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E-Patient Update: The Smart Medication Management Portal

Posted on December 16, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As I work to stay on top of my mix of chronic conditions, one thing that stands out to me is that providers expect me to do most of my own medication tracking and management. What I mean by this is that their relationship to my med regimen is fairly static, with important pieces of the puzzle shared between multiple providers. Ultimately, there’s little coordination between prescribers unless I make it happen.

I’ve actually had to warn doctors about interactions between my medications, even when those interactions are fairly well-known and just a Google search away online. And in other cases, specialists have only asked about medications relevant to their treatment plan and gotten impatient when I tried to provide the entire list of prescriptions.

Sure, my primary care provider has collected the complete list of my meds, and even gets a updates when I’ve been prescribed a new drug elsewhere. But given the complexity of my medical needs, I would prefer to talk with her about how all of the various medications are working for me and why I need them, something that rarely if ever fits into our short meeting time.

Regardless of who’s responsible, this is a huge problem. Patients like me are being sent with some general drug information, a pat on the back, and if we experience side effects or are taking meds incorrectly we may not even know it.

So at this point you’re thinking, “Okay, genius, what would YOU do differently?” And that’s a fair question. So here’s what I’d like to see happen when doctors prescribe medications.

First, let’s skip over the issue of what it might take to integrate medication records across all providers’s HIT systems. Instead, let’s create a portal — aggregating all the medication records for all the pharmacies in a given ZIP Code — and allow anyone with a valid provider number and password to log in and review it.  The same site could run basic analytics examining interactions between drugs from all providers. (By the way, I’m familiar with Surescripts, which is addressing some of these gaps, but I’m envisioning a non-proprietary shared resource.)

Rather than serving as strictly a database, the site would include a rules engine which runs predictive analyses on what a patient’s next steps should be, given their entire regimen, then generate recommendations specific to that patient. If any of these were particularly important, the recommendations could be pushed to the provider (or if administrative, to staff members) by email or text.

These recommendations, which could range from reminding the patient to refill a critical drug to warning the clinician if an outside prescription interacts with their existing regimen. Smart analytics tools might even be able to predict whether a patient is doing well or poorly by what drugs have been added to their regimen, given the drug family and dosage.

Of course, these functions should ultimately be integrated into the physicians’ EMRs, but at first, hospitals and clinics could start by creating an interface to the portal and linking it to their EMR. Eventually, if this approach worked, one would hope that EMR vendors would start to integrate such capabilities into their platform.

Now I imagine there could be holes in these ideas and I realize how challenging it is to get disparate health systems and providers to work together. But what I do know is that patients like myself get far too little guidance on how to manage meds effectively, when to complain about problems and how to best advocate for ourselves when doctors whip out the prescription pad. And while I don’t think my overworked PCP can solve the problem on her own, I believe it may be possible to improve med management outcomes using smart automation.

Bottom line, I doubt anything will change here unless we create an HIT solution to the problem. After all, given how little time they have already, I don’t see clinicians spending a lot more time on meds. Until then, I’m stuck relying on obsessive research via Dr. Google, brief chats with my frantic retail pharmacist and instincts honed over time. So wish me luck!

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 71-75

Posted on August 5, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the second entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

75. Find out how easy it is to do process improvement
This could be phrased another way. How much with the EMR you’re considering improve your processes and how much will the EMR cause you to change your EMR processes for the worse? I love when EMR vendors like to say that they’re EMR makes it so the clinic doesn’t have to change their processes. It makes me laugh, because just the fact that you have to enter something electronically instead of on paper means you’re changing something. Even if the doctor still writes on paper and scans it in, that means they’ve changed their process since now they have to scan it and view the documents in a scanned format.

The point obviously being that any and every EHR implementation requires change. The question you should consider is how many of the changes will improve your clinic and how many of the changes will cause heartache. I’d guess that every EHR vendor will have quite a few of both types of change.

74. Predictive analytics are a huge benefit
I’ll let Shawn’s words speak for themselves on this one: “Everyone wants to know what volumes are going to like like next year. How many encounters will I have? How many admissions? If the analytics are built straight into the EMR you will have a much easier time trying to estimate the costs and resources necessary for the upcoming years. This improves your ability to do strategic planning, and should lower your costs from 3rd party applications or consultants.”

73. Automatic trending with graphing is a huge help
As they say, a picture is worth a thousand words. It’s amazing the impact a graph can have on seeing trends. This is true if the graph is about an individual patient or across all your patients. Look for EHR vendors that do a good job capturing the trends you want to watch as a doctor.

72. Evaluate process flows that come directly from the application
This relates to EMR tip #75 above. Many process flows in an EHR are flexible, but other things are hard coded and can’t be changed. Make sure the hard coded EHR processes are ones that you can live with before you sign your EHR contract. If you can’t see any hard coded processes in the EHR you’re evaluating, you probably haven’t looked hard enough or in the right places.

71. Are we integrating or interfacing
This topic is particularly important in the hospital setting where you always have multiple systems running. How well you integrate or interface those systems matters a lot. Plus, every EHR vendor has different abilities to integrate or interface. Be aware of what’s possible and more importantly the limitations of those integrations or interfaces.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.