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Appl Clin Inform 2014; 05(04): 971-987
DOI: 10.4338/ACI-2014-08-RA-0062
Research Article
Schattauer GmbH

Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities

A Formative Evaluation
A. Tariq
1   Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
,
E. Lehnbom
1   Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
,
K. Oliver
1   Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
,
A. Georgiou
1   Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
,
C. Rowe
2   UnitingCare Ageing, Sydney, New South Wales, Australia
,
T. Osmond
2   UnitingCare Ageing, Sydney, New South Wales, Australia
,
J. Westbrook
1   Centre of Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

received: 24 August 2014

accepted: 24 November 2014

Publication Date:
19 December 2017 (online)

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Summary

Introduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.

Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.

Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.

Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014; 5: 971–987

http://dx.doi.org/10.4338/ACI-2014-08-RA-0062

Keywords

Medication administration - electronic medication administration records - residential aged care facilities - system design - formative evaluation

 

  • References

  • 1 Council APA. Guidelines for medication management in residential aged care facilities. 2007. Canberra: Australian Government; (3rd edition).
    Search in Google Scholar
  • 2 Gurwitz JH. et al. The incidence of adverse drug events in two large academic long-term care facilities. The American Journal of Medicine 2005; 118 (03) 251-258.
    CrossrefPubMedSearch in Google Scholar
  • 3 Roughead EE, Semple SJ, Gilbert AL. Quality use of medicines in aged-care facilities in Australia. Drugs Aging 2003; 20 (09) 643-653.
    CrossrefPubMedSearch in Google Scholar
  • 4 Szczepura A, Wild D, Nelson S. Medication administration errors for older people in long-term residential care. BMC Geriatrics 2011; 11 (01) 82.
    CrossrefPubMedSearch in Google Scholar
  • 5 van den Bemt PM, Idzinga JC, Robertz H, Kormelink DG, Pels N. Medication administration errors in nursing homes using an automated medication dispensing system. Journal of the American Medical Informatics Association 2009; 16 (04) 486-492.
    CrossrefPubMedSearch in Google Scholar
  • 6 Committee on Identifying, Preventing Medication Errors Philip Aspden, Julie Wolcott, Lyle Bootman J, Linda R. Cronenwett, Editors. Preventing Medication Errors: Quality Chasm Series. The National Academies Press; 2007
    Search in Google Scholar
  • 7 Hinchliffe A. Medication administration errors in care homes. NHS Wales 2010 7th April 2010, Available at www.nphs.wales.nhs.uk.
    PubMed
  • 8 Verrue CL, Mehuys E, Somers A, Van Maele G, Remon JP, Petrovic M. Medication administration in nursing homes: Pharmacists’ contribution to error prevention. Journal of the American Medical Directors Association 2010; 11 (04) 275-283.
    CrossrefPubMedSearch in Google Scholar
  • 9 Pierson S, Hansen R, Greene S, Williams C, Akers R, Jonsson M, Carey T. Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system. Quality & Safety in Health Care 2007; 16 (04) 297-302.
    PubMedSearch in Google Scholar
  • 10 Bates DW, Gawande AA. Improving Safety with Information Technology. New England Journal of Medicine 2013; 348 (25) 2526-2534.
    PubMedSearch in Google Scholar
  • 11 Committee on Patient Safety and Health Information Technology, Institute of Medicine. Health IT and Patient Safety: Building Safer Systems for Better Care. The National Academies Press; 2012
    Search in Google Scholar
  • 12 Forni A, Chu HT, Fanikos J. Technology utilization to prevent medication errors. Current Drug Safety 2010; 5 (01) 13-18.
    CrossrefPubMedSearch in Google Scholar
  • 13 McKibbon KA. et al. Enabling medication management through health information technology. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011
    Search in Google Scholar
  • 14 Chaudhry B. et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 2006; 144 (10) 742-752.
