Abstract
Background Physicians, patients and others involved need to have accurate information on patients’ current drug prescriptions available, and have that information protected from unauthorized access. During the past decade, many counties in Sweden have implemented regionally shared medication lists within health care. Objective The aim of this study was to describe physicians’ views on changes in accuracy, availability and confidentiality in the transition from local medication lists to a regionally shared medication list. Setting Health care units in four different counties of Sweden after the transition from local medication lists to a regionally shared medication list. The shared medication list was an integrated part of the electronic health record system in the respective counties, but the system and implementation process varied. Methods Physicians (n = 7) with experience of transition from local medication lists to a regionally shared medication list were interviewed in a semi-structured manner. Main outcome measure: Physicians’ views on changes in information risks, focusing on accuracy, availability and confidentiality. Results The transition from local medication lists to a shared medication list increased the availability of information: from being time consuming or not possible to access from other care givers to most information being available in one place. A regionally shared medication list was perceived as having the potential to provide a greater accuracy of information, but not always: the shared medication list was perceived as more complete but with more non-current drugs. On the other hand, a shared medication list implied an increased risk of violating patient privacy, placing greater demands on IT security in order to protect the confidentiality of information. Conclusion Physicians perceived a regionally shared medication list to increase the availability of information about current prescriptions and potentially the accuracy but may decrease the confidentiality of information. To implement a shared medication list, we recommend providing clear description of responsibilities and routines for normal activities as well as back-up routines, consider IT-security and data protection early, involve patients to improve the accuracy of the list as well as to monitor and evaluate the implementation.
Similar content being viewed by others
References
Hovstadius B, Hovstadius K, Astrand B, Petersson G. Increasing polypharmacy—an individual-based study of the Swedish population 2005–2008. BMC Clin Pharmacol. 2010;10:16.
Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc. 2008;15(5):585–600.
Bates DW, Cohen M, Leape LL, Overhage JM, Shabot MM, Sheridan T. White paper—reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc. 2001;8(4):299–308.
Roughead EE, Kalisch LM, Barratt JD, Gilbert AL. Prevalence of potentially hazardous drug interactions amongst Australian veterans. Br J Clin Pharmacol. 2010;70(2):252–7.
Wester K, Jonsson AK, Spigset O, Druid H, Hagg S. Incidence of fatal adverse drug reactions: a population based study. Br J Clin Pharmacol. 2008;65(4):573–9.
Kongkaew C, Noyce PR, Ashcroft DM. Hospital admissions associated with adverse drug reactions: a systematic review of prospective observational studies. Ann Pharmacother. 2008;42(7):1017–25.
Leendertse AJ, Visser D, Egberts AC, van den Bemt PM. The relationship between study characteristics and the prevalence of medication-related hospitalizations: a literature review and novel analysis. Drug Saf. 2010;33(3):233–44.
Jonsson AK, Hakkarainen KM, Spigset O, Druid H, Hiselius A, Hagg S. Preventable drug related mortality in a Swedish population. Pharmacoepidemiol Drug Saf. 2010;19(2):211–5.
Howard RL, Avery AJ, Howard PD, Partridge M. Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study. Qual Saf Health Care. 2003;12(4):280–5.
Tully MP, Kettis A, Hoglund AT, Morlin C, Schwan A, Ljungberg C. Transfer of data or re-creation of knowledge - experiences of a shared electronic patient medical records system. Res Social Adm Pharm. 2013;9(6):965–74.
Sinnemaki J, Sihvo S, Isojarvi J, Blom M, Airaksinen M, Mantyla A. Automated dose dispensing service for primary healthcare patients: a systematic review. Syst Rev. 2013;2:1.
Sjoberg C, Edward C, Fastbom J, Johnell K, Landahl S, Narbro K, et al. Association between multi-dose drug dispensing and quality of drug treatment–a register-based study. PLoS One. 2011;6(10):e26574.
McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O’Reilly D, et al. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc. 2012;19(1):22–30.
Tamblyn R, Poissant L, Huang A, Winslade N, Rochefort CM, Moraga T, et al. Estimating the information gap between emergency department records of community medication compared to on-line access to the community-based pharmacy records. J Am Med Inform Assoc. 2014;21(3):391–8.
Rahmner PB, Gustafsson LL, Holmstrom I, Rosenqvist U, Tomson G. Whose job is it anyway? Swedish general practitioners’ perception of their responsibility for the patient’s drug list. Ann Fam Med. 2010;8(1):40–6.
Janzek-Hawlat S, Ammenwerth E, Dorda W, Duftschmid G, Hackl W, Horbst A, et al. The Austrian e-Medikation pilot evaluation: lessons learned from a national medication list. Stud Health Technol Inform. 2013;192:347–51.
Stock R, Mahoney ER, Gauthier D, Center L, Minniti M, Scott J, et al. Developing a Community-Wide Electronic Shared Medication List. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 4: Technology and Medication Safety). Advances in Patient Safety. Rockville (MD)2008.
Ekedahl A, Brosius H, Jonsson J, Karlsson H, Yngvesson M. Discrepancies between the electronic medical record, the prescriptions in the Swedish national prescription repository and the current medication reported by patients. Pharmacoepidemiol Drug Saf. 2011;20(11):1177–83.
