"We need data to understand what was happening behind the prescribing process. Things can be similar in different countries but still are different enough for us to need additional insight to understand and address them," said Better Meds Product Lead Božidarka Radović at the Talking Healthtech Winter Summit, which took place in August.
At the last Winter Talking HealthTech Summit - an Australian one-day online conference, Melissa Fodera, Chief Pharmacy Informatics Officer (CPIO) Western Health Australia, Božidarka Radović, Better Meds Product Lead at the health IT company Better and Gidi Stein, CEO of MedAware highlighted the challenges that still need to be overcome to improve medication safety.
The complexity of the hospital
Medication management doesn’t end with a doctor typing a prescription into a computer. A clinical pharmacist needs to review what was prescribed and if the right drugs in the right dose are chosen for a specific patient. Sometimes, laboratory results need to be checked before prescribing a drug, and hospitals use pharmacy robots and digitised ward cabinets to prevent errors at the point of dispensing. In essence, a large number of hospital systems are involved in medication management.
The highest safety standard for medication management is the so-called closed-loop medication management, which is achieved when each part of the medication journey is digitalised. It is also what Melissa Fodera sees as the most impactful needed change in improving medication safety.
Western Health is the major healthcare provider covering a population of 900,000 people. It provides a comprehensive, integrated range of clinical services at all levels of care and is highly digitised. However, some parts of medication still run on paper, and electronic prescribing is not paperless, said Melissa Fodera. Digital transformation is still in progress.
Any digital transformation manager of a hospital or vendor trying to enter the hospital IT space needs to understand processes from various perspectives emphasised Božidarka Radović. The hospital team and end users need to know what is reasonable to expect from electronic prescribing and medication administration systems (ePMA). For one thing, ePMA is only one part of a larger puzzle. The vendor and the hospital need to have an implementation team that prepares a detailed implementation plan, which starts with a gap analysis. The third important aspect is customisation and localisation. “Even though roughly 80% of the processes are pretty similar everywhere, 20% usually have local specifics,” said Božidarka Radović.
While the futuristic ideas of healthcare innovation expect patients to receive tailor-made, highly precise treatment recommendations upon hospital admission and during a hospital stay, technology is not there yet. When clinical decision support gives a wrong alert a few times, users lose trust in them. “My residents accept 15 to 20 patients at night, each having 10 to 15 medications. The sheer number of patients makes it almost impossible for a clinician or a pharmacist or a nurse or a physician to actually really dive deep and understand the patient's situation, the different medications that they're taking, and the different risks that are imposed on these medications,” said Gidi Stein, CEO of MedAware, an Israeli based startup trying to refine the number of alerts by taking into account information in the patient’s electronic record and lab results. However, if a hospital uses several systems from different providers, which are not integrated, those recommendations can’t be made.
Next step improvement require a paradigm shift in software design and a focus on patient engagement
“I've seen medication errors where the alert of a clinical decision support system didn't fire, when it should have, and an incidence occurred for something that was rarely prescribed. Alerts need to be very specific to be useful, but the flip side, if you only capture such a small group of alerts, there are also the times when you need it and it may not fire,” Melissa Fodder added to the debate about improvements in medication-related decision support systems.
For Gidi Stein, the spotlight needs to turn to patients. “I think the next frontier is finding technology to empower patients and caregivers, to be more involved in their medication management and be more proactively involved in the safety of their own treatment,” he concluded the panel.
From the product development side, Božidarka Radović sees improvements in software design as the next big change in the evolution of medication management software. “I would point to two things: data and modularity. We need data to understand what was happening behind the prescribing process. What, when, and why it happened. Things can be similar in different countries but still are different enough for us to need additional insight to understand and address them. The second thing is modularity - meaning that we create a piece of a puzzle for the improvement of each process.”
Listen to the conversation at the podcast below.