    CrossrefPubMedSearch in Google Scholar
  • 15 Clyne B, Bradley MC, Hughes C, Fahey T, Lapane KL. Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence. Clinics in Geriatric Medicine 2012; 28 (02) 301-322.
    CrossrefPubMedSearch in Google Scholar
  • 16 McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O’Reilly D, Tamblyn R, Hemens BJ, Basu R, Troyan S, Roshanov PS. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. Journal of the American Medical Informatics Association 2012; 19 (01) 22-30.
    CrossrefPubMedSearch in Google Scholar
  • 17 Scott-Cawiezell J, Madsen RW, Pepper GA, Vogelsmeier A, Petroski G, Zellmer D. Medication safety teams’ guided implementation of electronic medication administration records in five nursing homes. Joint Commission Journal on Quality and Patient Safety 2009; 35 (01) 29-35.
    PubMedSearch in Google Scholar
  • 18 Vogelsmeier AA, Halbesleben JR, Scott-Cawiezell JR. Technology implementation and workarounds in the nursing home. Journal of the American Medical Informatics Association 2008; 15 (01) 114-119.
    CrossrefPubMedSearch in Google Scholar
  • 19 Barber N, Cornford T, Klecun E. Qualitative evaluation of an electronic prescribing and administration system. Quality & Safety in Health Care 2007; 16 (04) 271-278.
    CrossrefPubMedSearch in Google Scholar
  • 20 Kaplan B. Evaluating informatics applications—some alternative approaches: theory, social interactionism, and call for methodological pluralism. International Journal of Medical Informatics 2001; 64 (01) 39-56.
    CrossrefPubMedSearch in Google Scholar
  • 21 Burns P, Perkins DA, Larsen K, Dalley A. The introduction of electronic medication charts and prescribing in aged care facilities: An evaluation. Australasian Journal on Ageing 2007; 26 (03) 131-134.
    CrossrefPubMedSearch in Google Scholar
  • 22 iCareHealth. iCareHealth –Clinical and Care Management Software. 2014 Available at: http://www.icarehealth.com.au. Accessed 10/13, 2013.
    PubMedSearch in Google Scholar
  • 23 Silverman D. Doing qualitative research : a practical handbook / David Silverman. 3rd ed. SAGE; London: 2010
    Search in Google Scholar
  • 24 Mathison S. Why Triangulate?. Educational Researcher 1988; 17 (02) 13-17.
    PubMedSearch in Google Scholar
  • 25 Hägglund M, Scandurra I, Koch S. Scenarios to capture work processes in shared homecare—From analysis to application. International Journal of Medical Informatics 2010; 79 (06) e126-e134.
    CrossrefPubMedSearch in Google Scholar
  • 26 Nolan TW. System changes to improve patient safety. BMJ: British Medical Journal 2000; 320 7237 771.
    CrossrefPubMedSearch in Google Scholar
  • 27 Burton-Jones A, Straub Jr. DW. Reconceptualizing system usage: An approach and empirical test. Information Systems Research 2006; 17 (03) 228-246.
    CrossrefPubMedSearch in Google Scholar
  • 28 Tariq A, Georgiou A, Westbrook J. Medication errors in residential aged care facilities: A distributed cognition analysis of the information exchange process. International Journal of Medical Informatics 2013; 82 (05) 299-312.
    CrossrefPubMedSearch in Google Scholar
  • 29 Koppel R, Kreda DA. Healthcare IT usability and suitability for clinical needs: Challenges of design, work-flow, and contractual relations. Studies in Health Technology and Informatics 2010; 157: 7-14.
    PubMedSearch in Google Scholar
  • 30 Harrison MI, Koppel R, Bar-Lev S. Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis. Journal of the American Medical Informatics Association 2007; 14 (05) 542-549.
    CrossrefPubMedSearch in Google Scholar
  • 31 Nanji KC, Rothschild JM, Boehne JJ, Keohane CA, Ash JS, Poon EG. Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. Journal of the American Medical Informatics Association 2014; 21 (03) 481-486.
    CrossrefPubMedSearch in Google Scholar
  • 32 Odukoya O, Chui MA. Retail pharmacy staff perceptions of design strengths and weaknesses of electronic prescribing. Journal of the American Medical Informatics Association 2012; 19 (06) 1059-1065.
    CrossrefPubMedSearch in Google Scholar
