The Clinical Decision Support Lab

Dr. Tamblyn’s research focuses on conducting observational and interventional studies in public health and health services delivery aimed at improving the safety and quality of health care. Her research program aims to identify modifiable determinants of adverse events and improved health outcomes. She develops and evaluates computer-enabled interventions to address these determinants (e.g. computerized decision-support, personal health record portals and self-management tools, automated surveillance systems.)

LAB LEAD

Robyn Tamblyn

Scientific Director Professor, Department of Medicine and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Faculty of Medicine

Dr. Robyn Tamblyn is a Professor in the Department of Medicine and the Department of Epidemiology, Biostatistics and Occupational Health at McGill University. She is a James McGill Chair, a Medical Scientist at the McGill University Health Center Research Institute, and the Scientific Director of the Clinical and Health Informatics Research Group at McGill University. Dr Tamblyn’s ground-breaking research on educational outcomes has elucidated important relationships between health professional training, licensure and practice that have subsequently guided credentialing policies. Her work on prescription drug use, its determinants, and computerized interventions to improve drug safety (MOXXI) has been recognized internationally. She leads a CIHR-funded team to investigate the use of e-health technologies to support integrated care for chronic disease, and co-leads a Canadian Foundation for Innovation Informatics Innovation Laboratory to create advanced technologies to monitor adverse events in populations and create new tools to improve the safety and effectiveness of health care. Her work is published in the Journal of the American Medical Association, the Annals of Internal Medicine, the British Medical Journal, Medical Care, and Health Services Research, among others. She has been awarded the CHSRF KT award for her research in improving the use of medication, the ACFAS Bombardier award for innovation in the development of a computerized drug management system and the John P. Hubbard Award by the NBME for her contribution to the assessment of professional competency and educational program development in medical education and delivery of healthcare. In January 2011, she became the Scientific Director of the Institute of Health Services and Policy Research at the Canadian Institutes of Health Research. Dr Tamblyn was appointed to the Order of Canada in December 2014 for her contributions to patient safety, notably through her research on physician training, health system monitoring and prescription drug management. In 2015 Dr. Tamblyn received an Outstanding Achievement Award from the Medical Council of Canada.


    Nadyne Girard Analyst and Project Coordinator / Analyste principale des données

      Thai Tran Developer / Développeur

        Manish Thakur Lead Developer / lead developpeur

          Bettina Habib Research Assistant / Assistante de recherche

          Physician, graduate of the University of Buenos Aires. Médecin, diplômé de l'Université de Buenos Aires.

            Santiago Marquez Fosser Post Doc

              Siyana Kurteva PhD Student / Doctorante

                Fiona Chan PhD Student / Doctorante

                  Teresa Moraga Analyst / Analyste

                    Jeanne Vachon Field Research Assistant / Assistante de recherche de terrain

                    Projects

                    Smart About Meds

                    Empowering Patients to Better Manage their Medications: The ‘Smart About Meds’ (SAM) Mobile Application

                    Over 3 million hospitalizations and 17 million emergency department visits occur each year in Canada, a significant proportion of which are medication-related and preventable. Studies have shown that many such events are the result of prescribing or dispensing errors, incomplete drug information, and the underuse or overuse of medications. In fact, our previous study showed that 55% of patients discharged from hospital did not adhere to at least one of the changes made to their medication regimen at discharge, which subsequently increased their risk of adverse events. Analyses of patient interview data suggest that unclear communication with patients about medication changes may be driving non-adherence, as might difficulties in managing complex drug regimen information and dosing schedules. To address this apparent need for patient support mechanisms that reduce medication non-adherence, we developed the SAM mobile application, which is aimed at improving medication management following hospital discharge. The app provides patients and their caregivers with a continuously updated medication list, pill images, drug information, medication reviews by other patients, a side effect checker, alerts if they do not follow planned therapy, and the ability to connect with hospital pharmacists when needed. We plan to conduct a pilot study to assess the usability of the app and, at a later stage, a larger clinical trial to evaluate its effectiveness in improving adherence and reducing the occurrence of adverse events.

                    Funded By: Économie et l’Innovation Québec

                    Medication Reconciliation: The RightRx Trial

                    Effective implementation of medication reconciliation is essential to reduce preventable adverse drug events occurring at the transitions between community and hospital care. More efficient and reliable methods of obtaining the community drug list are critical to improve hospital staff adherence to the medication reconciliation process and reduce unintended discrepancies in community and hospital medication at discharge. Community-based pharmacy records could be used, particularly if the hospital treatment team could automatically retrieve these records. Adherence to medication reconciliation at discharge will likely be improved by providing an automated order entry process that facilitates re-ordering of hospital and community-based medications at discharge. Moreover, the effectiveness of an electronic medication reconciliation module in reducing adverse drug events may be augmented by interventions to improve the successful transmission of treatment discontinuation and change orders to community-based pharmacists and physicians.

