Month: March 2017

Notes from academic paper: Analysis of community chain pharmacists’ interventions on electronic prescriptions

Reasons for interventions were grouped into 21 different categories. In some cases pharmacists cited multiple reasons (i.e., problems) for their intervention. Overall, 102 problematic e-prescription orders required intervention. Participating pharmacists documented a total of 113 reasons for intervention. The most common reason for pharmacists’ interventions on e-prescriptions was to supplement omit- ted information (32.7%), especially missing directions. Other common problems included insufficient (9.7%) or excessive (8.0%) dose.

They identify problems with overdose or wrong directions on how to take the medicine, drug-drug interaction etc. I suppose that these problems would interfere with patient compliance and adherence towards the medicine.

Prescribers may be more likely to make prescribing errors when using software or software options with which they are unfamiliar.

Pharmacists in this study recognized most problems independently of computer-assisted expert systems. However, pharmacists reported that computer systems were useful in identifying non-formulary medications, drug–drug interactions, and drug–allergy conflicts. These data once again emphasize that the currently available computer-assisted drug-use review decision support systems can be helpful but are not capable of supplanting the clinical judgment of the pharmacist. Can be connected with this paper.

Several recommendations can be made to improve the safety of e-prescribing in the community practice setting. First, physicians should perform their own e-prescription data entry or at least carefully review e-prescriptions that are entered by support staff before transmission to the pharmacy. Second, prescriber- side decision support software should be enabled and routinely used. Third, e-prescribing system safeguards and decision sup- port should be improved to more closely scrutinize new prescriptions to prevent commonly occurring errors. Fourth, when developing decision support systems for e-prescribing, special emphasis should be given to dosing error prevention.

Notes from academic paper: Analysis of pharmacists’ interventions on electronic versus traditional prescriptions in 2 community pharmacies

Very important as to why we choose only literature based on the UK instead of globaly:

E-prescribing in the United States is defined as “the transmission, using electronic media, of prescription or prescription-related information, be- tween a prescriber, dispenser, pharmacy benefit manager (PBM), or health plan in either direction or through an intermediary, including an e-prescribing network. It includes, but is not limited to, two-way transmission between the point of care and the dispenser.” In other countries, such as the United Kingdom, electronic prescriptions can occur in 2 methods:

  1. a mechanism whereby prescribers can download medication data or generate an electronic prescription automatically from the core network, but the system still uses a paper prescription infrastructure
  2. generate an electronic encrypted signature and be allowed to transfer the prescription electronically as opposed to having the patient take the prescription to the pharmacy.

They use the same definition as : this paper

These results are in line with other evaluations of e-prescribing interventions. In their study of self-reported community pharmacists’ interventions on e-prescribing, Warholak and Rupp concluded that although e-prescribing can improve safety and effectiveness in patient care, still emerging technology can pose threats to medication safety and improvements need to be made to systems to improve the safety, effectiveness, and efficiency of e-prescribing.

When comparing e-prescribing with handwritten interventions, no significant differ- ences existed among intervention rates in this study (P¼.21). This indicates that despite the fact that e-prescribing is purported to be a safer mechanism (ie, reducing the amount of medication errors) for prescription transmission, no decrease in pharmacist intervention rate was seen. This may have been because of the fact that e-prescribing is relatively new in community pharmacy practice, and prescriber inexperience with the system may cause an initial increase in the number of prescribing is- sues that need intervention by the pharmacist.




Notes from the academic paper: Electronic Prescribing in the United Kingdom and in the Netherlands

Outpatient care, sometimes called “ambulatory care,” takes place at a doctor’s office or at a day health care clinic.

Improved patient safety. With basic e-prescribing, medication errors can be prevented, through the elimination of illegible handwriting, better dosage advice, and alerts for adverse drug-drug or drug-allergy interaction.




Notes from academic paper: Personal health record ( PHR ) landscape review Final report

a PHR was defined in the project specification as:
… a digital tool that helps people to maintain their health and manage their care. It may do this by enabling them to capture their own health and care data, to communicate with health and care services, and/or to have access to their care record.

The literature review found evidence of unmet needs. Patient expectations were not being met by PHRs; in particular limited content of the record was being made available to patients and there was an inability to bring together records from different care settings into one place.

Recommendations for further research:

Understand what patients require from PHRs – what information do they want to see and what do they want to use PHRs for, and why (ie gain or benefit)? This understanding needs to include people who do not currently use PHRs and the requirements of different groups (eg adults, older people, children, people who are ‘hard to reach’, those with sensory and other disabilities and those with mental health issues, etc). Any study needs to examine requirements in a person-centred way across care setting boundaries, rather than from the perspective of specific care providers.


The categories of services provided currently by PHRs:

  • communicating with your care team through the PHR
  • seeing your medication records and tools, to review them and remind you to take medication
  • services to help you to plan and manage your own care
  • information and support services.

In the systems that were connected to the care providers’ EHR (17/23), 76% showed a benefit in the use of the PHR. However in standalone PHRs, benefits were seen only in 50% of the studies (3/6)

Responses about PHR services indicate that they are at a relatively low level of maturity.

