Medication, integration and quality control
"The quality of patients’ medication lists" & "Integration and medication in hospitals"
We have studied how an Electronic Medication Management System (EMMS) could contribute to increased quality in patients´ medication lists. We aim to contribute to the development of a socio-technical understanding and a robust implementation strategy of integration between different information technology systems in health care.
Both domestic and international research have shown deviation between the medication lists in the hospitals and the medication the patient actually is using. There is a general perception both from most health care professionals and from authorities that information technology like for instance an Electronic Medication Management System (EMMS) could help improve the quality of the medication list and thereby the patient treatment. We have asked the following questions: How do health care professionals today practice to achieve patient medication lists with sufficient quality? And how should this affect the implementation of an EMMS? We have taken a work practice perspective and have performed a case study at the University Hospital of Northern Norway. We have studied and compared the medication management process across several wards. The results show that quality in the medication process is not something we should take for granted. And this is not an issue that technology alone could fix. Improved quality requires effort and the quality and the effort depends on the context. In addition have we challenge the predominant technical focus on integration in health care. We have suggested that organisational and social factors have been overlooked in many integration efforts. Our aim is to contribute to the development of a socio-technical understanding and a robust implementation strategy of integration in health care. We have analysed how clinical practice and the history of existing systems play a crucial role in integration efforts. Empirically our project draws on the implementation and integration of a large-scale Electronic Medication Management System (EMMS) in the Health Authority Northern Norway, which was initiated in 2012. In total we have conducted 14 interviews with nurses, physicians and project members. In addition we have attended workshops and project meetings.
Medication, integration and quality control
a successful EMMS is hard to achieve in practice and such systems have not yet become widely available. Aligned with current efforts in all four health regions in Norway, in this research project we will develop theoretically informed guidelines and strategies for how to achieve this in a complex and heterogeneous health care environment.
Drug-related problems such as improper use and adverse effects of drugs cause hospitalization and deaths among patients. Preventable adverse events increase health care expenses and other national costs. They reduce patients’ quality of life and are sometimes the leading cause of death. Several studies suggest that the use of an electronic medication management system (EMMS) – including computerized physician order entry (CPOE), an electronic decision support system, and a medication administration and pharmacy review module – can reduce the incidence of serious errors. Empirically, we will study the new EMMS project in the Northern Norway Regional Health Authority, which has a budget of EUR 20 million. We will approach the EMMS project through a qualitative, in-depth longitudinal study where we endeavour to gain an increased understanding of the EMMS as an emerging phenomenon. Our findings will be fed into the health region’s on-going project activities through presentations, reports and discussions. It has been decided that the EMMS in the Northern Norway Regional Health Authority will cover pre-hospital services, emergency units, intensive care and anaesthesia departments, operating rooms, outpatient clinics and clinical wards. To support the needs of health personnel at every step in the patient’s pathway, the EMMS is intended for use wherever the patient is located. The major goals in the project are: a) A standardized and integrated system that supports complete patient pathways, b) Automatic data acquisition from medical technical equipment and devices, c) A standardized solution across the whole region, d) Overview of drug interactions, dosages, adverse effects, mixing, administration, e) Access to the patient list of medications through the whole patient pathway and f) Clinical decision support. Like EMMS projects internationally, this project is recognized as having an extremely high degree of complexity. This complexity in turn requires a very flexible technology, as the EMMS project group recognizes: “The system must possess a high degree of flexibility to be able to collect data from different sources and digital resources (…) [this includes] development of modules, configuration, adjustments, integrations and interconnecting medical instruments”42. Likewise, the large inter-departmental scope (both intensive/anaesthesia and ordinary bed wards) together with the standardized objectives for the region makes this an attractive study object for both national and international health-related research communities.