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Bergman F, Hammar T. Healthcare professionals' perceptions of a web-based application for using the new National Medication List in Sweden. Digit Health 2023; 9:20552076231171966. [PMID: 37188079 PMCID: PMC10176565 DOI: 10.1177/20552076231171966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Objective During the first stage of implementing the National Medication List in Sweden, a web-based application called Förskrivningskollen (FK) was launched. FK includes information about a patient's prescribed and dispensed medications, and it works as a backup system until the healthcare electronic health record (EHR) systems are fully integrated. The aim of this study was to examine the healthcare professionals' experiences and perceptions of FK. Methods The study applied a mixed methods approach, with statistics about the use of FK and a survey with open and closed questions. The respondents (n = 288) were healthcare professionals who were users or potential users of FK. Results Overall there was little knowledge about FK and uncertainty regarding working routines and the regulations connected to the application. Lack of interoperability with the EHRs made FK time-consuming to use. Respondents said that the information in FK was not updated, and they were concerned that using FK could lead to a false sense of security about the accuracy of the list. Most clinical pharmacists thought FK added benefit to their clinical work, while as a group, physicians were more ambivalent about FK's benefit. Conclusions The concerns of healthcare professionals give important insights for future implementation of shared medication lists. Working routines and regulations linked to FK need to be clarified. In Sweden, the potential value of a national shared medication list will probably not be realized until it is fully integrated into the EHR in a way that supports healthcare professionals' desired ways of working.
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Affiliation(s)
- Frida Bergman
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Tora Hammar
- eHealth Institute, Department of
Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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2
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Austria's Digital Vaccination Registry: Stakeholder Views and Implications for Governance. Vaccines (Basel) 2021; 9:vaccines9121495. [PMID: 34960241 PMCID: PMC8706289 DOI: 10.3390/vaccines9121495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/20/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
In this study, we explore the recent setup of a digital vaccination record in Austria. Working from a social-scientific perspective, we find that the introduction of the electronic vaccination pass was substantially accelerated by the COVID-19 pandemic. Our interviews with key stakeholders (n = 16) indicated that three main factors drove this acceleration. The pandemic (1) sidelined historical conflicts regarding data ownership and invoked a shared sense of the value of data, (2) accentuated the need for enhanced administrative efficiency in an institutionally fragmented system, and (3) helped invoke the national vaccination registry as an indispensable infrastructure for public health governance with the potential to innovate its healthcare system in the long term.
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Waldron C, Cahill J, Cromie S, Delaney T, Kennelly SP, Pevnick JM, Grimes T. Personal Electronic Records of Medications (PERMs) for medication reconciliation at care transitions: a rapid realist review. BMC Med Inform Decis Mak 2021; 21:307. [PMID: 34732176 PMCID: PMC8565006 DOI: 10.1186/s12911-021-01659-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background Medication reconciliation (MedRec), a process to reduce medication error at care transitions, is labour- and resource-intensive and time-consuming. Use of Personal Electronic Records of Medications (PERMs) in health information systems to support MedRec have proven challenging. Relatively little is known about the design, use or implementation of PERMs at care transitions that impacts on MedRec in the ‘real world’. To respond to this gap in knowledge we undertook a rapid realist review (RRR). The aim was to develop theories to explain how, why, when, where and for whom PERMs are designed, implemented or used in practice at care transitions that impacts on MedRec. Methodology We used realist methodology and undertook the RRR between August 2020 and February 2021. We collaborated with experts in the field to identify key themes. Articles were sourced from four databases (Pubmed, Embase, CINAHL Complete and OpenGrey) to contribute to the theory development. Quality assessment, screening and data extraction using NVivo was completed. Contexts, mechanisms and outcomes configurations were identified and synthesised. The experts considered these theories for relevance and practicality and suggested refinements. Results Ten provisional theories were identified from 19 articles. Some theories relate to the design (T2 Inclusive design, T3 PERMs complement existing good processes, T7 Interoperability), some relate to the implementation (T5 Tailored training, T9 Positive impact of legislation or governance), some relate to use (T6 Support and on-demand training) and others relate iteratively to all stages of the process (T1 Engage stakeholders, T4 Build trust, T8 Resource investment, T10 Patients as users of PERMs). Conclusions This RRR has allowed additional valuable data to be extracted from existing primary research, with minimal resources, that may impact positively on future developments in this area. The theories are interdependent to a greater or lesser extent; several or all of the theories may need to be in play to collectively impact on the design, implementation or use of PERMs for MedRec at care transitions. These theories should now be incorporated into an intervention and evaluated to further test their validity. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01659-8.
