Enabling Medication Management through Utilization of Health Information Technology

This project reviewed the evidence on use and impact of health information technology (IT) in assisting all of the phases of medication management, including prescribing and ordering, order communication, dispensing, administration, and monitoring as well as education and reconciliation.  The project team searched major electronic databases including MEDLINE, EMBASE, CINAHL Cochrane, International Pharmaceutical Abstracts, Compendex, INSPEC, including IEEE, Library and Information Science Abstracts, E-Prints in Library and Information Science, PsycINFO, Sociological Abstracts, and Business Source Complete.  In addition a grey literature search was done which included an Internet search and review of relevant Web sites.  The Agency for Healthcare Research and Quality provided the project team references they had on e-Prescribing, bar coding, and computerized provider order entry (CPOE).  Gaps in the literature were identified, and recommendations on possible future research in this area were made. 

The main objective of the project was to:

• Summarize evidence on the extent to which health IT enables improved quality and safety in the medication management phases, which include but are not limited to: 1) accurate and timely prescribing of medication in response to a specific patient, 2) correct first-fill and refill dispensing of medications, 3) appropriate administering of medication, and 4) patients’ taking of the pharmaceutical treatment regimen as prescribed.

A total of 32,785 articles were identified; each was reviewed at the title and abstract level. Of these, the full text was reviewed for 4,578 articles.  A total of 789 articles were included in the final report. Three hundred and sixty-one of the articles had limited data and thus were included in the bibliography only; therefore data from 428 articles were included in the final report. The quality of the studies varied by the phase of medication management studied. The prescribing and monitoring phases had a greater number of studies, which had relatively stronger comparative methods than the other phases. Of those health IT applications which support medication management, clinical decision support and CPOE systems had the greatest number of studies. Physicians were most often the subject of the research, rather than others such as other health care professionals, patients, and families.  The team noted that each of these groups has differing needs, they value these systems in different ways, and each uses the systems differently.

In terms of settings where medication management systems are used, the literature studied hospitals and ambulatory clinics more often than long-term care facilities, communities, homes, and pharmacies outside of hospitals.  The focus of most studies was on the evaluation of changes in: process and outcomes of use; usability; and knowledge, skills, and attitudes, most of which showed moderate to substantial improvement with the adoption of these systems.  The economics of the systems and clinical outcomes were studied the least frequently. For those studies that did look at these areas, the studies were equivocal as to the effectiveness and cost-effectiveness of the systems. 

The project team concluded that health IT and medication management is well-studied, although the evidence is not even across the various phases of medication management, the groups involved, or the types of applications. Areas in which the literature is lacking includes clinical and economics studies and the understanding of sustainability issues.