CancelRx case study: implications for clinic and community pharmacy work systems.

Area of Science:

• Health Informatics
• Patient Safety
• Systems Engineering

Background:

• Medication prescribing and discontinuation are complex processes involving multiple stakeholders and health IT.
• CancelRx is a health IT system designed to improve communication of medication discontinuations between clinics and pharmacies.
• Implementation occurred in a Midwest academic health system with 15 outpatient community pharmacies.

Purpose of the Study:

• To describe changes in clinic and community pharmacy work systems and their interactions regarding medication discontinuations.
• To evaluate the impact of CancelRx implementation on these processes over time.

Main Methods:

• Qualitative study involving interviews with Medical Assistants (n=9), Community Pharmacists (n=12), and Pharmacy Administrators (n=3).
• Interviews conducted at three time points: pre-implementation, 3 months post-implementation, and 9 months post-implementation.
• Hybrid analysis combining deductive content analysis (SEIPS framework) and inductive analysis.

Main Results:

• CancelRx altered medication discontinuation processes in both clinics and pharmacies.
• Clinic workflows and tasks evolved, while MA roles and communication remained variable.
• Pharmacies experienced streamlined message processing but increased workload and new errors.

Conclusions:

• The study used a systems approach to analyze disparate systems within a patient network.
• Future research should examine health IT implications for inter-system communication and the role of implementation decisions.