A nationwide computerized patient medication history: Evaluation of the Austrian pilot project “e-Medikation”

doi:10.1016/j.ijmedinf.2014.06.004

International Journal of Medical Informatics

Volume 83, Issue 9, September 2014, Pages 655-669

https://doi.org/10.1016/j.ijmedinf.2014.06.004 Get rights and content

Highlights

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A nationwide medication list can be created without a national e-Prescription.
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Physicians showed lower acceptance of e-Medikation than pharmacists.
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The Austrian pilot project generated important recommendations for technical and organizational improvement.

Abstract

Purpose

To manage medication treatment and to assure medication safety, health care professionals need a complete overview of all drugs that have been prescribed or are taken by a patient. In 2009, Austria launched the pilot project “e-Medikation” in three pilot regions. E-Medikation gives access to a patient's nationwide medication list and includes medication safety checks. The objective of this paper is to report on the evaluation results and lessons learnt.

Methods

A formative evaluation study performed between July and December 2011 comprised a standardized survey of participating physicians, pharmacists, and patients, as well as an analysis of the e-Medikation log files.

Results

During the evaluation period, 18,310 prescriptions and 13,797 dispensings were documented, and 22,359 medication safety checks were performed. Overall, 61 physicians, 68 pharmacists, and 553 patients responded to a written survey. The results showed high acceptance of the idea of e-Medikation among pharmacists and patients and mixed acceptance among physicians. The satisfaction with the quality of the software used in the pilot project was low.

Conclusions

The overall aim to increase medication safety seems achievable through e-Medikation, but several limitations of the pilot project need to be solved before a national rollout. Based on the evaluation results and after redesign of e-Medikation, Austria is now planning a nationwide introduction of e-Medikation starting in 2015.

Section snippets

Background and objectives

A comprehensive medication overview is essential for health care professionals to manage medication treatment and to assure medication safety when prescribing or changing drugs.

Traditionally, to obtain the complete medication history at the first encounter, the physician asks the patient about the current medication. Any new orders are balanced with this information. This medication reconciliation process is designed to prevent medication errors at patient transition points [1] and is seen as

The Austrian e-Medikation system

The e-Medikation pilot project was a public national service launched in March 2009. E-Medikation managed the medication list of a patient. This list comprised all medications prescribed and/or dispensed in the last six months, their dosages, as well as their start and stop date. It also included selected OTC drugs that had been defined by a national expert group as being especially relevant in the context of drug–drug interactions. E-Medikation was one of the first services to be provided as

Participants and return rate

During the evaluation period, 92 physicians, 58 pharmacies (with approx. 230 pharmacists), and 5431 patients (representing 1.3% of the population in the pilot regions) participated in the pilot project. In the survey, 61 physicians (return rate 66%), 68 pharmacists (return rate 30%), and 553 patients (return rate 10%) provided valid responses. All responding physicians and pharmacists were active participants in the pilot project and thus used e-Medikation in their daily routine.

In the survey,

e-Medikation in relation to similar approaches in other countries

As discussed in the background section, some countries have already established a national e-Prescription system or reimbursement databases that can be used to assess prescription or pharmacy dispensing information.

Austria has chosen another approach: prescriptions are still issued in paper-based form, but the information on a prescription as well as information on a dispensing (including OTCs) is automatically communicated and stored in a national e-Medikation database. In the absence of a

Conclusion

The approach chosen by the Austrian e-Medikation complements, but does not replace, any future Austrian e-Prescribing system. The results of the pilot project are promising, as participants expect a benefit of e-Medikation for patient safety after national rollout. However, all pharmacies and physicians need to participate in order to achieve complete medication lists, and several technical and organizational improvements need to be made. Based on the evaluation results, Austria is now planning

Author contributions

EA wrote the first version of the manuscript. All co-authors commented and provided input. All authors have agreed to the final version of the manuscript.

Conflict of interest

All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare: all authors (except MJe) received financial support from ELGA GmbH for the evaluation. EA, WOH, AH, MJe, MJu, KW declare no other financial relationships with any organizations that might have an interest in the submitted work in the previous three years; WD, GD, WG declare relationships (funding of research projects) with the Main Association of Austrian Social Security

Acknowledgements

We thank all health care providers, pharmacists, and patients for their participation in this survey, ELGA GmbH for initiating the evaluation, Ernst Eigenbauer for technical data preparation, and SVC and PharmGK for provision of log files.

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A nationwide computerized patient medication history: Evaluation of the Austrian pilot project “e-Medikation”

Highlights

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Background and objectives

The Austrian e-Medikation system

Participants and return rate

e-Medikation in relation to similar approaches in other countries

Conclusion

Author contributions

Conflict of interest

Acknowledgements

Am. J. Geriatr. Pharmacother.

Am. J. Geriatr. Pharmacother.

J. Crit. Care

Jt. Comm. J. Qual. Saf.

Soc. Sci. Med.

J. Am. Med. Inform. Assoc.

J. Am. Med. Inform. Assoc.

Clin. Geriatr. Med.

Lancet

Lancet

J. Geriatr. Oncol.

Am. J. Geriatr. Pharmacother.

Int. J. Med. Inform.

The case for medication reconciliation

Nurs. Manage.

Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review

CMAJ

Patient Safety Primer: Medication Reconciliation

Making inpatient medication reconciliation patient centered, clinically relevant and implementable: a consensus statement on key principles and necessary first steps

J. Hosp. Med.

Medication reconciliation during internal hospital transfer and impact of computerized prescriber order entry

Ann. Pharmacother.

The nine Patient Safety Solutions: WHO Collaborating Centre for Patient Safety Solutions

Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial

Arch. Intern. Med.

Results of the medications at transitions and clinical handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission

J. Gen. Intern. Med.

Errors in medication history at hospital admission: prevalence and predicting factors

BMC Clin. Pharmacol.

Medication history taking in emergency department triage is inaccurate and incomplete

Acad. Emerg. Med.

Effect of patient- and medication-related factors on inpatient medication reconciliation errors

J. Gen. Intern. Med.

Prescription data improve the medication history in primary care

Qual. Saf. Health Care

Design and implementation of a personal medication record – MyMedicationList

AMIA Annu. Symp. Proc.

Medikationsplan für den Überblick

Dt Ärzteblatt

Discrepancies in the use of medications: their extent and predictors in an outpatient practice

Arch. Intern. Med.

Assessing the accuracy of computerized medication histories

Am. J. Manage. Care

Sources and types of discrepancies between electronic medical records and actual outpatient medication use

J. Manage. Care Pharm.

Development and use of a medication history service associated with a health information exchange: architecture and preliminary findings

AMIA Annu. Symp. Proc.