Implementing an electronic medication overview in Belgium.

Abstract

Objectives: Digitally sharing information enables improved communication, consequently increasing accuracy of a medication overview, resulting in reduced medication errors [1]. The aim of this study is to evaluate implementation of an electronic medication overview, particularly its accessibility and usability. Methods: In Belgium a project called “Vitalink” was implemented. Main objective of this project was to improve the exchange of health information between healthcare professionals as well as towards patients. Software packages generating an electronic medication overview out of patients’ health records, were developed. The generated medication overview listed all prescribed medication with name, dose, frequency, way of administration and moment of intake. Because data is transferred over the Internet, a lot of thought went into secured data transfer and authorized access. Security is guaranteed by: encoding health information as well as encrypting the encryption key; two separate decoding keys; registration of all actions performed on the data. Access is granted only to those healthcare professionals selected by the patient through an informed consent. To check authorization healthcare professionals’ and patients’ identities are verified by reading their e-ID using an e-ID reader. This e-ID reader is linked to one’s computer, connected to the Internet. When authorization is approved, there are still restrictions as to the actions that can be performed on the data, depending on the type of healthcare professional who’s accessing the medication overview. General practitioners and pharmacists can consult and change the medication overview whereas nurses, home care staff and secondary caregivers can only consult it. The patient as well can only consult the electronic medication overview. Expectations of general practitioners, pharmacists, nurses, home care staff and secondary care professionals of four regions in Belgium were documented using an online survey at the start of the project. Complementary findings were gathered by the coordinating teams. Enrollment of healthcare professionals was voluntary. To obtain medical information, patients granted access to participating healthcare professionals through informed consent. Only records of patients meeting the following criteria were eligible: being prescribed minimum 3 different, chronic drugs and having signed an informed consent. Residing in a nursing home is an exclusion criterion. The study was approved by the Ethics Committees of the Universities of Hasselt and Antwerp. Data were analyzed by one researcher using SPSS 20.0. Results: A total of 263 healthcare professionals filled out the survey. Nurses represented the biggest group (55,6%). Most healthcare professionals perceived patients’ compliance to be “moderate” and perceived themselves as “sometimes” detecting medication errors. Healthcare professionals’ expectations about barriers regarding the implementation are: an administrative burden (because of the setup of the software and the follow up of the project) and problems with maladjusted software. Conclusion: A successful implementation of an electronic medication overview highly depends on the accessibility and usability of the tool. This means that there’s a need for secured and quick access to medical data. Secondly, software should meet the needs of its users, adapted to daily activities of healthcare professionals.