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Affiliation(s)
- Catherine Waldron
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Joan Cahill
- Centre for Innovative Human Systems & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sam Cromie
- Centre for Innovative Human Systems & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Tim Delaney
- Pharmacy Department, Tallaght University Hospital, Dublin, Ireland
| | - Sean P Kennelly
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | | | - Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
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4
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Bugnon B, Geissbuhler A, Bischoff T, Bonnabry P, von Plessen C. Improving Primary Care Medication Processes by Using Shared Electronic Medication Plans in Switzerland: Lessons Learned From a Participatory Action Research Study. JMIR Form Res 2021; 5:e22319. [PMID: 33410753 PMCID: PMC7819781 DOI: 10.2196/22319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/23/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022] Open
Abstract
Background Several countries have launched health information technology (HIT) systems for shared electronic medication plans. These systems enable patients and health care professionals to use and manage a common list of current medications across sectors and settings. Shared electronic medication plans have great potential to improve medication management and patient safety, but their integration into complex medication-related processes has proven difficult, and there is little scientific evidence to guide their implementation. Objective The objective of this paper is to summarize lessons learned from primary care professionals involved in a pioneering pilot project in Switzerland for the systemwide implementation of shared electronic medication plans. We collected experiences, assessed the influences of the local context, and analyzed underlying mechanisms influencing the implementation. Methods In this formative action research study, we followed 5 clusters of health care professionals during 6 months. The clusters represented rural and urban primary care settings. A total of 18 health care professionals (primary care physicians, pharmacists, and nurses) used the pilot version of a shared electronic medication plan on a secure web platform, the precursor of Switzerland’s electronic patient record infrastructure. We undertook 3 group interviews with each of the 5 clusters, analyzed the content longitudinally and across clusters, and summarized it into lessons learned. Results Participants considered medication plan management, digitalized or not, a core element of good clinical practice. Requirements for the successful implementation of a shared electronic medication plan were the integration into and simplification of clinical routines. Participants underlined the importance of an enabling setting with designated reference professionals and regular high-quality interactions with patients. Such a setting should foster trusting relationships and nurture a culture of safety and data privacy. For participants, the HIT was a necessary but insufficient building block toward better interprofessional communication, especially in transitions. Despite oral and written information, the availability of shared electronic medication plans did not generate spontaneous demand from patients or foster more engagement in their medication management. The variable settings illustrated the diversity of medication management and the need for local adaptations. Conclusions The results of our study present a unique and comprehensive description of the sociotechnical challenges of implementing shared electronic medication plans in primary care. The shared ownership among multiple stakeholders is a core challenge for implementers. No single stakeholder can build and maintain a safe, usable HIT system with up-to-date medication information. Buy-in from all involved health care professionals is necessary for consistent medication reconciliation along the entire care pathway. Implementers must balance the need to change clinical processes to achieve improvements with the need to integrate the shared electronic medication plan into existing routines to facilitate adoption. The lack of patient involvement warrants further study.
