Doctors may sometimes be perceived as omniscient, but the reality is they are only human.
Unsafe practices – such as inappropriate prescriptions, inadequate monitoring, and harmful drug interactions – take their toll every year. More than 11,000 adverse drug events were reported to Health Canada in 2005, but the actual unreported numbers are much higher, according to IBM Canada research.
Many of these incidents could be prevented – if doctors had the right information at their fingertips.
The Ottawa-based Canadian Pharmacists Association (CPhA) seeks to offer them that.
The CPhA recently launched its e-Therapeutics portal, an online knowledge management system that delivers up-to-date and unbiased drug information to healthcare practitioners.
Developed in conjunction with Markham-based IBM Canada, the portal aggregates several disparate, largely paper-based sources into a centralized e-repository.
Many factors contribute to adverse drug events, says Neil Stuart, a partner in IBM Canada’s healthcare practice. The sheer number, range and complexity of drugs available today feed into the problem.
Stuart says drug therapy management is particularly difficult when patients are handed-off from one physician or specialist to another for treatment. And the aging demographics of Canadian society means more and more people need treatment for chronic conditions such as diabetes, cardiovascular disease and arthritis. “Particularly with senior patients who are taking multiple drugs, it’s hard to manage the effects without some kind of knowledge tool.”
The difficulties of keeping up with the latest information are acute for general practitioners such as family physicians. They must cover the entire gamut of illnesses, says Stuart. But the volume of material available is overwhelming. Medline, for example, a leading online database provided by the U.S. National Library of Medicine, indexes about 4,000 articles annually on coronary disease alone. “If a physician were to spend 15 minutes on each article, he would require 115 8-hour days just to stay current – and that’s just one disease,” says Stuart.
In addition to volume, e-Therapeutics also removes the biases that may exist in other sources. “This issue relates to pharmaceutical companies and the significant amount of influence they have on the prescribing of medication,” says Dr. John Maxted, associate executive director of the Mississauga-based College of Family Physicians of Canada. “They spend a lot of money on these drugs and research, and then of course they’re going to want to recover their investments by trying to sell their products. To be fair, they are required by law to outline all the contraindications and side-effects of their medications – but they also want to sell them.”
To eliminate this bias, the CPhA uses 130 authors – all experts in their medical specialty areas – to develop content for e-Therapeutics. What they come up with, in turn, is cross-reviewed by panels of clinical authorities, says Diane Conrad, director of product management, adding that the CPhA receives no funding from pharmaceutical companies.
In addition, the portal eliminates the ambiguity that U.S.-based sources (which often list medications under different brand names than what are found in Canada) may introduce, she says.
The CPhA’s compendium of pharmaceutical information, a massive tome that physicians call the “blue bible”, has long been a reliable source of information, says Maxted. Having a searchable, online version of the reference work incorporated in e-Therapeutics is a godsend. “When you’re seeing 30 to 50 patients a day in family practice, you can’t spend a lot of time looking up information or you’ll never get through your day,” he says.
E-Therapeutics is one component of the larger effort to drive Canada’s healthcare system into the electronic age. “About 70 per cent of physicians have Web access at the office, 45 per cent have a medical warning system on their PDAs, and only about 14 per cent have electronic medical records,” says Maxted. But this situation is changing rapidly, says IBM’s Stuart. “An increasing number of medical schools are requiring their students have PDAs because they’re building PDA use right into the curriculum.”
Integration of e-Therapeutics with other medical systems will be a big focus in the future. “Many provinces are in the process of introducing pharmacy information networks, which are transactional systems that manage the interface between prescribers and retail pharmacies,” says Stuart. “It would be terrific if this product could be embedded in that.”
There are many projects planned under the auspices of Canada Health Infoway, a Montr