In part I of this blog I proposed an activity to define a single content standard for representing general patient history – something that would make it easy both for patients visiting different healthcare providers but also for researchers to better manage and utilize the information value of medical history when recruiting or enrolling clinical trial subjects. But this is only one of the ways our healthcare system annoys patients. Another is the single-most asked question when visiting any provider each and every time — “What meds are you taking?
Now, I’m disputing the need to ask. We know that many serious drug-related adverse events may stem from drug interactions, and that many patient conditions may just as well be caused as cured by certain drugs. The problem is that we seem to handle this data so poorly, and instead of following the mantra of “Collect once, use many times” providers and researchers just keep collecting over and over again – and sloppily at that.
In my case, I always keep a simple document of all the meds I’m on plus any nutritional supplements I may take with dosages and frequencies included. I print this out and bring a long a USB drive with the same material. Even so, I’m almost always asked to write it down on one of those paper forms – just like that annoying medical history form. Then someone types it into a system. Just like a game of telephone, the data may get slightly skewed with each new transcription – which is yet another reason why the question must be asked each time. At one provider (when I needed an ECG) I had to repeat it 3 times to a nurse, doctor and an intern – despite handing in the printout and copying it to their form.
When I type “medication tracker” in the Apple App Store, I get 148 hits of apps that can do this for me, and I know of websites that offer to do the same. What I can’t seem to find is a simple standard way of recording my medication use data once so that all of my providers (or any research investigators) could access a single trusted source of information for Patient Wayne. My ideal meds app would allow me to pick each med I’m taking from a list of available medications that are coded according to NCD, RxNorm and WHODRUG codes, perhaps be able to import a record of a new prescription from my docs automatically, and allow me to edit my actual usage data before my next doctor visit if I changed my habits. I’d still expect the doc to ask to confirm, but only after looking at my current official list.
There are multiple ways to make such accessible – perhaps I might have a Personal Health Record (such as the ones that Microsoft and Google were trying to power through Healthvault and Google Health). Or maybe I can just use the portal of my primary care provider and trust them to make it accessible to all the other specialists I must occasionally visit (of course, this presumes that interoperability between providers actually is functional, which hasn’t been true so far in my case to date). Or maybe it’s just an XML file on my phone that I can send on demand.
Wouldn’t this be better than having me scribble this on a form over and over, or a physician having to guess if I happened to be pulled unconscious into an ER one of these days, or with data managers having to deal with sloppy and unreliable data on a ConMeds CRF? Having ready access to reliable medication use data for patients could be a tremendous boost to pharmacovigilance and epidemiological research as well.
Yes, Interoperability should be great once it finally arrives. In the meantime, can’t we just find a simpler, standardized way for my doctors to know my meds?