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Affiliation(s)
- Benjamin Bugnon
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Direction Générale de la Santé, État de Vaud, Lausanne, Switzerland
| | - Antoine Geissbuhler
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Thomas Bischoff
- Direction Générale de la Santé, État de Vaud, Lausanne, Switzerland
| | - Pascal Bonnabry
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Christian von Plessen
- Direction Générale de la Santé, État de Vaud, Lausanne, Switzerland.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland
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Rice DD, Abramovitch K, Olson GW, Christiansen EL. Data management practices of cone beam computed tomography volumes: An exploratory user survey. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e100-e107. [DOI: 10.1016/j.oooo.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 12/20/2018] [Accepted: 04/10/2019] [Indexed: 10/27/2022]
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Liu MC, Lee CC. An Investigation of Pharmacists' Acceptance of NHI-PharmaCloud in Taiwan. J Med Syst 2018; 42:213. [PMID: 30264375 DOI: 10.1007/s10916-018-1017-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
Abstract
Taiwan's National Health Insurance (NHI) is one of the most successful insurance programs in the world. The National Health Insurance Administration (NHIA) established the NHI-PharmaCloud as a platform to reduce medication duplication and other medication errors among the NHI-contracted facilities. The NHI-PharmaCloud can help pharmacists access patient medication information from the preceding 3 months to improve drug safety. The use of NHI-PharmaCloud can improve the quality of healthcare, but improvements cannot occur if pharmacists are unwilling to use the platform. Therefore, the main objective of our study is to investigate the factors affecting pharmacists' adoption of the NHI-PharmaCloud. This study develops a research model using theories of technology adoption, self-efficacy, and perceived risk and uses randomly distributed survey questionnaires to collect data from local pharmacists. The results show that self-efficacy, perceived usefulness, and perceived psychological risk are 3 critical factors that could affect pharmacists' willingness to use the NHI-PharmaCloud. The research results may also help NHIA to effectively promote the usage of the NHI-PharmaCloud in Taiwan. In addition, governments in other countries may refer to the results of this study when implementing their own PharmaCloud-type systems to improve drug safety.
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Affiliation(s)
- Meng-Chi Liu
- National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan
| | - Ching-Chang Lee
- National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan.
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Assessment of Health Information Technology Interventions in Evidence-Based Medicine: A Systematic Review by Adopting a Methodological Evaluation Framework. Healthcare (Basel) 2018; 6:healthcare6030109. [PMID: 30200307 PMCID: PMC6165327 DOI: 10.3390/healthcare6030109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The application of Health Information Technologies (HITs) can be an effective way to advance medical research and health services provision. The two-fold objective of this work is to: (i) identify and review state-of-the-art HITs that facilitate the aims of evidence-based medicine and (ii) propose a methodology for HIT assessment. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Furthermore, we consolidated existing knowledge in the field and proposed a Synthesis Framework for the Assessment of Health Information Technology (SF/HIT) in order to evaluate the joint use of Randomized Controlled Trials (RCTs) along with HITs in the field of evidence-based medicine. RESULTS 55 articles met the inclusion criteria and refer to 51 (RCTs) published between 2008 and 2016. Significant improvements in healthcare through the use of HITs were observed in the findings of 31 out of 51 trials-60.8%. We also confirmed that RCTs are valuable tools for assessing the effectiveness, acceptability, safety, privacy, appropriateness, satisfaction, performance, usefulness and adherence. CONCLUSIONS To improve health service delivery, RCTs apply and exhibit formalization by providing measurable outputs. Towards this direction, we propose the SF/HIT as a framework which may help researchers to carry out appropriate evaluations and extend their studies.
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The impact of a medication record sharing program among diabetes patients under a single-payer system: The role of inquiry rate. Int J Med Inform 2018; 116:18-23. [PMID: 29887231 DOI: 10.1016/j.ijmedinf.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/14/2018] [Accepted: 05/18/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Taiwan's single health insurer introduced a medication record exchange platform, the PharmaCloud program, in 2013. This study aimed to evaluate the effects of the medication record inquiry rate on medication duplication among patients with diabetes. MATERIALS AND METHODS A retrospective pre-post design with a comparison group was conducted using nationwide health insurance claim data of diabetic patients from 2013 to 2014. Patients whose medication record inquiry rate fell within the upper 25th percentile were classified as the high-inquiry group, and the others as the low-inquiry group. The dependent variables were the likelihood of receiving duplicated medication and the overlapped medication days of the study subjects. Generalized estimation equations with difference-in-difference analysis were calculated to examine the net effect of the PharmaCloud inquiry rate for a matched sub-sample. RESULTS In total, 106,508 patients with diabetes were randomly selected. From 2013 to 2014, the medication duplication rate was reduced 7.76 percentile (54.12%-46.36%) for the high-inquiry group and 9.58 percentile (63.72%-54.14%) for the low-inquiry group; the average medication overlap periods were shortened 4.36 days (8.49-4.13) and 6.29 days (11.28-4.99), respectively. The regression models showed patients in the high-inquiry group were more likely to receive duplicated medication (OR = 1.11, 95% C.I. = 1.07-1.16) and with longer overlapped days (7.53%, P = 0.0081) after the program. CONCLUSION The medication record sharing program has reduced medication duplication among diabetes patients. However, higher inquiry rate did not lead to greater reduction in medication duplication; the overall effect might be due to enhanced internal control via prescription alert system in hospitals rather physician's review of the records.
