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Leonie Abbott, Barwon Health: How Are Electronic Medication Management Systems Communicating With PCEHR: Medview Pilot Implementation And National Prescription & Dispense Repository (NPDR) Case Study

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Leonie Abbott, NPDR Project Co-ordinator Barwon Health, VIC delivered this presentation at the 2013 Electronic Medication Management conference. It is Australia’s only conference to look solely at …

Leonie Abbott, NPDR Project Co-ordinator Barwon Health, VIC delivered this presentation at the 2013 Electronic Medication Management conference. It is Australia’s only conference to look solely at electronic prescribing and electronic medication management systems. For more information on the annual event, please visit the conference website: http://www.healthcareconferences.com.au/emedmanagement

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  • 1. A Medication Repository The MedView Pilot & NPDR Leonie Abbott
  • 2. MedView: The Pilot • 12 Federally funded PCEHR trial sites (Wave I and II) • To develop, deploy and test eHealth infrastructure in a practical setting • Fred IT Group was engaged to build a national medications repository • MedView worked in partnership with 8 software vendors: • Barwon Health was the only public organisation and hospital involved
  • 3. MedView: The Pilot • The Commonwealth Government provided funding for the development and implementation of MedView, as part of the National eHealth Program. • The pilot was conducted over 12 months. • Deployed March 2012 in the Barwon Region. • Completed June 2012. • At completion of the trial lessons learnt were shared with the Commonwealth.
  • 4. What was MedView The MedView pilot was a Medications Repository developed to demonstrate the ability of healthcare professionals to view consenting patient’s prescribed and dispensed medication information across hospital, community, and aged care settings. To facilitate the sharing of, and access to more comprehensive and better quality medications information in a timely manner between health professionals and organisations. • • • • Reduce duplication Reduce system-wide inefficiency Reduced health risks Improved healthcare through more visible medication history
  • 5. MedView Evaluation • Monash University conducted an independent evaluation of the pilot. • Triangulation was utilised through a combination of methods including interviews and surveys. • Interviews included Barwon Health practitioners and pharmacists, community pharmacists, consumers and General practitioners. • The pre-implementation phase involved qualitative interviews and a quantitative survey with end-users (pharmacists and doctors) • The post-implementation phase employed qualitative interviews of end-users and consumers. Excluding GPs.
  • 6. The next phase: NPDR • Following pilot completion integration with the Personally Controlled Electronic Health Record (PCEHR) system began. • This will be known as the National Prescription and Dispense Repository (NPDR) • The Prescription and Dispense view is intended to be an electronic summary of the prescription and dispense record information contained in a consumers PCEHR.
  • 7. Information Sources for MedView
  • 8. MedView – The Systems Involved
  • 9. Change Management Change management - development Validate High Level Business Impact Assessment • Socialise with key stakeholders Stakeholder Matrix Training Assessment • • What, how, when, where, who Stakeholder matrix for review by relevant areas • Stake in the changes Update & review process documents Develop training and comms materials Change management - design Detailed Business Impact Assessment • Changes / enhancements to high level BIA Communication Plan • Agree with Stakeholders • Changes, impacted users and impacts to be compiled Change management - deploy Communications Detailed Training Plan Training • Reviewed by stakeholders •Channels and activities validated Training Change Readiness / Adjustment July 2011 Evaluation March 2011 31 June Change – Implementation and Adoption APPROACH AWARENESS of the need for change DESIRE to support the change KNOWLEDGE on how to change ABILITY to implement skills and behaviour REINFORCEMENT to sustain the change Due to the geographical expanse, different strategies will be employed. change management This creates value in the evaluation phase, by providing comparators on the success of implementation, engagement and uptake. • Intensive – hands on change management support • Mixed – reduced hands-on change management support • Remote – limited hands on change management support
  • 10. Regions Involved Target Site was the Barwon Region This involved • Pharmacies • GPs • Barwon Health • One aged care facility Additional Sites - 10% nationally • Tasmania • Brisbane South • East Melbourne
