As I work to stay on top of my mix of chronic conditions, one thing that stands out to me is that providers expect me to do most of my own medication tracking and management. What I mean by this is that their relationship to my med regimen is fairly static, with important pieces of the puzzle shared between multiple providers. Ultimately, there’s little coordination between prescribers unless I make it happen.
I’ve actually had to warn doctors about interactions between my medications, even when those interactions are fairly well-known and just a Google search away online. And in other cases, specialists have only asked about medications relevant to their treatment plan and gotten impatient when I tried to provide the entire list of prescriptions.
Sure, my primary care provider has collected the complete list of my meds, and even gets a updates when I’ve been prescribed a new drug elsewhere. But given the complexity of my medical needs, I would prefer to talk with her about how all of the various medications are working for me and why I need them, something that rarely if ever fits into our short meeting time.
Regardless of who’s responsible, this is a huge problem. Patients like me are being sent with some general drug information, a pat on the back, and if we experience side effects or are taking meds incorrectly we may not even know it.
So at this point you’re thinking, “Okay, genius, what would YOU do differently?” And that’s a fair question. So here’s what I’d like to see happen when doctors prescribe medications.
First, let’s skip over the issue of what it might take to integrate medication records across all providers’s HIT systems. Instead, let’s create a portal — aggregating all the medication records for all the pharmacies in a given ZIP Code — and allow anyone with a valid provider number and password to log in and review it. The same site could run basic analytics examining interactions between drugs from all providers. (By the way, I’m familiar with Surescripts, which is addressing some of these gaps, but I’m envisioning a non-proprietary shared resource.)
Rather than serving as strictly a database, the site would include a rules engine which runs predictive analyses on what a patient’s next steps should be, given their entire regimen, then generate recommendations specific to that patient. If any of these were particularly important, the recommendations could be pushed to the provider (or if administrative, to staff members) by email or text.
These recommendations, which could range from reminding the patient to refill a critical drug to warning the clinician if an outside prescription interacts with their existing regimen. Smart analytics tools might even be able to predict whether a patient is doing well or poorly by what drugs have been added to their regimen, given the drug family and dosage.
Of course, these functions should ultimately be integrated into the physicians’ EMRs, but at first, hospitals and clinics could start by creating an interface to the portal and linking it to their EMR. Eventually, if this approach worked, one would hope that EMR vendors would start to integrate such capabilities into their platform.
Now I imagine there could be holes in these ideas and I realize how challenging it is to get disparate health systems and providers to work together. But what I do know is that patients like myself get far too little guidance on how to manage meds effectively, when to complain about problems and how to best advocate for ourselves when doctors whip out the prescription pad. And while I don’t think my overworked PCP can solve the problem on her own, I believe it may be possible to improve med management outcomes using smart automation.
Bottom line, I doubt anything will change here unless we create an HIT solution to the problem. After all, given how little time they have already, I don’t see clinicians spending a lot more time on meds. Until then, I’m stuck relying on obsessive research via Dr. Google, brief chats with my frantic retail pharmacist and instincts honed over time. So wish me luck!