The Clinical Decision Support Lab
Medication Reconciliation: The RightRx Trial
 

Software Used

 
 
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.


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In Collaboration With

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

 
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

 
The Clinical Decision Support Lab
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

 
The Clinical Decision Support Lab
The Medical Office for the Twenty First Century (MOXXI)
 

Software Used

 
 
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

 
The Clinical Decision Support Lab
Information Systems-enabled Outreach Program for Adverse Drug Events: The ISTOP-ADE Trial
 

 
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

 
The Clinical Decision Support Lab
International Pharmacosurveillance using Electronic Health Records and Health Information Technologies
 

 
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.


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