  • Most of the PHRs are currently setting-specific (ie primary, hospital or social care), although some suppliers have aspirations for integrated implementation across more than one setting.
  • PHRs mainly provide patients with a view of their records, rather than the ability to update or annotate them, let alone upload their own data.
  • Linkage of PHRs to electronic health or care record systems was in some cases aspirational, particularly when compared with implementer responses about current linkage. Also, the links are generally unidirectional (from the electronic health or care record to the PHR, rather than vice versa).
  • The main way in which users could communicate with their care teams was via email-type messaging rather than instant methods, such as video and instant messaging etc.
  • While PHRs enable patients or citizens to view their medications, they are generally setting- specific, for example only their GP or hospital medication records. Patients are unable to interact electronically with their medication record, eg to point out errors or to remind themselves to take their medicines.

The main use of PHRs is currently access to blood test results. In patient online access to GP records, repeat prescriptions and appointment booking are also major uses. PHRs tend to be used before or after appointments, which indicates that preparation for and debriefing on consultations is important. These uses are quite limited and, in the case of blood results, are limited to specific patient groups. There is still little evidence about how PHRs are used, what they are used for and why.

Potential benefits for both patients (improved experience and outcomes) and organisations (time, effectiveness and cost savings) were identified in the survey responses, but the majority were aspirational and we were able to obtain little supporting evidence of objectively realised benefits. The literature review identified a number of studies that identified patient benefits, but these were largely qualitative, focusing on how patients felt about the PHRs, rather than any quantitative assessment of their impact on health outcomes (eg lifestyle improvements) derived from bias-free study designs.

Similarly, reports of disbenefits were mainly related to fears and anxieties, for example of increased burden on clinicians or patient confidentiality, with little supporting evidence.


Notes from the academic paper: Putting patients in control ? Personal Health Records

The Markle Foundation’s definition of a PHR, as follows: ‘An Internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it.’

Recognising that PHRs act as a means to enable better care and coordination, the table below summarises the types of capabilities that typical PHRs provide, and shows which of those elements are distinct from the Record Access capability.

The PHR utility is wide-ranging and offers potential solutions to age-old problems. For example, when consulting a GP, patients often have to recall parts of their medical history from memory (not always successfully), taking up valuable time in clinic. As noted in the table, part of the PHR’s function is to support patient-entered data. This can include subjective data such as symptom scores, qualitative descriptions of symptoms or medical problems. It may also be possible for patients to complete questionnaires and to write their history before arriving for a consultation. The current RCGP advice is that ‘health professionals should use this to supplement, not replace, their clinical assessment’.
Furthermore, through direct patient entry or via interoperable devices, patients’ self-monitoring data from telehealth devices could be added into their PHR. This could include blood pressure, peak flow, blood sugars and oxygen saturation measurements, and lifestyle information such as diet and exercise charts.

PHRs for complex/chronic care users

Our work suggests that PHR usage is most likely to take off amongst engaged groups of patients, committed to self-management. Those with complex, chronic conditions, often with more than one long term condition, are most likely to find a PHR useful and have the most to gain in the first instance.
Of those who did not believe a PHR would help them keep better track of their healthcare records, there was only one frequent user of existing online resources (4.8%) and 4 fairly regular users (19%), while the majority did not use these resources at all (76.2%). The clear implication is that exposure to existing online resources informs the desire to use a PHR.
As one patient we spoke to said, ‘Obtaining test results, clinical advice, repeat prescriptions, condition monitoring at home, the ability to correct mistakes, communicate with the clinical team are all aspects which make an individual’s life easier and it is these things which would encourage uptake. It also offers the most gain for clinicians too.’
In our survey of 172 people with long term conditions, 39% said they would find a PHR reassuring, and 28.4% claimed they would be fairly reassured; 23.3% said they would not be reassured at all, and 9.3% didn’t know.
Of those who said they would not be reassured, 65% were very concerned that information available on their record would be accessible to health professionals for whom it was not relevant, and almost all of them (92.3%) cited security and the risk of unauthorised record access as their major concern.
When asked whether they believed a PHR would to organise and keep track of their healthcare records better, they responded:

  • 45.3% A lot
  • 30.2% A little
  • 12.8% Not at all
  • 11.6% Don’t know

Many respondents who believed a PHR would help organise and keep track of records better were already frequent users of online resources: 25.6% confessed to being regular users and 53.8% said they were fairly regular. This group was more likely to be concerned with accuracy of the record (76.3%) rather than security (71.1%).
This group was more likely to be concerned with accuracy of the record (76.3%) rather than security (71.1%).
Of those who did not believe a PHR would help them keep better track of their healthcare records, there was only one frequent user of existing online resources (4.8%) and 4 fairly regular users (19%), while the majority did not use these resources at all (76.2%). The clear implication is that exposure to existing online resources informs the desire to use a PHR



Notes from academic paper: Sociotechnical challenges to developing technologies for patient access to health information exchange data

The codes were categorized according to the Brender framework of socio-technical success and failure factors. For simplicity, we collapsed three of Brender’s categories into related categories to create nine categories: ▸ functionality (functions offered by the software and their fit to user needs);

  • technical issues (technical support for these functions, including data and messaging standards, and system performance);
  • organizational/managerial issues (planning, resource allocation, communication processes between developers and users, and implementation processes);
  • culture (culture of healthcare and of patients);
  • policy/strategy (national, statewide, and/or institutional policy and strategy);
  • legal issues (HIPAA, state law, and other legal frameworks);
  • economic issues (organizational and vendor resources, broader economic climate);
  • education (user education and training on the system);
  • behavior/user acceptance (user attitude, motivation, acceptance).