Evaluation Report On Prince Edward Island: Improving Patient Safety And Health

Evaluation

Discuss about the Evaluation Report On Prince Edward Island.

The PEI or Prince Edward Island information system is a province wide computer system introduced in Canada, which enables healthcare providers and pharmacists to access the centralized medication profile (Bassi & Lau, 2013). These information systems enable their authorized users to share, manage, safeguard and access patient’s medicinal history. According to Jeff Jardine who is a pharmacist at Prince Edward Island Drug Information System has helped and contributed a lot to improve patient’s safety and health. He explains “ It helps us in catching up with past records of our patients even when they had went to some other pharmacist. This helps me to prevent any drug interaction or allergy that I may not be aware of. It helps me to see the complete picture at one go”. He explains how people find it difficult to remember the dosage they have to take.  Having a drug information system enables us to prepare a prescription according to their condition. (Borycki, Kushniruk,& Carvalho,2013)

The implementation of this program in provincial pharmacies and community started in the year 2008 and the implementation with physicians and healthcare centers are still going on (Aung, & Whittaker,2013). In this evaluation the project life cycle is considered for early benefits, oppurtunities for improvement and improvements that have occurred since 2009. A framework was created for the evaluation based on these questions:-

• Implementations Questions-
• Was the Drug Information System implemented as planned?
• Was the change management effective? 

• Outcome questions-
• If the Drug Information system is achieving the objectives and whether it is giving stakeholder benefits?
• If the Drug information systems achieving stated objectives for the patients 

Questions that are asked for the implantation process are answered fully through a description based on mandates and documents from the year 2015 benefit evaluation, whereas the questions that were asked for the outcome related part were answered based on the end user survey and administrative data review. (Lau, Kuziemsky, Price, & Gardner,2010) 

The data that was used in this evaluation was collected in two ways, the administrative data was collected from the Drug information system warehouse. Other than that a survey of physicians, health care providers and pharmacists was also used from the Drug information system.

The data that was used from the Drug Information system warehouse was used to study the outcomes of limited number of physicians, patient’s, the overall system and pharmacists. The Drug Information System is still being rolled out to the physicians in different contexts therefore the outcomes of the target group would vary. However for now the focus is on system outcomes, pharmacists and patients. Descriptive statistics are used to analyse the data that was relevant.

Methods

All the people who were using Drug Information System irrespective whether they were health care providers, patients and pharmacists were interviewed about their experience with the system. The survey was developed by Canada Health Infoway and covered dimensions such as information, service quality, improvements, system functions and system that were changed since its introduction. Infoway’s aim is to ensure that all Canadians profiles are stored in the jurisdiction drug information repository. This information has to be made available for the authorized clinicians. Till 2014 about 60% of the Canadians information was stored in this system that is triple than the numbers that were achieved in 2006 (Kushniruk, Kaipio, Nieminen, Hyppönen, Lääveri, Nohr, Kanstrup, Berg Christiansen,  Kuo, & Borycki, 2014 )An email invite was sent to the Prince Edward Island pharmacists and those were counted in the survey who actively responded to the email. Number of dimensions were used in the survey and some of these were- Profession (whether respondent’s is a physician, pharmacist, or health care professional), Work Location (which county did the respondent belong to), Length of use (how long have they been using the system), and computer proficiency (how proficient were they in using computers). (Smylie, & Firestone, 2015), (Borycki,& Kushniruk, 2010)

As the period that the system has been online is quite long before this evaluation the limitations were alleviated due to the lengthy period (Gooch & Roudsari ,2011)There were many improvements from the previous evaluation as now no paper based surveys were used but emails were used to submit the surveys.

Implementation and change management process:-

The Prince Edward Island information system met the targets that were set by Canada Health Infoway or CHI. This system has been exceptionally useful. But the physician uptakes have not geared up in speed, even now therefore it is realized that the full benefits of this system has still not met. There has been valid evidence that end user satisfaction is suffering due to the lack of physicians as visible improvements are needed in recruiting physicians for this system. In our investigation we found out that there has been steady drop in on-going support and training of physicians that are added for the system training. (Zinszer, Tamblyn, W Bates,&  Buckeridge,2013)

Drug information system outcome:-

Data was made available from the drug information system warehouse that was about the service quality indicators and patient outcomes. Data was reviewed in areas about multiple prescribers, drug utilization reviews, patient compliance, patient’s profiles views according to location, time required for to resolve tickets by DeltaWare system and senior’s medication use. We observed the first two years period for the first stage users for the time the drug information system was made available online. Baseline numbers are used to track and control issues related to poly pharmacy behavior, senior medication use, ticket resolution time, poly-doctor behavior, patient’s profile views, DUR messaging and patient compliance based on achievements in pharmacist and patient’s outcomes. Majority of these baseline numbers are also used to track the physician intake and its effects. (Lau, Price, Boyd, Partridge, Bell, & Raworth,2013)

Administrative Data Review

The aim of the Drug Information system was to link the sites across province and settings in a database of electronic records of the patients. This centralized medical database was accessible from the Drug Information system that provided information about drug allergies and prescribed medications. Through this Drug Information System the healthcare workers can record, manage and view any information about the drug online. They can also interact with the decision supporting tools and can prescribe medications online.

Number of benefits was proposed to the key stakeholders.

