Enabling Medication Management through Health IT: Review Protocol

Medication Management & Health IT
Full Title: Enabling Medication Management through Health Information Technology (Health IT)
Evidence-based Practice Center Review Protocol
Expected Release Date: late 2010

Contents
Background and Objectives for the Systematic Review
Key Questions
Analytic Framework
Methods
References
Definition of Terms
Summary of Protocol Amendments



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Background and Objectives for the Systematic Review
Medication management is one of the major components of health care. It goes beyond prescribing. Bell's medication management model1 describes a framework for evaluating systems based on their functional capabilities. The model shows the 5 phases in medication management: select and prescribe, transmit, dispense, administer, and monitor; and 14 functional capabilities for medication management systems.

Numerous information technology (IT) systems have been designed to facilitate one or more of these phases, in multiple settings across the spectrum of prescribers, patients and their informal caregivers, pharmacists, other healthcare providers, and administrators. Interventions using these systems are complex and difficult to evaluate. Medication management systems include, but are limited to, e-prescribing, Computerized Provider Order Entry (CPOE) systems, Clinical Decision Support Systems (CDSS), barcode medication administration, and patient-directed reminders to improve adherence have been summarized in review articles. Many of these reviews have concentrated on randomized controlled trials, potentially leaving out evidence important to the understanding of the likely role and challenges of health IT. Non-randomized trial evidence is important to domains such as health IT where systems are often implemented and evaluated without formal clinical trial testing.

The goal of this Evidence Report is to summarize the evidence of how health IT affects the 5-phase medication management process. The final report will concentrate on existing systems, processes, and outcomes; provide data on barriers and facilitators; and highlight areas lacking in evidence. This project is unique in that it aims to unify the evidence of all aspects of health IT in medication management in one document. The report is being produced at the behest of the AHRQ Health Information Technology branch.

Medication Management System (MMS) Components or Phases are defined as the following for this report:

•Phase 1: Prescribing (outpatient settings) and ordering (hospital and long-term care) and transitions in care venue.
•Phase 2: Transmission, verification, transformation, and communication (perfecting).
•Phase 3: Dispensing (prepared and delivered from the pharmacy).
•Phase 4: Administration (receipt and initiation of the medications).
•Phase 5: Monitoring (evaluation of the patient, medication reconciliation, patient compliance and adherence).
Education and medication reconciliation are important to all of the 5 phases. Education can refer to all people involved in the MMSs but excludes preprofessional education (medical, nursing, and pharmacy students studying before certification).

The phases are cyclical in nature and loop back to complete the total process.

Short forms of the 5 phases:

•Phase 1: Prescribing and ordering.
•Phase 2: Order communication (transmission and verification).
•Phase 3: Dispensing.
•Phase 4: Administration.
•Phase 5: Monitoring and adherence.

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Enabling Medication Management through Health IT: Review Protocol