Balon J, Thomas SA. Comparison of hospital admission medication lists with primary care physician and outpatient pharmacy lists. J Nurs Scholarsh. 2011;43(3):292–300.
Picton C, H. W. Keeping patients safe when they transfer between care providers—getting the medicines right. 2012;288(7710):718.
Linsky A, Simon SR. Medication discrepancies in integrated electronic health records. BMJ Qual Saf. 2013;22(2):103–9.
Fitzsimons M, Grimes T, Galvin M. Sources of pre-admission medication information: observational study of accuracy and availability. Int J Pharm Pract. 2011;19(6):408–16.
Tamblyn R, Huang AR, Meguerditchian AN, Winslade NE, Rochefort C, Forster A, et al. Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial. Trials. 2012;13:150.
Leonhardt KK, Pagel P, Bonin D, Moberg DP, Dvorak ML, Hatlie MJ. Creating an Accurate Medication List in the Outpatient Setting Through a Patient-Centered Approach. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools). Advances in Patient Safety. Rockville (MD)2008.
Teinila T, Kaunisvesi K, Airaksinen M. Primary care physicians’ perceptions of medication errors and error prevention in cooperation with community pharmacists. Res Social Adm Pharm. 2011;7(2):162–79.
Weeks DL, Corbett CF, Stream G. Beliefs of ambulatory care physicians about accuracy of patient medication records and technology-enhanced solutions to improve accuracy. J Healthc Qual. 2010;32(5):12–21.
Ekedahl A. Patients’ information on their prescribed current treatment. Journal of pharmaceutical health services research. 2012;3(2):79–84.
Remen VM, Grimsmo A. Closing information gaps with shared electronic patient summaries: how much will it matter? Int J Med Inform. 2011;80(11):775–81.
Vogelsmeier A, Pepper GA, Oderda L, Weir C. Medication reconciliation: A qualitative analysis of clinicians’ perceptions. Res Social Adm Pharm. 2013;9(4):419–30.
van Deursen N, Buchanan WJ, Duff A. Monitoring information security risks within health care. Computers & Security. 2013;37:31–45.
Neame R. Effective sharing of health records, maintaining privacy: a practical schema. Online J Public Health Inform. 2013;5(2):217.
Ljungberg C. Prerequisites and responsibility for appropriate prescribing - the prescribers view [dissertation]. Uppsala: Uppsala Universitet; 2010.
Kierkegaard P. E-Prescription across Europe. Health and Technology. 2012;3(3):205–19.
Kierkegaard P. eHealth in Denmark: A Case Study. J Med Syst. 2013;37(6):9991.
Kierkegaard P. Electronic health record: Wiring Europe’s healthcare. Computer Law & Security Review. 2011;27(5):503–15.
Deutsch E, Duftschmid G, Dorda W. Critical areas of national electronic health record programs-is our focus correct? Int J Med Inform. 2010;79(3):211–22.
Suna T. Finnish National Archive of Health Information (KanTa). Fujitsu Sci Tech. 2011;47(1):49–57.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.
Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–40.
Ekedahl A, Tärning E, Rutberg H, Yngevesson M, Hoffman M. [In Swedish] [Errors in the pharmaceutical and prescription lists are very common. Patient data on prescriptions compared with medical records and prescription database] Mycket vanligt med fel i läkemedels- och receptlistorna. Läkartidningen. 2012;109(20-21).
Rosenthal TC. The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med. 2008;21(5):427–40.
Midlöf P. Drug-related problems in the elderly - Interventions to improve the quality of pharmacotherapy [dissertation]. Lund: Lund University; 2006.
Powell J, Fitton R, Fitton C. Sharing electronic health records: the patient view. Inform Prim Care. 2006;14(1):55–7.
Keers RN, Williams SD, Cooke J, Ashcroft DM. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Saf. 2013;36(11):1045–67.
Keers RN, Williams SD, Cooke J, Ashcroft DM. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Ann Pharmacother. 2013;47(2):237–56.
Jokela P, Karlsudd P, Östlund M. Theory, method and tools for evaluation using a systems-based approach. Electronic Journal of Information Systems Evaluation. 2008;3(11):197–212.
Wallerstedt SM, Fastbom J, Johnell K, Sjoberg C, Landahl S, Sundstrom A. Drug treatment in older people before and after the transition to a multi-dose drug dispensing system–a longitudinal analysis. PLoS One. 2013;8(6):e67088.
Hammar T, Nyström S, Petersson G, Rydberg T, Åstrand B. Swedish pharmacists value ePrescribing: a survey of a nation-wide implementation. J Pharm Health Serv Res. 2010;1(1):23–32.
Montelius E, Astrand B, Hovstadius B, Petersson G. Individuals appreciate having their medication record on the web: a survey of attitudes to a national pharmacy register. J Med Internet Res. 2008;10(4):e35.
Acknowledgements
The authors thank Benny Pun, BSc, for assistance with litterature search and translation of some material for the manuscript.
Funding
Funding by the Swedish Civil Contingencies Agency, the Swedish Medical Products Agency and Linnaeus University.
Conflicts of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hammar, T., Ekedahl, A. & Petersson, G. Implementation of a shared medication list: physicians’ views on availability, accuracy and confidentiality. Int J Clin Pharm 36, 933–942 (2014). https://doi.org/10.1007/s11096-014-0012-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-014-0012-0