JMIR Publications

ABSTRACT

Background:

Several countries have launched health information technology (HIT) systems for shared electronic medication plans (SEMPs). These systems shall enable patients and healthcare professionals to use and manage a common list of current medications across sectors and settings. SEMPs have great potential to improve medication management and patient safety. Yet their integration in the complex medication-related processes has proven difficult and there is little scientific evidence to guide their implementation.

Objective:

To summarize the learning from a pioneering pilot project in Switzerland for the system wide implementation of a SEMP system. We collected experiences of primary care professionals, assessed the influences of the local context, and analyzed underlying mechanisms influencing the implementation of the SEMP.

Methods:

In this formative action research study, we followed five clusters of healthcare professionals during six months. The clusters represent rural and urban primary care settings. Eighteen healthcare professionals (primary care physicians, pharmacists, nurses) used the pilot version of a SEMP on a secure web platform, the precursor of Switzerland’s current electronic patient record infrastructure. Participants reflected and discussed their experiences with a SEMP. We undertook three group interviews with each of the five cluster, analyzed the content longitudinally and across clusters, and summarized it into lessons learned.

Results:

Participants considered medication plan management, digitalized or not, a core element of good clinical practice. Requirements for the successful implementation of a SEMP were 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 SEMP system was a necessary, but not sufficient, building block for better interprofessional communication, especially in transitions. In spite of oral and written information, the availability of SEMPs did not generate spontaneous demand from patients or foster more engagement in their medication management. The variable settings illustrate the diversity of medication management and the need for local adaptations.

Conclusions:

The results of our study present a unique and comprehensive description of the socio-technical challenges of implementing SEMPs 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 healthcare professionals is necessary for consistent medication reconciliation along the entire care pathway. Implementers must balance the need of changing clinical processes to achieve improvements with the need to integrate the SEMP into existing routines to facilitate adoption. Given the obvious implication of patients in medication management, the lack of patient participation in the implementation of the SEMP warrants further study.