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Many Drugs and Many Doctors Lead to Many Mistakes
When a patient is admitted to a hospital, the current system tries to resolve this chaos through a process called medication reconciliation. The doctors compile a medication list by relying on computer records, if there are any, or more often on the patient’s memory. That information is entered into the hospital’s computer system, as are the new drugs that are inevitably prescribed, again by a number of different doctors.
Despite the use of electronic records, errors creep in. The beta blocker was stopped on admission. Should the patient restart it after discharge? He wasn’t told. He goes home with two medications for reflux: the old one he had been on and the new one he started in the hospital. Does he need both? And the patient takes nutritional supplements but doesn’t consider them medications and so didn’t mention them to the hospital staff. They are left off the list, even though supplements can alter the effectiveness of some drugs.
Much of this confusion could be relieved if there was a simple way for patients or their caregivers to list all their medications and if clinicians could easily obtain and refer to that list, with both entering updates as needed.
Introducing MyRxCloud: a cloud-based, free, ad-free, voluntary, nonprofit mobile app (also available online) that can exchange information with existing electronic health records and does nothing more than keep accurate lists of all patient medications, including prescription and over-the-counter drugs, implants, nutritional supplements, IV solutions and injectables, such as insulin and heparin.
MyRxCloud exists only in my imagination, but it’s a simple solution to the problem of mistakes in medication records. Some existing apps already include medication lists as part of managing family members’ health care (CareZone) and helping patients locate low-cost prescriptions (GoodRx). Some even pretty much do what MyRxCloud would do (MyRxList). The difference is that those apps intend to help patients but are not available to clinicians, or they are available to some clinicians but only those within a particular network. So while they may make the keeping of medication lists easier, they cannot reduce the number of medication errors caused by poor communication between patients and their doctors, or among doctors themselves.
The tricky part of implementing MyRxCloud would be “interoperability” — ensuring it is able to communicate with the computer systems in doctors’ offices and hospitals. Existing electronic health record systems are not good at talking to one another, so importing information from one system to another is at best difficult and at worst impossible. The Department of Health and Human Services wants these record systems to be interoperable by 2024, but many people think that is optimistic.
But what if the Centers for Medicare and Medicaid set up MyRxCloud and gave incentives to hospitals and prescribers to use it? What if MyRxCloud could smoothly import medication information from electronic health records? What if patient safety advocates pushed the idea of “One patient, one list” to cajole the makers of the record systems to work with MyRxCloud?
I’m not a software developer. But if we begin with the idea that the patient — not the pharmacy, hospital or prescriber — owns her list of medications and work backward from that, for the sole purpose of creating and then curating a singularly accurate drug list to keep her safe and healthy, I imagine it could be done.