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9
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Motulsky A, Weir DL, Couture I, Sicotte C, Gagnon MP, Buckeridge DL, Tamblyn R. Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada. J Am Med Inform Assoc 2018; 25:722-729. [PMID: 29590350 DOI: 10.1093/jamia/ocy015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
Objective (1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE. Methods A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process. Results There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list. Conclusions Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.
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Affiliation(s)
- Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada
| | - Daniala L Weir
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | | | - Claude Sicotte
- Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.,Healthcare organization management host team (EA7348 MOS - Management des organisations de santé - Healthcare Organization Management), EHESP - École des hautes études en santé publique, France
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
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Christopoulou SC, Kotsilieris T, Anagnostopoulos I. Evidence-based health and clinical informatics: a systematic review on randomized controlled trials. HEALTH AND TECHNOLOGY 2018. [DOI: 10.1007/s12553-016-0170-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Elysee G, Herrin J, Horwitz LI. An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities. Medicine (Baltimore) 2017; 96:e8274. [PMID: 29019898 PMCID: PMC5662321 DOI: 10.1097/md.0000000000008274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. Against this backdrop, we assessed the relationships between the 3 capabilities.We conducted an observational study applying partial least squares-structural equation modeling technique to 27 variables obtained from the 2013 American Hospital Association annual survey Information Technology (IT) supplement, which describes health IT capabilities.We included 1330 hospitals. In confirmatory factor analysis, out of the 27 variables, 15 achieved loading values greater than 0.548 at P < .001, as such were validated as the building blocks of the 3 capabilities. Subsequent path analysis showed a significant, positive, and cyclic relationship between the capabilities, in that decreases in the hospitals' adoption of one would lead to decreases in the adoption of the others.These results show that capability for high quality medication reconciliation may be impeded by lagging adoption of interoperability and health information exchange capabilities. Policies focused on improving one or more of these capabilities may have ancillary benefits.
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Affiliation(s)
- Gerald Elysee
- Health Information Technology Programs, Department of Computer Technology, Benjamin Franklin Institute of Technology, Boston, MA
| | - Jeph Herrin
- Section of Cardiology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Leora I. Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
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Tseng YT, Chang EH, Kuo LN, Shen WC, Bai KJ, Wang CC, Chen HY. Preliminary physician and pharmacist survey of the National Health Insurance PharmaCloud system in Taiwan. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 149:69-77. [PMID: 28802331 DOI: 10.1016/j.cmpb.2017.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/05/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The PharmaCloud system, a cloud-based medication system, was launched by the Taiwan National Health Insurance Administration (NHIA) in 2013 to integrate patients' medication lists among different medical institutions. The aim of the preliminary study was to evaluate satisfaction with this system among physicians and pharmacists at the early stage of system implementation. METHODS A questionnaire was developed through a review of the literature and discussion in 6 focus groups to understand the level of satisfaction, attitudes, and intentions of physicians and pharmacists using the PharmaCloud system. It was then administered nationally in Taiwan in July to September 2015. Descriptive statistics and multiple regression were performed to identify variables influencing satisfaction and intention to use the system. RESULTS In total, 895 pharmacist and 105 physician questionnaires were valid for analysis. The results showed that satisfaction with system quality warranted improvement. Positive attitudes toward medication reconciliation among physicians and pharmacists, which were significant predictors of the intention to use the system (β= 0.223, p < 0.001). Most physicians and pharmacists agreed that obtaining signed patient consent was needed but preferred that it be conducted by the NHIA rather than by individual medical institutions (4.02 ± 1.19 vs. 3.49 ± 1.40, p < 0.01). CONCLUSIONS The preliminary study results indicated a moderate satisfaction toward the PharmaCloud system. Hospital pharmacists had a high satisfaction rate, but neither are physicians and community pharmacists. Continuously improvement on system quality has been performing based on the results of this preliminary survey. Policies and standardization processes, including privacy protection, are still warranted further actions to make the Taiwan PharmaCloud system a convenient platform for medication reconciliation.
