Minimally disruptive medicine is needed for patients with multimorbidity: time to develop computerised medical record systems to meet this requirement

Abstract

Background Minimally disruptive medicine (MDM) is proposed as a method for more appropriately managing people with multiple chronic disease. Much clinical management is currently single disease focussed, with people with multimorbidity being managed according to multiple single disease guidelines. Current initiatives to improve care include education about individual conditions and creating an environment where multiple guidelines might be simultaneously supported. The patientcentred medical home (PCMH) is an example of the latter. However, educational programmes and PCMH may increase the burden on patients. Problem The cumulative workload for patients in managing the impact of multiple disease-specific guidelines is only relatively recently recognised. There is an intellectual vacuum as to how best to manage multimorbidity and how informatics might support implementing MDM. There is currently no alternative to multiple singlecondition-specific guidelines and a lack of certainty, should the treatment burden need to be reduced, as to which guideline might be 'dropped'. Action The best information about multimorbidity is recorded in primary care computerised medical record (CMR) systems and in an increasing number of integrated care organisations. CMR systems have the potential to flag individuals who might be in greatest need. However, CMR systems may also provide insights into whether there are ameliorating factors that might make it easier for them to be resilient to the burden of care. Data from such CMR systems might be used to develop the evidence base about how to better manage multimorbidity. Conclusions There is potential for these information systems to help reduce the management burden on patients and clinicians. However, substantial investment in research-driven CMR development is needed if we are to achieve this.

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study

“…In turn, such a system could help mitigate risks of safety resulting from inappropriate polypharmacy. 578 Developing such a CDS system is challenging as it must be capable of handling the breadth and complexity of multimorbid patients. Indeed, multimorbidity has been recognised as one of the 'grand challenges' of clinical decision support.…”

In this issue: Prerequisites for precision medicine are genomics, computerised medical record systems, and big data analytics

“…Knowing there is such a large number of different combinations is important and has implications for our potential to offer stratified, let alone precision, medicine. The CMR systems we look to support the delivery care to people with multi-morbidity – must not only offer more minimally disruptive medicine,11 they must also potentially collate data from vast numbers of possible combinations of conditions.…”

Digital disparities, complexity and patient safety: in this issue

“…There are growing numbers of people with comorbidity, all of which have their own guidance; particularly for older people, we need to practice less disruptive medicine 5. A paper by Litchfield et al .,6 looks to steer us through the dilemma created by multiple potentially conflicting guidelines and sets out how we might address these conflicts.…”