Drug information technology shouldn’t be an experiment

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Health informatics is almost 50 years old. Many clinicians practicing today are digital natives, and information solutions are embedded throughout the curriculum. But with Big Tech and venture capitalists constantly changing bets, is it time to invest in clinical-centric technology approaches instead?

Funding for health information technology is at an all-time high and new “experiments” are being announced almost daily. Just in March, Microsoft sold Watson Health ‘assets’ including Micromedex to Francisco Partners and acquired Nuance. And Google announced a new partnership between Google Health and Meditech to “work together on an integrated clinical solution”. Some may remember that in 2008, the main objective and purpose for Google Health was to “unify digital health records and data.” This was dropped four years later.

Is it time to invest in clinical-centric approaches from proven organizations to improve healthcare decisions and patient outcomes?

Principles of clinic-centric informatics approaches

When it comes to drug reference and clinical decision support (CDS) technology, clinicians need to be able to trust the solutions they refer to every day and immediately see the value they derive from them, without further burdening their workflow. If you ask them what the standard should be for these solutions, they almost invariably come back to the same four general principles: accuracy, applicability, accessibility, and interoperability.

For healthcare leaders, IT and technology solutions are very expensive. But not getting the right information at the point of care is a major safety risk and can mean the life or death of patients. Investing in clinic-centric IT approaches that leverage stakeholders with a proven commitment to better care decisions can make a big difference.

1. Accuracy

New evidence is constantly being released, but not all of it is equal, meaningful, or applicable. And, just like health care data, the clinical evidence and guidelines that underpin the practice of evidence-based medicine change over time.

In July 2021, researchers from the Jameel Clinic at Massachusetts Institute of Technology worked with Stat News to understand whether popular sepsis detection algorithms have held up over time. Three algorithms were tested at three-year intervals on a database of 40,000 patients admitted to intensive care units at Beth Israel Deaconess Medical Center between 2008 and 2019.

The result? According to the Stat article“Instead of transforming care, algorithms have crumbled in the face of rapidly changing clinical conditions – unable to keep up with the pace of change. Their fragility reveals gaping holes in product governance including silent deterioration in hospitals across the country threatens to mislead doctors and compromise patient safety.

This means that the content of these solutions must go through a rigorous development and maintenance process for accuracy and reliability over time. This process can only be performed by physicians and pharmacists who:

  1. Have first-hand experience in clinical practice
  2. Are trained to understand the different types and quality of evidence
  3. Are trained to write clinical recommendations which can then be approved by independent experts
  4. Are supported by trained medical writers for digital publishing

Nada Al-Qadheeb, PharmD, BCCCP, FCCP, FCCM, is a Critical Care Clinical Pharmacy Consultant, Head of Pharmaceutical Care and Formulary Management Affairs for the Eastern Health Cluster (EHC), which includes 22 hospitals and was the first organized in the Kingdom of Saudi Arabia under the national plan Vision 2030.

Dr Al-Qadheeb was also a consultant for the Lexicomp® editorial team for nearly 10 years. She is one of more than 300 expert consultants, many leading specialists and sub-specialists in the United States and abroad, who are regularly called upon by publishers to verify new drug additions and product updates. new evidence to existing monographs. These requests are classified as urgent or non-urgent.

Of the editorial process, she says, “I know the details that go into publishing a monograph. I know the rigor behind the content. There are always several internal pharmacy specialists and external consultants reviewing my comments, and other specialists focus on sections such as adverse drug events (ADRs) or dosing areas. For us, we fight for Lexicomp.

2. Applicability

The content of health IT solutions must be contextualized and organized in a way that clinicians know and understand the delivery of care, and this goes far beyond publishing drug labels or evidence.

Nada was first introduced to Lexicomp in 2011 while doing her fellowship in Critical Care Pharmacy at Tufts Medical Center and Northeastern University. At the time, publishers were beginning to build the Lexi-Drugs Multinational drug database and were looking for consultants outside of the United States.

“As a Lexicomp content consultant, I am asked specific questions about the practice of specific drugs in Saudi Arabia, what I would like to add to the monographs to reflect current best practice and the regional perspective, and what is the evidence The editors then discuss and decide if there is enough to support adding new local guidelines to the monograph.

But context is more than location. When asked about the specific types of information his pharmacists need, Dr. Al-Qadheeb cites dosing, kidney failure, pediatric dosing, off-label indications, cancer drugs, management of antimicrobials, IV compatibility, trauma care, and the list goes on.

This level of information is also essential for service expansion and quality initiatives. For EHC, international accreditations are very important and drug reference content that meets these standards is a must.

“International accreditations mean that institutions like ours meet or exceed specific quality and safety standards that are globally recognized by our profession. It also brings comfort and confidence to our clinicians and patients. Everyone feels safer.

Having accreditations also helps to scale research, such as being able to get more clinical trials approved and enroll more patients, and to affiliate with other hospitals, centers universities and research centers.

A year ago, as the Covid-19 pandemic raged, King Fahad Specialist Hospital-Dammam (KFSHD) was awarded the coveted Magnet recognition by the American Nurses Credentialing Center. This was added to the accreditations of the International Joint Commission and others won by the hospitals of the cluster.

3. Accessibility

To have an impact, drug reference solutions must be used by clinicians at the time of decision-making, which varies enormously between members of the healthcare team and between different types of organizations. This means that they must be available, at hand (both physically and linguistically) and easy to use anytime and anywhere. The complete content must be viewable on mobile devices, and available directly from EHRs or other information systems, where available. Content should be responsive and written for digital and with the mindset of clinicians.

For the past two years, accessibility has been essential. Teams had to adapt to new environments and take on new roles. Dr Al-Qadheeb recalls, “We had to move a lot of pharmacists from hospital pharmacies to Covid centers or to cover primary health clinics where people with Covid symptoms went. We also had many pharmacy technicians in the vaccination centers, and I worked with other hospital pharmacy managers to make sure we had coverage when staff were sick.

4. Interoperability

Initially, interoperability consists of using solutions that respect HL7 and other internationally and locally accepted standards by which they can connect, exchange data and operate together in an IT ecosystem.

But interoperability is still too often the only concern of IT managers, and without clear guidelines and C-suite level adherence, it sometimes goes unnoticed. This is especially true in the context of limited financial resources, which most hospitals struggle with. This limitation is often exacerbated by misaligned and inflexible budgets and IT infrastructure, and a lack of planning based on measurable goals. Health IT ecosystems and solutions must be planned for measurable improvements in quality and operation.

Asked about the technology, Dr. Al-Qadheeb echoes what most healthcare leaders are going through. “We have just hired a new IT manager for the entire cluster for a global vision and coordination of our technological ecosystem. We believe in technology, but it is very expensive and we have competing priorities. And technology needs vary from cluster to cluster.

Again, she cites the example of KFSHD, the largest of the 22 hospitals in the cluster. There, teams have access to many technologies, such as the Pyxis™ automated drug delivery system, which is connected to the information system, health information system technology, infusion pumps, codes bars, etc.

Essential Medicine and Clinical Decision Technology

The first driver of technology planning is security. And because budgets are stretched and priorities shift, drug reference and CDS technology are sometimes relegated to the “nice to have” list, and choosing the most affordable option, instead of the one that made its evidence, becomes acceptable.

But in Dr. Al-Qadheeb’s mind, there is no doubt. “I know the detail and precision that goes into developing evidence-based content and guidance in Lexicomp. Each statement is verified. Other drug information tools are not as detailed. It’s a lot of work and my teams appreciate it and trust it. Practicing without Lexicomp is risky and dangerous.

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