  • 11. Medication Activity Record
  • 12. Medication Activity Record
  • 13. Medication Profile
  • 14. Easy Access through CIS
  • 15. Prior to implementation: Current State 2–3 % of hospital admissions are medication related. 10% of patients attending GP experience adverse drug events. Medication error rates are: • high in elderly patients • high during transfer of care between hospital and community • estimated that 52 – 88% of transfer documents contain an error Monash Evaluation Reported • Greater than 70% of GPs, hospital doctors and pharmacists had difficulty accessing accurate medication information
  • 16. Practitioner Perceived Benefits of MedView Provide seamless continuity of care between healthcare settings Reduced medication misadventure Improve communication between healthcare professionals Save time in obtaining a medication history MedView was expected to be used for • New patients • After hours • Emergency admissions • Accessing hospital discharge information Hospital pharmacists indicating they would be most frequent users
  • 17. Pre-implementation attitudes o GPs and community pharmacists saw most benefit in having access to hospital discharge information. o Prescribing and dispensing information was expected to be useful in assessing adherence and facilitating patient education. o Central benefit of having accurate hospital prescribing and discharge medication history o Medication safety o Facilitate decision making
  • 18. Implementation Outcomes Early adoption for Barwon Health - March 5th 2012 Community pharmacies had a rolling implementation from 1st of April 2012 Within the Barwon region there were • 43 community pharmacies • 2 general practice sites Significant issues with release of upgraded general practice prescribing software within the time frame
  • 19. Barwon Health Functionality (March 5th – June 30th) Frequency MedView Profiles with Hospital Prescriptions 7522 Prescribed items 34189 Dispensed items 34366 Hospital Doctors 200 Hospital Pharmacy Users 49 Views of MedView 697
  • 20. Overall Project Functionality Frequency Total Number of MedView Records 196032 Number of Patients with a MedView Record 13173 Number of Pharmacies Uploading 192 Number of Doctors Uploading 225 Number of Prescribed items Uploaded 81002 Number of Dispense items uploaded 84263 Number of Views 1488 Number of consumers who withdrew consent 1
  • 21. Post-implementation user attitudes Interviews occurred 3-5 weeks following release of MedView • GPs were excluded • 38 consumers Themes • Generally user-friendly and easily accessible • Majority perceived it to be beneficial • Concerns regarding potential incompleteness of information. • Perception by hospital doctors that the system wasn’t useful to them • Some stated they had issues with the training offered • Issues with misuse of information
  • 22. Challenges Change adoption throughout the region for a pilot • Timeline making this difficult Timing of training and communications • Junior doctors new to Barwon Health Co-operation between numerous private vendors and the constraints of a pilot project Training time poor healthcare practitioners in a new concept • understanding of MedView differed significantly. Delays in vendor software release Length of pilot Ensuring interaction with CIS was going to display information in a clinically meaningful way
  • 23. Issues Raised: Hospital Healthcare practitioners MedView would still contain information that was out of date • The healthcare practitioner still needed to use their own judgement • Similar to lists now which quickly become out of date • A repository is not a list • More an event record Incomplete • No information from Melbourne specialists • Handwritten prescriptions not included • Not 100% of GPs and pharmacies involved That the patient gives consent
  • 24. Pharmacist Use of MedView Hospital Pharmacist A patient who had recently been discharged was readmitted used MedView. This contained both the information from the prescribing CIS and dispensing system. Hospital Pharmacist Found information on a patient’s MedView profile that the patient hadn’t mentioned, which assisted in collating an accurate medicines reconciliation record. Community Pharmacist Was able to “correct a medication error from the hospital” and to check the dose of a medication. In both examples the information was available on MedView.
  • 25. Conclusion Achieved objectives Demonstrated that a repository could receive information from • Community pharmacy • General Practitioners • Hospital prescribing and dispensing systems Facilitated the sharing of health information across a broad range of providers. Feedback indicated • Access to this information is highly valuable
  • 26. Questions