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Analysis of an AHRQ Project

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From September of 2004 till September of 2008 Paul Gorman of the North Lincoln Hospital conducted a project that was geared towards using information technology to improve mediation safety for the elderly in rural areas.  The primary concern of this project focuses on limiting the discrepancies that occur in the process of prescribing medication by better utilizing technology. By developing RxSafe, a new technology that brought together a myriad of medical information the project aspired to provide safer and more efficient care to their patients.

Analysis of an AHRQ Project:

“Using Information Technology to Improve Medication Safety for Rural Elders”

Paul Gorman, MD of North Lincoln Hospital, on the Oregon Coast conducted a research experiment in a nursing home to develop the RxSafe technology so as to better the “quality and the safety of medication management via the integration and utilization of medication management systems and technologies” (Gorman, 2008). The project received $1,496,748 in funds for the four yearlong study, and at its’ conclusion had stayed on budget.  Today, the Oregon Health and Science University continues to work with RxSafe program to improve and expand the impact it could have on the healthcare system (RxSafe, 2008).

The major concern of the project was the RxSafe program, and therefore the strategic plan primarily involved testing out and developing RxSafe.  As a result of creating and retooling the RxSafe program a RHIO (Regional Health Information Organization) was built that linked “medication information contained in the diverse and isolated information systems of multiple independent organizations (clinics, hospital, pharmacies)” (Gorman, 2008).  By 2005 the prototype was built, and the following 3 years were spent testing the prototype. With the conclusion of the project further development and improvement was needed, and the project was picked up by OHSU as mentioned earlier (RxSafe, 2008).

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To control the quality of health care the RxSafe program provides several tools for clinicians to standardize access to medical information so as to improve their methods of treatment.  Some of the achievements, which will help professionals in the future, have better control over the care they will provide included a system that could: 

  • “Create and maintain an organizational structure that would permit secure sharing of patient data across disparate institutions
  • Design and implement a technical architecture that could enable clinicians to view medication list information from multiple sites at the same time.
  • Create a useful and usable prototype application integrated into clinical workflow that could take advantage of this shared medication list system.
  • Conduct a formative evaluation of the impact of this system on clinical users” (Gorman 2008)

Some of these aims were accomplished by holding routine meetings with the Chronic Care Committee and doing interviews with nurses and patients, so as to better evaluate RxSafe’s impact.

AHRQ’s summary of the project did not include detailed budgetary information. So it is impossible to know exactly what was done to make sure the costs were appropriately contained. However, the fact that RxSafe was passed on to OHSU after four years suggests that there may have been no more money or allotted time to fund the research (Gorman, 2008).  

Although, it is also likely that Gorman handed RxSafe over to OHSU because he felt they could improve it in ways that North Lincoln Hospital could not. In this way the project aligns itself with both health care professionals within the hospital, and university. Not only did these professionals study and develop RxSafe, but they also implemented the prototype into their hospitals so as to best test its capabilities (Gorman, 2008). In some ways the study met success, and others it failed.

RxSafe succeeded in that it brought important groups of medical professionals together to share information. It also provided a tool that clinicians found useful, and the project successfully evaluated the capabilities of RxSafe (Gorman, 2008).  However, these successes seem to be generic, and the failures much more significant.

Gorman and the North Lincoln Hospital failed to acquire commitment and involvement from all of the different organizations that would be needed to make RxSafe effective enough to be a permanent installment in the hospital. They also failed to “achieve the complete technical integration of this medication information into existing information systems” (Gorman, 2008). These two failures make it hard to justify the costs of the project to the taxpayers. For although the program did have some successes, the project was unable to produce a program that clinicians would want to use. 

Perhaps Gorman’s major accomplishment is that he supplied OHSU with all of the information that they need to improve RxSafe so that it could be what it originally was envisioned to be.  So much work, time and money have already gone into the project that it would be silly to abandon it now. Furthermore, Gorman’s failures are not insurmountable, and with time it is completely possible that they will be overcome.

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