Patients:-

• Patient satisfaction level will be increased by the use of this system
• Treatments will be enhanced to a better level through this Drug Information System
• As medical professionals will have a shared view, counseling of the patients will be better.
• This shared view will ensure better communication between health care providers and health facilities providers
• This will reduce the hospital stay and physician visits.

Pharmacies/pharmacists

• The efficiency for the care of the patients is greatly increased through cognitive services and professional counseling
• Patients that are under multiple providers are benefited by improved drug therapy management
• Reduced risk of dispensing and medication errors

Physicians

• As the physicians are able to access complete information about the patient, the effectiveness of the care automatically improves
• This system ensures that physicians get an ability to intervene in any inappropriate drug use
• Physicians also get access to discharge medication through the health facility data

Administrative data from the Data Information System provides insights into groups such as pharmacists and patients.  This system till now is being used by very few physicians therefore data related to their use is limited.

It is crucial that the patients fill the prescriptions properly as only that information can ensure that they get proper medications from the physicians. As the Drug Information System had been online for more than two years the data available is greater than any sample taken for a month.

Multiple Prescribers

It is key concern in the health care sector that there are multiple prescribers that have to be dealt with. Through this system it is possible to poly doctor.

Seniors medication use

One of the functions that this system served is to effectively track seniors (>65 years)( Lafortune, Huson, Santi, & Stolee,2015)

Most common medications that were prescribed

When the data was entered about the most commonly prescribed medications a picture was provided about the common drugs being prescribed to the patients of Prince Edward Island patients.

These medications were most commonly prescribed to patients from Prince Edward Island:-

• NOVO-Hydrazide
• Metadol
• Lipitor
• Celebrex
• RATIO-Salbutamol-HFA
• RATIO-Omeprazole
• Synthriod
• Plavix
• Crestor
• APO-Ramipril

Through this list we can denote that the majority of patients are suffering from asthma and cardiovascular diseases.

The Drug Information System is being used by a number of pharmacists who are viewing profiles of patients. But even the compliance of pharmacists can be tracked through this system by viewing the Drug Utilization Reviews. (Whittaker, Hodge, E Mares, & Rodney,2015)

System outcomes

The frequency of the use of the Drug Information System is determined by the number of patient’s profiles views by the pharmacies.( Nutley,&  Reynolds,2013)

The survey covered areas such as service use, satisfaction, service quality and information. Respondents were asked whether they were satisfied with the system. System Quality was another area that was asked about (McGinn, Gagnon, Shaw, Sicotte, Mathieu, Leduc, Grenier, Duplantie, Abdeljelil, & Légaré, 2012) Service quality of the system whether it is unacceptable, acceptable or neither unacceptable nor acceptable. Results of the survey showed that respect to satisfaction has been made in quality of care, the relevance of information, focus of the work and the speed of the information. The progress was slow due to the lack of physicians and lack of coordination in training and information.  (Ahanhanzo, Ouedraogo, Kpozèhouen, Coppieters, Makoutodé, & Dramaix ,2015),( Aminpour, Sadoughi, & Ahamdi,2014)  (Choi, 2012)

Pharmacist, Health Care Provider Study and Physician

The areas such as provider efficiency, actual use, system functionality, intention and system functionality are the Pan Canadian Indicators. The Drug Information system is a fit for these indicators. 

 There are many disadvantages of Drug Information systems like the Prince Edward Island Drug information system:-

• Lack of job security and Unemployment:- these system do save a lot of time and efforts after their implementation. Time required doing a lot of paperwork and labor mechanic work is saved. Financial transactions are done automatically. These tasks that were previously done by humans are done in a fraction of time by these systems. This technology usage causes humans to lose their jobs and gives rise to large scale unemployment. (Kayser, Kushniruk, Osborne, Norgaard, & Turner,2015)
• Security issues:- another threat that arises from information systems like these are hackers and thieves getting the data that are saved on these databases. The data includes medical history and personal data of numerous people. The hackers can use this sensitive information against the patients. (Jawhari, Ludwick, Keenan, Zakus, & Hayward,2016)
• Implementation costs:- the cost that is attached to implementing systems like these is huge.  

• In order to ensure that long term goals for the Data Information system are met continuity planning, reviewing of procedures and comprising change management is essential.
• In order to ensure the sound functioning of the Data Information system we need to establish strict security standards as recommended by the Attorney general.
• For better knowledge transfer and better understanding new communication should be established for Data Information system end users which will enable better understanding of the Data Information system updates and features
• Regular communications and on-site visits are required to focus on end user support and training. This would help in alleviating concerns that were pointed out in online survey with collaboration with the software vendors.
• Checking of the project documentation and Data Information system management structure to create a protocol for updates.
• With respect to the Drug utilization reviews or DUR’s system stability and response time should always be prioritized for providing efficient service.

Conclusion 

The Drug Information system is achieving the Canadian health Infoway targets by good uptake. This has been demonstrated by the data that was made available for the patient outcomes, performance monitoring, quality and safety activities. This evaluation report shows that there are definitive impacts and trends of the system. Health care providers have reported a low satisfaction with Drug information system for now but they do believe that this system is improving (Dixon, Pina, Kharrazi, Gharghabi, & Richards ,2015)It is visible that these improvements will increase over time and the system will become better with time. An ongoing impediment for the system is the limited participation of the physicians which is prohibiting in realizing the full use of the system. The level of satisfaction can be increased by role clarity, information sharing and increased communication. Satisfaction among the providers can also be increased by confirming the long term visions that were set for the Drug Information System. 

References

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Limitations

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