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Affiliation(s)
- Yu-Ting Tseng
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan
| | - Elizabeth H Chang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Li-Na Kuo
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wan-Chen Shen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Jen Bai
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chi Wang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Statistics, University of Virginia, Charlottesville, VA, USA
| | - Hsiang-Yin Chen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan; Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Chen CM, Kuo LN, Cheng KJ, Shen WC, Bai KJ, Wang CC, Chiang YC, Chen HY. The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 134:109-119. [PMID: 27480736 DOI: 10.1016/j.cmpb.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/31/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study evaluated a medication therapy management service using the Taiwan National Health Insurance Administration's PharmaCloud system in a medical center in Taiwan. The new PharmaCloud System, launched in 2013, links a complete list of prescribed and dispensed medication from different hospitals, clinics, and pharmacies for all insured patients. METHOD The study included patients with polypharmacy (≥5 drugs) at a medication therapy management service from March 2013 to March 2014. A structured questionnaire was designed to collect patients' baseline data and record patients' knowledge, attitudes, and practice scores before and after the service intervention. Phone follow-ups for practice and adherence scores on medication use were performed after 3 months. RESULTS There were 152 patients recruited in the study. Scores for medication use attitudes and practice significantly increased after the service (attitudes: 40.06 ± 0.26 to 43.07 ± 0.19, p <0.001; practice: 33.42 ± 0.30 to 40.37 ± 0.30, p <0.001). The scores for medication adherence also increased from 3.02 ± 0.07 to 3.92 ± 0.02 (p <0.001). CONCLUSIONS The PharmaCloud system facilitates accurate and efficient medication reconciliation for pharmacists in the medication therapy management service. The model improved patients' attitudes and practice of the rational use of medications and adherence with medications. Further studies are warranted to evaluate human resources, executing costs, and the cost-benefit ratio of this medication therapy management service with the PharmaCloud system.
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Affiliation(s)
- Chang-Ming Chen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Li-Na Kuo
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Kuei-Ju Cheng
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Wan-Chen Shen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Kuan-Jen Bai
- Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chi Wang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Statistics, University of Virginia, Charlottesville, Virginia, USA
| | - Yi-Chun Chiang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
| | - Hsiang-Yin Chen
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan; Department of Pharmacy, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan.
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14
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Trinh-Duc A, Painbeni T, Byzcko A, Fort PA. Le dossier pharmaceutique dans un service d’accueil des urgences : évaluation de son accessibilité et de son impact sur le niveau de connaissance du traitement du patient. ANNALES PHARMACEUTIQUES FRANÇAISES 2016; 74:288-95. [DOI: 10.1016/j.pharma.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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15
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Gall W, Aly AF, Sojer R, Spahni S, Ammenwerth E. The national e-medication approaches in Germany, Switzerland and Austria: A structured comparison. Int J Med Inform 2016; 93:14-25. [PMID: 27435943 DOI: 10.1016/j.ijmedinf.2016.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies show that many patients are harmed due to missing or erroneous information on prescribed and taken medication. Many countries are thus introducing eHealth solutions to improve the availability of this medication information on a national scale (often called "e-medication"). The objective of this study is to analyse and compare the national e-medication solutions just being introduced in Germany, Switzerland and Austria. METHODS Information on the situation in the three countries was collected within an expert group and complemented by an analysis of recent literature and legislation in each country. RESULTS All three countries formulate comparable goals for the national eHealth solutions, focusing on improving medication safety. All three countries do not have a national e-prescription system. In all three countries, the implementation process was slower than expected and e-medication is not yet fully available. Differences of the three countries exist regarding chosen architectures, used standards, offered functionalities, and degree of voluntariness of participation. CONCLUSION Nationwide e-medication systems and cross-border harmonization are acknowledged as important goals towards medication safety, but they develop slowly mainly due to privacy and security requirements, the need for law amendments and last but not least political interests.
