancy, …) that properly tackles alert fatigue,
- Support for complex calculations based on patients body weight or body surface,
- Support to prevent the “never events” such as: Overdose of Methotrexate for non cancer treatment, Wrong dose for Warfarin, “Mis-Selections” of medications and others,
- Warnings to prevent overdose with paracetamol at the time of prescribing and/or administration,
- Allergy warnings,
- Collaboration and Task lists,
- Seamless integration with EHR and Pharmacy systems.
However, If you want care teams to actually embrace the medication management system and really start using it on a daily basis, even with all the smart features and fancy decision support, the product has to cover all use cases they currently do on the paper. Because unless you can fully support care teams workflows in electronic form it really makes no sense to move to the electronic version because there will still be paper prescription orders on the wards for unsupported scenarios. And mixed such medication management process is even more dangerous and error prone than the paper-only version.
By now it should be obvious that mediation management is far from easy and although there are many ePrescribing solutions available most of them do not really support the breadth and depth of the process and are not solving the right pain points. Although it is absolutely clear to clinicians, nurses and pharmacists that most medication errors could be prevented with a proper e-system in place it is the role of IT, domain experts and designers to work together and develop a solution that will make the transition to an electronic medication management system as easy as possible and in return make the care process safer.