Bugnon Benjamin, Geissbuhler Antoine, Bischoff Thomas, Bonnabry Pascal, von Plessen Christian
Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
Direction Générale de la Santé, État de Vaud, Lausanne, Switzerland.
JMIR Form Res. 2021 Jan 7;5(1):e22319. doi: 10.2196/22319.
Several countries have launched health information technology (HIT) systems for shared electronic medication plans. These systems enable patients and health care professionals to use and manage a common list of current medications across sectors and settings. Shared electronic medication plans have great potential to improve medication management and patient safety, but their integration into complex medication-related processes has proven difficult, and there is little scientific evidence to guide their implementation.
The objective of this paper is to summarize lessons learned from primary care professionals involved in a pioneering pilot project in Switzerland for the systemwide implementation of shared electronic medication plans. We collected experiences, assessed the influences of the local context, and analyzed underlying mechanisms influencing the implementation.
In this formative action research study, we followed 5 clusters of health care professionals during 6 months. The clusters represented rural and urban primary care settings. A total of 18 health care professionals (primary care physicians, pharmacists, and nurses) used the pilot version of a shared electronic medication plan on a secure web platform, the precursor of Switzerland's electronic patient record infrastructure. We undertook 3 group interviews with each of the 5 clusters, analyzed the content longitudinally and across clusters, and summarized it into lessons learned.
Participants considered medication plan management, digitalized or not, a core element of good clinical practice. Requirements for the successful implementation of a shared electronic medication plan were the integration into and simplification of clinical routines. Participants underlined the importance of an enabling setting with designated reference professionals and regular high-quality interactions with patients. Such a setting should foster trusting relationships and nurture a culture of safety and data privacy. For participants, the HIT was a necessary but insufficient building block toward better interprofessional communication, especially in transitions. Despite oral and written information, the availability of shared electronic medication plans did not generate spontaneous demand from patients or foster more engagement in their medication management. The variable settings illustrated the diversity of medication management and the need for local adaptations.
The results of our study present a unique and comprehensive description of the sociotechnical challenges of implementing shared electronic medication plans in primary care. The shared ownership among multiple stakeholders is a core challenge for implementers. No single stakeholder can build and maintain a safe, usable HIT system with up-to-date medication information. Buy-in from all involved health care professionals is necessary for consistent medication reconciliation along the entire care pathway. Implementers must balance the need to change clinical processes to achieve improvements with the need to integrate the shared electronic medication plan into existing routines to facilitate adoption. The lack of patient involvement warrants further study.
多个国家已推出用于共享电子用药计划的健康信息技术（HIT）系统。这些系统使患者和医疗保健专业人员能够在不同部门和环境中使用和管理当前用药的通用清单。共享电子用药计划在改善用药管理和患者安全方面具有巨大潜力，但事实证明，将其整合到复杂的用药相关流程中很困难，而且几乎没有科学证据来指导其实施。
本文的目的是总结参与瑞士一项开创性试点项目的基层医疗专业人员在全系统实施共享电子用药计划方面所吸取的经验教训。我们收集了经验，评估了当地环境的影响，并分析了影响实施的潜在机制。
在这项形成性行动研究中，我们在6个月内跟踪了5组医疗保健专业人员。这些组代表农村和城市基层医疗环境。共有18名医疗保健专业人员（基层医疗医生、药剂师和护士）在一个安全的网络平台上使用了共享电子用药计划的试点版本，该平台是瑞士电子病历基础设施的前身。我们对这5组人员分别进行了3次小组访谈，纵向和跨组分析了访谈内容，并将其总结为经验教训。
参与者认为，无论是否数字化，用药计划管理都是良好临床实践的核心要素。成功实施共享电子用药计划的要求是将其整合到临床常规中并进行简化。参与者强调了一个有利环境的重要性，该环境要有指定的参考专业人员，并与患者进行定期的高质量互动。这样的环境应促进信任关系，并培育安全和数据隐私的文化。对参与者来说，HIT是实现更好的跨专业沟通的必要但不充分的组成部分，尤其是在转诊过程中。尽管提供了口头和书面信息，但共享电子用药计划的可用性并未引发患者的自发需求，也没有促使他们更多地参与用药管理。不同的环境说明了用药管理的多样性以及进行本地化调整的必要性。
我们的研究结果对基层医疗中实施共享电子用药计划的社会技术挑战进行了独特而全面的描述。多个利益相关者之间的共同所有权是实施者面临的核心挑战。没有任何一个利益相关者能够构建和维护一个包含最新用药信息的安全、可用的HIT系统。所有参与的医疗保健专业人员的认可对于在整个护理路径中进行一致的用药核对是必要的。实施者必须在改变临床流程以实现改进的需求与将共享电子用药计划整合到现有常规中以促进采用的需求之间取得平衡。患者参与度的缺乏值得进一步研究。