                    Funded by: Canada Foundation for Innovation, Canadian Institutes for Health Research

                    In Collaboration with: MUHC-RU and MSSS Quebec

                    Reducing Injuries from Medication-Related Falls by Generating Targeted Computerized Alerts for High Risk Patients within an Electronic Prescribing System

                    Drug-related illness is the sixth leading cause of mortality. Preventable adverse drug events in ambulatory practice  are estimated to occur in 2% to 3% of patients treated per year, of which 58% are related to prescribing errors. Older adults are at higher risk of adverse events and medication-related fall injuries are the most common problem. Approximately 10% to 39% of falls are attributable to the inappropriate use of psychotropic drugs and are potentially preventable. The purpose of this research is to reduce medication-related fall injuries by using computerized electronic prescribing and drug management systems to identify high risk patients and provide physicians with patient-specific recommendations for modifying psychotropic medication use to reduce this risk. We will develop and test a “smart-alert” system for modifying high risk psychotropic drug use among high risk patients within the MOXXI system  to determine if the smart-alert system reduces the rate of inappropriate psychotropic drug prescriptions and fall-related injuries.
                    Funded By: Canadian Institutes for Health Research

                    Providing Comparative Out-of-Pocket Cost Information for Prescription Drugs through an Integrated Physician Electronic Prescribing System: A Proof of Concept with Anti-hypertensive Drugs

                    The potential benefits of new drug treatments and increased medication utilization rates have not been fully realized, even though the proportion of health costs due to drug expenditures continues to rise on a yearly basis. This has created a need to investigate new methods to maximize the benefits of existing and new drug treatments while minimizing costs. This research will build on initiatives to implement electronic prescribing and integrated drug management systems to improve patient safety. The study will assess a) whether access to detailed comparative information on patient out-of-pocket cost for drugs of equivalent effectiveness at the time of prescribing will improve the cost-effectiveness of drugs prescribed for uncomplicated hypertension and b) determine the impact on patient adherence with the anti-hypertensive therapy. The results will help to assess the degree to which evidence-based decision-support systems that provide physicians with information on out-of-pocket payments from patients can be integrated into electronic prescribing and integrated drug management systems and produce improvements in cost-effective prescribing.

                    Funded By: Canadian Institutes for Health Research

                    The Medical Office for the Twenty First Century (MOXXI)

                    The MOXXI project is a computerized system to manage medications and electronically write prescriptions. The goal of the research project is to study the impact of these new technologies on quality of care delivered and on patient outcomes.

                    Optimal management of prescription medications is an increasingly complex challenge. In order to ensure the best and safe treatment of their patients, physicians and pharmacists must keep their knowledge about medications and their use up-to-date. Today there are:

                    • More than 33,000 drug interactions
                    • More than 6,500 prescription drugs that are counter-indicated in the presence of certain illnesses
                    • More than 3,500 prescription drugs that can cause allergic reactions.  The goals of the project are to determine whether the MOXXI system can prevent undesirable drug-induced effects by testing
                    • An electronic prescription module, including therapeutic intent, in order to reduce errors in the prescription, transcription, and delivery of medications.
                    • A therapeutic advisor, to rapidly detect drug interactions and ineffective treatments.
                    • A module for the follow-up of drug treatment adherence.

                    Funded By: Canada Foundation for Innovation

                    Information Systems-enabled Outreach Program for Adverse Drug Events: The ISTOP-ADE Trial

                    Medications are an effective intervention for managing and preventing health problems but their benefit can be undermined by non-adherence or adverse drug events (ADEs).  As these issues are interconnected, efforts to improve non-adherence should also include reduction of ADEs.  We have developed the ISTOP-ADE system (Information Systems-enabled Outreach for Preventing Adverse Drug Events) which enables timely monitoring of patients for ADEs and couples it with an intervention to manage ADEs.  The objectives of this study are to determine whether the ISTOP-ADE system, compared to routine care, will reduce a) the probability of discontinuing of prognosis-altering medications, b) the probability of a patient experiencing a severe ADE, c) the proportion of patients experiencing ADEs, preventable ADEs, and ameliorable ADEs, and d) health services utilization.

                    Funded By: Canadian Institutes for Health Research

                    International Pharmacosurveillance using Electronic Health Records and Health Information Technologies

                    While there are considerable benefits from modern drug therapy, the frequent occurrence of adverse drug-related events and the uncertainty about effects of drugs after they enter the market have highlighted fundamental shortcomings in the ability to actively monitor drugs after their approval. Electronic health records, computerized prescribing and automated patient follow-up systems are health information technologies that provide an unprecedented opportunity to develop an active surveillance system that will monitor and provide patients and physicians with real-time feedback on the comparative safety and effectiveness of new drugs. Conducting active surveillance on a collaborative international scale will provide more rapid information about drug safety and effectiveness from users around the world, as well as permit more personalized risk/benefit analysis for subgroups where drugs may have a different risk/benefit profile. The purpose of this project is to develop state-of-the-art methods of i) monitoring, and ii) analyzing the comparative risk and benefit of new drug therapies, in real-time, through an international prospective surveillance system, and iii) communicating this information to clinicians to inform treatment decision-making at the point-of-care.

                    Funded By: Canadian Institutes for Health Research

                    Former Members

                    Jenna Wong

                    Ania Syrowatka

                    Daniala Weir

                    Lina Petrella

                    Jessica Nadigel

                    Nancy Winslade

                    Aude Motulsky

                    Melissa Bustillo

                    Sarah Elsayed