Are you still taking Prozac?

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Reviewing the medication list is a routine part of the visit for patients with chronic visits, or those needing refills. This is often not such a simple task. The tools we have are flawed in the world of EMR's. They improve on the written list by making changes dynamic and instantaneous. They make doing refills much simpler.

Many med list modules are limited and assume a fairly black and white reality: The doctor ordered it. You took it. You got better.

The real world is more chaotic and variable. We need systems that allow adding qualifiers, to cover circumstances like these:

  1. I cut it back to one a day, so I wouldn’t run out before this appointment
  2. The pharmacy switched me to the one covered by my insurance
  3. They stopped that when I left the hospital. Should I still be taking it?
  4. I'm not taking it yet. I plan to get that medicine this Friday, when I get paid.
  5. I went to get it, and the copay was $75! So I didn't get it.

So the modern medicine list needs to accommodate the vagaries of the real world. Here are some of the features needed in an ideal EMR medication module:

    The basics (you can skip over this section!):
    1. name of drug (generic and brand name)
    2. dosage and form
    3. when and how taken (in patient-friendly language, and large-enough font for age)
    4. purpose (the reason, not the ICD-9 description)
    5. start and stop dates
    6. quantities
    7. number of refills
    8. refill dates
    9. who prescribed it
    Other predictable features that are needed, but rarely present today:
    1. Danger signs (e.g. symptoms to report promptly)
    2. Monitoring required (e.g. periodic lab)
    3. Notes about side-effects, dose adjustments, food-drug or drug-drug interactions to be alert for.
    Weird events that are harder to describe:
    1. I ran out ____ days/weeks/months ago.
    2. I was about to run out, so I reduced the dose by ____% about ____ days/weeks/months ago.
    3. I thought it was causing me problems/wasn't working, so I reduced/increased the dose.
    4. I forget a lot of doses, especially the evening ones.
    5. I ran out of the Nexium, so your nurse gave me some Prevacid samples, and my sister had some left-over Protonix she gave me for a couple weeks.

Can you think of other weird events to consider in the ideal med list design?

Notes:
For a model med list, see: Med List (a Microsoft Word document) from the Massachusetts Coalition for the Prevention of Medical Errors. It includes a number of helpful features to promote safety and clear communication.