  • 33 Niazkhani Z, Pirnejad H, Van der Sijs H, de Bont A, Aarts J. Computerized Provider Order Entry System–Does it Support the Inter-professional Medication Process?. Methods of Information in Medicine 2010; 49: 20-27.
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Pirnejad H, Bal R, Berg M. Building an inter-organizational communication network and challenges for preserving interoperability. International Journal of Medical Informatics 2008; 77 (12) 818-827.
    CrossrefPubMedSearch in Google Scholar
  • 35 Ellingsen G, Monteiro E. Seamless integration: standardisation across multiple local settings. Computer Supported Cooperative Work (CSCW) 2006; 15 5–6 443-466.
    PubMedSearch in Google Scholar
  • 36 Robertson T, Li J, O’Hara K, Hansen S. Collaboration within different settings: A study of co-located and distributed multidisciplinary medical team meetings. Computer Supported Cooperative Work (CSCW) 2010; 19 (05) 483-513.
    CrossrefPubMedSearch in Google Scholar
  • 37 Schmidt K. Remarks on the complexity of cooperative work. In: Pascal S, Benchekroun TH. editors. Cooperation and Complexity in Sociotechnical Systems, [special issue of] Revue des sciences et technologies de l’information, [série] Revue d’intelligence artificielle (RSTI-RAI). vol. 16, no. 4–5 Paris: Hermes/Lavoisier; 2002. p 443-448.
    Search in Google Scholar
  • 38 Schmidt K, Simone C. Coordination mechanisms: Towards a conceptual foundation of CSCW systems design. Computer Supported Cooperative Work: CSCW: An International Journal 1996; 5 2–3 155-200.
    CrossrefPubMedSearch in Google Scholar
  • 39 Yu P, Zhang Y, Gong Y, Zhang J. Unintended adverse consequences of introducing electronic health records in residential aged care homes. International Journal of Medical Informatics 2013; 82 (09) 772-788.
    CrossrefPubMedSearch in Google Scholar
  • 40 Edwards PJ, Moloney KP, Jacko JA, Sainfort F. Evaluating usability of a commercial electronic health record: A case study. International Journal of Human-Computer Studies 2008; 66 (10) 718-728.
    PubMedSearch in Google Scholar
  • 41 Chiasson MW, Davidson E. Pushing the contextual envelope: developing and diffusing IS theory for health information systems research. Information and Organization 2004; 7 14 (03) 155-188.
    CrossrefPubMedSearch in Google Scholar
  • 42 Berg M, Goorman E. The contextual nature of medical information. International Journal of Medical Informatics 1999; 56 (01) 51-60.
    CrossrefPubMedSearch in Google Scholar
  • 43 Karsh B, Weinger MB, Abbott PA, Wears RL. Health information technology: fallacies and sober realities. Journal of the American Medical Informatics Association 2010; 17 (06) 617-623.
    CrossrefPubMedSearch in Google Scholar
  • 44 Borycki EM, Kushniruk AW. Towards an integrative cognitive-socio-technical approach in health informatics: analyzing technology-induced error involving health information systems to improve patient safety. The Open Medical Informatics Journal 2010; 4: 181-187.
    CrossrefPubMedSearch in Google Scholar
  • 45 Lawler EK, Hedge A, Pavlovic-Veselinovic S. Cognitive ergonomics, socio-technical systems, and the impact of healthcare information technologies. International Journal of Industrial Ergonomics 2011; 41 (04) 336-344.
    CrossrefPubMedSearch in Google Scholar
  • 46 Ash JS, Sittig DF, Dykstra R, Campbell E, Guappone K. The unintended consequences of computerized provider order entry: Findings from a mixed methods exploration. International Journal of Medical Informatics 2009; 78: S69-S76.
    CrossrefPubMedSearch in Google Scholar
  • 47 Redwood S, Rajakumar A, Hodson J, Coleman JJ. Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents. BMC Medical Informatics and Decision Making 2011; 11 (01) 29.
    CrossrefPubMedSearch in Google Scholar
  • 48 Koppel R, Wetterneck T, Telles JL, Karsh B. Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety. Journal of the American Medical Informatics Association 2008; 15 (04) 408-423.
    CrossrefPubMedSearch in Google Scholar
  • 49 Baxter G, Sommerville I. Socio-technical systems: From design methods to systems engineering. Interacting with Computers 2011; 23 (01) 4-17.
    CrossrefPubMedSearch in Google Scholar