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Affiliation(s)
- Walter Gall
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria.
| | - Amin-Farid Aly
- IQTIG - Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, 10787 Berlin, Germany.
| | - Reinhold Sojer
- Federal Office of Public Health (FOPH), 3003 Bern, Switzerland.
| | - Stéphane Spahni
- eHealth & Telemedicine Unit, HUG - University Hospitals of Geneva, 1205 Geneva, Switzerland.
| | - Elske Ammenwerth
- Institute of Biomedical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria.
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Rinner C, Sauter SK, Endel G, Heinze G, Thurner S, Klimek P, Duftschmid G. Improving the informational continuity of care in diabetes mellitus treatment with a nationwide Shared EHR system: Estimates from Austrian claims data. Int J Med Inform 2016; 92:44-53. [PMID: 27318070 DOI: 10.1016/j.ijmedinf.2016.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Shared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continuity of care are rare. The goal of this study was to quantitatively analyze (i) the degree of fragmentation of DM care in Austria as an indicator for the need for HIE, and (ii) the quantity of information (i.e. number of documents) from Austrian DM patients that would be made available by a nationwide Shared EHR system for HIE. METHODS Our analyses are based on social security claims data of 7.9 million Austrians from 2006 and 2007. DM patients were identified through medication data and inpatient diagnoses. The degree of fragmentation was determined by the number of different healthcare providers per patient. The amount of information that would be made available by a nationwide Shared EHR system was estimated by the number of documents that would have been available to a healthcare provider if he had access to information on the patient's visits to any of the other healthcare providers. As a reference value we determined the number of locally available documents that would have originated from the patient's visits to the healthcare provider himself. We performed our analysis for two types of systems: (i) a "comprehensive" Shared EHR system (SEHRS), where each visit of a patient results in a single document (progress note), and (ii) the Austrian ELGA system, which allows four specific document types to be shared. RESULTS 391,630 DM patients were identified, corresponding to 4.7% of the Austrian population. More than 90% of the patients received health services from more than one healthcare provider in one year. Both, the SEHRS as well as ELGA would have multiplied the available information during a patient visit in comparison to an isolated local EHR system; the median ratio of external to local medical documents was between 1:1 for a typical visit at a primary care provider (SEHRS as well as ELGA) and 39:1 (SEHRS) respectively 28:1 (ELGA) for a typical visit at a hospital. CONCLUSIONS Due to the high degree of care fragmentation, there is an obvious need for HIE for Austrian DM patients. Both, the SEHRS as well as ELGA could provide a substantial contribution to informational continuity of care in Austrian DM treatment. Hospitals and specialists would have gained the most amount of external information, primary care providers and pharmacies would have at least doubled their available information. Despite being the most important potential feeders of a national Shared EHR system according to our analysis, primary care providers will not tap their full corresponding potential under the current implementation scenario of ELGA.
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Affiliation(s)
- Christoph Rinner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Simone Katja Sauter
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Gottfried Endel
- Main Association of Austrian Social Security Institutions, Kundmanngasse 21, A-1031 Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Stefan Thurner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; Santa Fe Institute, Santa Fe, NM 87501, USA; International Institute for Applied Systems Analysis, A-2361 Laxenburg, Austria
| | - Peter Klimek
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Georg Duftschmid
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria.
