A Medication RepositoryThe MedView Pilot & NPDRLeonie Abbott

• 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

MedView: The Pilot

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.

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

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.

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.

Information Sources for MedView

MedView – The Systems Involved

Change Management

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

Change management - development

Evaluation

July 2011

Communications

Change management - deploy

Change – Implementation and Adoption

Change management - design

31 June

Detailed Business Impact Assessment

Validate High Level Business Impact

Assessment

Communication Plan

Training AssessmentStakeholder Matrix

Develop training and comms materials

Update &

review process

documents

Training

Change Readiness

/ Adjustment

• Changes / enhancements

to high level BIA

• Stakeholder matrix for

review by relevant areas

• Stake in the changes

• Agree with Stakeholders

• Changes, impacted users and

impacts to be compiled

• What, how, when,

where, who

• Reviewed by stakeholders

•Channels and activities

validated

• Socialise with key stakeholders

Detailed Training Plan

Training

March 2011

APPROACH

Due to the geographical expanse, different change management

strategies will be employed.

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

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

Medication Activity Record

Medication Activity Record

Medication Profile

Easy Access through CIS

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

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

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

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

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

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

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

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

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

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.

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

Questions