Playing Telephone: Understanding the state of medication decision making in growing healthcare teams in the time of electronic health records

Grindrod, K (NPI); Burns, C; Chin, J; Kerestecioglu, D; Mercer, K; Waked, K; Abidi, S; Dogba, J; Guénette, L; Guirguis, L; Legare, F; McKinnon A.

Background

Concerns about polypharmacy, medication safety and non-adherence are omnipresent. Interventions such as de-prescribing, medication reviews or reminders often target a single party— namely the physician, pharmacist or patient. Rarely, are solutions developed to support all three parties in working together.

Objective

To study how health records systems can be designed to support physicians, pharmacists and patients in sharing medication decisions.

Approach

The methodology was developed by a patient-engaged, multidisciplinary team. Participants included pharmacists, physicians and patients in Alberta, Ontario, Quebec, and Nova Scotia. We collected data through workflow observations and semi-structured interviews. Data were analysed using two approaches: 1) team coding to develop a multidisciplinary framework, and 2) a cognitive work analysis.

Results

Participants included 36 patients, 25 pharmacists and 11 physicians. We identified several gaps in the design of health records systems related to medications. Office-based systems support billing and documentation not communication. Regional systems share information about dispensing, lab values and hospital reports while key information such as medication indications or adherence are not shared. Pharmacists and physicians compensate for missing information with guesswork and/or by relying on the patient as messenger. Patient systems also do not share information in a way that has meaning to patients. Finally, all parties struggle to understand the workflow and decision processes of the others, leading to misunderstandings, frustration and conflict.

Conclusion

Health records systems need to evolve to share useful information about medications between physicians, pharmacists and patients; to allow for three-way communication, and; to allow all parties to understand the contexts and constraints of the others.