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Effects of Shared Electronic Health Record Systems on Drug-Drug Interaction and Duplication Warning Detection. BIOMED RESEARCH INTERNATIONAL 2015; 2015:380497. [PMID: 26682218 PMCID: PMC4670632 DOI: 10.1155/2015/380497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/08/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022]
Abstract
Shared electronic health records (EHRs) systems can offer a complete medication overview of the prescriptions of different health care providers. We use health claims data of more than 1 million Austrians in 2006 and 2007 with 27 million prescriptions to estimate the effect of shared EHR systems on drug-drug interaction (DDI) and duplication warnings detection and prevention. The Austria Codex and the ATC/DDD information were used as a knowledge base to detect possible DDIs. DDIs are categorized as severe, moderate, and minor interactions. In comparison to the current situation where only DDIs between drugs issued by a single health care provider can be checked, the number of warnings increases significantly if all drugs of a patient are checked: severe DDI warnings would be detected for 20% more persons, and the number of severe DDI warnings and duplication warnings would increase by 17%. We show that not only do shared EHR systems help to detect more patients with warnings but DDIs are also detected more frequently. Patient safety can be increased using shared EHR systems.
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Heinze G, Jandeck LM, Hronsky M, Reichardt B, Baumgärtel C, Bucsics A, Müllner M, Winkelmayer WC. Prevalence and determinants of unintended double medication of antihypertensive, lipid-lowering, and hypoglycemic drugs in Austria: a nationwide cohort study. Pharmacoepidemiol Drug Saf 2015; 25:90-9. [DOI: 10.1002/pds.3898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 09/07/2015] [Accepted: 09/22/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Lisanne M. Jandeck
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Milan Hronsky
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Berthold Reichardt
- Sickness Fund Burgenland; Burgenländische Gebietskrankenkasse; Eisenstadt Austria
| | | | - Anna Bucsics
- Main Association of the Austrian Social Security Institutions; Vienna Austria
- Department of Finance; University of Vienna; Vienna Austria
| | - Marcus Müllner
- Austrian Agency for Health and Food Safety; Vienna Austria
- PERI Change GmbH; Vienna Austria
| | - Wolfgang C. Winkelmayer
- Division of Nephrology; Stanford University School of Medicine; Palo Alto CA USA
- Section of Nephrology, Department of Medicine; Baylor College of Medicine; Houston TX USA
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19
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Raghu T, Frey K, Chang YH, Cheng MR, Freimund S, Patel A. Using secure messaging to update medications list in ambulatory care setting. Int J Med Inform 2015; 84:754-62. [DOI: 10.1016/j.ijmedinf.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/13/2015] [Accepted: 06/02/2015] [Indexed: 11/25/2022]
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20
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NHI-PharmaCloud in Taiwan—A preliminary evaluation using the RE-AIM framework and lessons learned. Int J Med Inform 2015; 84:817-25. [DOI: 10.1016/j.ijmedinf.2015.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 11/20/2022]
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21
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Vivas-Consuelo D, Usó-Talamantes R, Trillo-Mata JL, Mendez-Valera P. Methods to control the pharmaceutical cost impact of chronic conditions in the elderly. Expert Rev Pharmacoecon Outcomes Res 2015; 15:425-37. [DOI: 10.1586/14737167.2015.1017564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- David Vivas-Consuelo
- 1Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio7J, Campus de Vera s/n 46022-Valencia, Spain
| | - Ruth Usó-Talamantes
- 2Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
| | - José Luis Trillo-Mata
- 2Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
| | - Pablo Mendez-Valera
- 2Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain
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Leguelinel-Blache G, Arnaud F, Bouvet S, Dubois F, Castelli C, Roux-Marson C, Ray V, Sotto A, Kinowski JM. Impact of admission medication reconciliation performed by clinical pharmacists on medication safety. Eur J Intern Med 2014; 25:808-14. [PMID: 25277510 DOI: 10.1016/j.ejim.2014.09.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/03/2014] [Accepted: 09/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many activities contribute to reduce drug-related problems. Among them, the medication reconciliation (MR) is used to compare the best possible medication history (BPMH) and the current admission medication order (AMO) to identify and solve unintended medication discrepancies (UMD). This study aims to assess the impact of the implementation of admission MR by clinical pharmacists on UMD. METHOD This prospective study was carried out in two units of general medicine and infectious and tropical diseases in a 1844-bed French hospital. A retroactive MR performed in an observational period was compared to a proactive MR realized in an interventional period. We used a logistic regression to identify risk factors of UMD. RESULTS During both periods, 394 patients were enrolled and 2,725 medications were analyzed in the BPMH. Proactive MR reduced the percentage of patients with at least one UMD compared with retroactive process (respectively 2.1% vs. 45.8%, p<0.001). Patients with at least one UMD during both periods were older compared to patients without UMD (79 vs. 72, p<0.005) and had more medications at admission (7 vs. 6, p<0.0001). UMD occur 38 times more often when there is no clinical pharmacist intervention. Among the 226 UMD detected in both periods, 42% would have required monitoring or intervention to preclude harm, and 10% had potential harm to the patient and 2% were life threatening. CONCLUSION Proactive MR performed by clinical pharmacists is an acute process of detection and correction of UMD, but it requires a lot of human resources.
