Improving the safety of Australian medicines

More than 250,000 Australians are hospitalised each year, and another 400,000 present to emergency departments, because of medication errors, inappropriate use, misadventure or interactions, according to the Pharmaceutical Society of Australia’s Medicine Safety: Take Care report.

As these figures make clear, usability of clinical systems is an important factor in patient safety, and information about medicines, allergies and adverse reaction is among the most critical health data available in Australia’s My Health Record system. 

A poor clinical experience when accessing or entering this health data can have extremely serious consequences.

THE CHALLENGE

The complexity of the health digital ecosystem involves multiple points of care across public and private hospital networks, community pharmacies, general practice and aged care services – using different systems, different levels of digital maturity and complex interoperability challenges.

The Australian Digital Health Agency approached ThinkPlace to provide research and user-centred design capability to improve the display, usability and clinical safety of this information across the sector and to develop a roadmap to guide the agency, clinical stakeholders and developers through implementation now and in the future.

OUR RESPONSE

To gain a deep understanding of the challenges clinical users face, and how they need medicine-related information to be presented at the point of care, ThinkPlace undertook research within clinical environments – talking to doctors, hospital administrators, emergency workers, pharmacists and aged-care workers across Australia.

We also engaged in ongoing discussions with the Agency’s core team of around 30 systems and data specialists and clinical advisors to understand the interoperability of data, policy and clinical safety requirements that needed to govern the emerging designs.

HOW WE DID IT

Insights gained from our research activities were described in journey maps and a series of detailed design hypotheses. 

We then took these hypotheses and used them to develop interactive prototypes, conducting further evaluation with users through a series of agile design iterations.  

Throughout this process we tracked the evolution of the designs through the lenses of usability and clinical safety and communicated findings through weekly meetings with the Core Design Team, keeping track of the evidence, decisions and outcomes through team collaborative tools such as Trello and Confluence.

“This design process enabled a deep and collaborative user-centred design approach to efficiently and effectively inform decision making, with all decisions being made from a solid and shared understanding of the evidence base.” Project Lead Darren Menachemson. 

KEY FEATURES

• Contextual enquiry with real-world users provided deep insights into the needs of clinical users at the point of care
• User research was tracked and communicated using shared online tools by the project team
• Living and collaborative project tools enabled a clear line of sight and record of decisions made through research, prototyping and the final roadmap.
• Continuous research and validation feeding into collaborative decision making meant issues relating to governance and clinical safety were quickly identified and efficiently addressed
• The collaborative agile design methodology informed the roadmap from immediate release to future strategy.
• Evidence-based decision making meant easier prioritisation of features aligned to user need and clinical safety concerns

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THE IMPACT

Changes to My Health Record, contributed to by ThinkPlace, have been hugely impactful. 

“We are already seeing benefits being realised around improved medication management, improved decision making, reduction in adverse events and savings in time in collecting medical information at the point of care.” ADHA

One such benefit: When serious flooding washed over Townsville in early 2019 many people were cut off from resources, including patients who could not visit their regular pharmacy for essential medications.

“The biggest problem for pharmacists is people being cut off from their home pharmacies – so they’re presenting at whatever pharmacies are open, without much knowledge of their medicines and without their prescriptions,” Pharmacist Paul Willis told ajp.com.au.

“So at the moment, My Health Record is absolutely shining. The doctors are loving it, the nurses are loving it, the traditional relationships between GPs and patients don’t really exist at the moment so everyone’s trying to help each other and My Health Record is able to provide a consistent medication profile.”

The ADHA reports that: “The Medicines view was a key enhancement that has helped ADHA drive their pharmacist adoption rates over the last year... now they have nearly 5,000 pharmacies registered using the system.”

Australian pharmacies signed up to the My Heath Record system in record numbers in the 12 months to April 2019. In April 2018, only 33% of pharmacies were registered with My Health Record. A year later that figure stood at 83%. 

Pharmacists are also uploading and viewing My Health Record more often, with a 667% increase in the number of dispense records uploaded to My Health Record and a 942% increase in the number of record views, comparing April 2018 to April 2019.