NHI-PharmaCloud in Taiwan—A preliminary evaluation using the RE-AIM framework and lessons learned

Huang, San‐Kuei; Wang, Pen-Jen; Tseng, Wen-Fuh; Syu, Fei-Kai; Lee, Miaw Chwen; Shih, Ru-Liang; Sheen, Mao-Ting; Chen, Michael S.

doi:10.1016/j.ijmedinf.2015.06.001

Cited by 26 publications

(17 citation statements)

References 19 publications

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“…Another example can be seen in a health information exchange (HIE): the mobilization of health care information electronically across organizations within a region, community, or hospital system [14]. Outside the U.S., PharmaCloud is a system that enables physicians at contracted medical services providers to search patients' medication records over the previous three months to prevent drug shopping [15]. Lastly, smart cards (NHI-IC cards) carry information about a patient's prescribed medications received from different hospitals nationwide.…”

Section: Rationalementioning

confidence: 99%

Health Information Technology and Doctor Shopping: A Systematic Review

et al. 2020

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Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.

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Section: Rationalementioning

confidence: 99%

Health Information Technology and Doctor Shopping: A Systematic Review

et al. 2020

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“…Duplication of medication can be defined as a patient being prescribed more than two medications of the same therapeutic class (including different doses, forms, frequencies, or routes) within an overlapping period, with one of the prescriptions being clinically redundant [ 1 - 3 ]. The duplication of medication orders is a critical issue that can result in some patients being affected by adverse drug reactions (ADRs) [ 4 - 6 ]. The potential for duplication of medications has increased, with patients visiting a greater number of different hospitals and following more extensive medication regimens.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, duplication of medications increases overall medical expenditures [ 4 - 6 ], causes serious environmental pollution, and wastes medical and social resources [ 10 , 11 ]. Each year in Taiwan, more than 3 tons of prescribed medications go unused [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In Taiwan, the National Health Insurance Administration (NHIA) has implemented approaches for sharing patients’ medical care information nationwide, including health smart cards [ 4 ] and a Web-based medication query system based on a national medication repository known as the PharmaCloud [ 4 , 15 ]. The PharmaCloud contains the most complete and up-to-date version of a patient’s medication history.…”

Section: Introductionmentioning

confidence: 99%

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A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

Yang¹,

Lo²,

Chen³

et al. 2018

JMIR Med Inform

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BackgroundA computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan.ObjectiveThis study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters.MethodsA CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter.ResultsThe CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled.ConclusionsThe CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the f...

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“…Utilizing the PharmaCloud system could decrease medication duplication and the potential cost containment could reach 2-5% of total medication expenditures. 7 According to NHIA statistics, rates of cross-hospital duplicate medication, including hypotensors, hypolipidaemics, hypoglycaemics, medication for schizophrenia, antidepressants and hypnotic tranquilizers, were reduced by 30-50% from 2014, after implementing the PharmaCloud system. It is estimated that around US $335 million (NT $10.4 billion) in medication expenditures has been saved in 2015.…”

Section: Introductionmentioning

confidence: 99%

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

Hung

Chen

et al. 2019

Brit J Clinical Pharma

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Aims The aim of this study was to improve medication reconciliation and reduce the occurrence of duplicate prescriptions by pharmacists and physicians within 72 hours of hospital admission using an intelligent prescription system combined with the National Health Insurance PharmaCloud system to integrate the database with the medical institution computerized physician order entry (CPOE) system. Methods This 2‐year intervention study was implemented in the geriatric ward of a hospital in Taiwan. We developed an integrated CPOE system linked with the PharmaCloud database and established an electronic platform for coordinated communication with all healthcare professionals. Patients provided written informed consent to access their PharmaCloud records. We compared the intervention effectiveness within 72 hours of admission for improvement in pharmacist medication reconciliation, increased at‐home medications documentation and decreased costs from duplicated at‐home prescriptions. Results The medication reconciliation rate within 72 hours of admission increased from 44.0% preintervention to 86.8% postintervention (relative risk = 1.97, 95% confidence interval [CI]: 1.69–2.31; P < .001). The monthly average of patients who brought and took home medications documented in the CPOE system during hospitalization increased by 7.54 (95% CI 5.58–20.49, P = .22). The monthly average of home medications documented increased by 102.52 (95% CI 38.44–166.60; P = .01). Savings on the monthly average prescription expenditures of at‐home medication increased by US$ 2,795.52 (95% CI US$1310.41–4280.63; P < .01). Conclusion Integrating medication data from PharmaCloud to the hospital's medical chart system improved pharmacist medication reconciliation, which decreased duplicated medications and reduced in‐hospital medication costs.

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NHI-PharmaCloud in Taiwan—A preliminary evaluation using the RE-AIM framework and lessons learned

Cited by 26 publications

References 19 publications

Health Information Technology and Doctor Shopping: A Systematic Review

Health Information Technology and Doctor Shopping: A Systematic Review

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

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