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Affiliation(s)
- Géraldine Leguelinel-Blache
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France; Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France
| | - Fabrice Arnaud
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France
| | - Sophie Bouvet
- Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France
| | - Florent Dubois
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France
| | - Christel Castelli
- Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France; Department of Biostatistics, Epidemiology, Clinical Research and Health Economics, Nîmes University Hospital, Nîmes, France
| | - Clarisse Roux-Marson
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France; Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France
| | - Valérie Ray
- Department of General Medicine, Nîmes University Hospital, Nîmes, France
| | - Albert Sotto
- Department of Infectious and Tropical Diseases, Nîmes University Hospital, Nîmes, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, Nîmes University Hospital, Nîmes, France; Laboratory of Biostatistics, Epidemiology, Clinical Research and Health Economics, EA2415, University Institute of Clinical Research, Montpellier University, Montpellier, France.
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23
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Hackl WO, Hoerbst A, Duftschmid G, Gall W, Janzek-Hawlat S, Jung M, Woertz K, Dorda W, Ammenwerth E. Crucial factors for the acceptance of a computerized national medication list: insights into findings from the evaluation of the Austrian e-Medikation pilot. Appl Clin Inform 2014; 5:527-37. [PMID: 25024766 DOI: 10.4338/aci-2014-04-ra-0032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this paper is to present crucial factors among registered doctors and pharmacists for acceptance of the Austrian 'e-Medikation' system which is aimed at providing, on a national level, complete and recent information on all the medication that were prescribed or dispensed to a patient. METHODS As the accompanying formative evaluation study of the pilot project showed different overall acceptance rates among participating physicians and pharmacists, a decision tree analysis of 30 standardized survey items was performed to identify crucial acceptance factors. RESULTS For the physicians' group, only two items (fear of improper data use and satisfaction with software support) were crucial for overall e-Medikation acceptance. The analysis of the pharmacists' data resulted in five crucial factors primarily focusing on functional aspects and the perceived benefits of e-Medikation. CONCLUSION The results indicate that the acceptance among physicians and pharmacists depends on quite different factors. This must be taken into account during the planned rollout of e-Medikation or of comparable products.
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Affiliation(s)
- W O Hackl
- Institute of Health Informatics, UMIT-University of Health Sciences, Medical Informatics and Technology , Hall in Tirol, Austria
| | - A Hoerbst
- Research Division for eHealth and Telemedicine, UMIT , Hall in Tirol, Austria
| | - G Duftschmid
- Section for Medical Information Management and Imaging, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna , Austria
| | - W Gall
- Section for Medical Information Management and Imaging, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna , Austria
| | - S Janzek-Hawlat
- Section for Medical Information Management and Imaging, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna , Austria
| | - M Jung
- Institute of Health Informatics, UMIT-University of Health Sciences, Medical Informatics and Technology , Hall in Tirol, Austria
| | - K Woertz
- Institute of Health Informatics, UMIT-University of Health Sciences, Medical Informatics and Technology , Hall in Tirol, Austria
| | - W Dorda
- Section for Medical Information Management and Imaging, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna , Austria
| | - E Ammenwerth
- Institute of Health Informatics, UMIT-University of Health Sciences, Medical Informatics and Technology , Hall in Tirol, Austria
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