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CancelRx Case Study: Implications for Clinic and Community Pharmacy Work Systems.

Taylor L Watterson1, Jamie A Stone2, Peter Kleinschmidt1

  • 1University of Wisconsin School of Medicine and Public Health.

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CancelRx improved medication discontinuation communication between clinics and pharmacies but introduced new errors and increased pharmacist workload. This health IT impacts clinical workflows and patient safety.

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Area of Science:

  • Health Informatics
  • Medication Management Systems
  • Healthcare Systems Engineering

Background:

  • Medication prescribing and de-prescribing involves complex interactions between healthcare actors, organizations, and health information technology (IT).
  • CancelRx is a health IT solution designed to automate medication discontinuation communication from electronic health records to community pharmacy dispensing platforms.
  • Implementation of CancelRx occurred in a Midwest academic health system in October 2017.

Approach:

  • A qualitative study involving interviews with Medical Assistants (n=9), Community Pharmacists (n=12), and Pharmacy Administrators (n=3).
  • Interviews were conducted at three time points: pre-implementation, 3-months post-implementation, and 9-months post-implementation.
  • Data analysis utilized deductive content analysis of transcribed interview recordings.

Key Points:

  • CancelRx altered medication discontinuation processes in both clinic and community pharmacy settings.
  • Clinic workflows and discontinuation tasks evolved, while Medical Assistant roles and staff communication remained variable.
  • Pharmacies experienced streamlined message reception but also increased workload and new error types.

Conclusions:

  • The study employed a systems approach to evaluate interconnected health IT systems within a patient network.
  • Future research should explore health IT impacts across different health systems and the influence of implementation strategies on IT adoption.
  • Assessing the role of implementation decisions is crucial for understanding health IT use and dissemination.