Envisioning for Medications Management

Nov 19, 2007 at 8:36 AM
Following on from the posting on Envisioning for Common User Interface, I’d like to use this discussion to solicit feedback in the specific scope area of Medications Management, which we define as “the development of guidance and components to facilitate and enhance the communication of a prescription or medicine order, aiding the choice, administration and supply of a medicine”.

If you have any initial thoughts on design guidance or toolkit controls for Meds Management that you think would be of greatest value for us to produce, please feel free to add them as a reply to this post.

Best regards,

Tony Rose
NHS CUI Project
Microsoft Ltd.
Dec 4, 2007 at 10:09 PM
This is a big area, crossing professional boundaries...nurses should have input as well, since they will be heavy users of these parts of the technology.

One approach would be to simply move current paper-based forms eg

MedOrderControl(inpatient use)
Prescription control
MedicationList control(MedGrid)
DrugInteractions Framework - that can be adapted to many different drug interaction modules.
MAR or Medication Administration Record - standard form in North American hospitals. An easy way in the hospital to see what's actually being given - RNs note each dose administered, etc.
ICU, CCU, NICU: often use iv meds/continuous infusions and specialized Medication Records.

GPs need a way of handling reorder requests from pharmacies as well. Would be nice to have a control that takes XML rx reorder requests, links them up with current medlist and presents them to me in vivid WPF, with one-click reorder capability...

And if your specs are to aid the choice of medicines too...are you referring to a Formulary and some form of guidelines for treating given conditions?
Dec 5, 2007 at 8:23 PM
It would be useful to start building generic/CUI Medication data input forms/templates that would guide the prescriber through the various "Prescription Types" used in secondary care. Some examples of different types of prescription are - Regular Meds - As Required Meds - Once Only Meds - Reducing Dose Meds - Variable Dose Meds - IV Infusions - Patient Group Direction Meds - At Nurses Discretion Meds.

Before creating a prescription/order the prescriber needs to decide which input form/template to select which should then ensure the correct data elements are entered for a particular "Prescription Type".
Dec 10, 2007 at 7:54 AM
Edited Dec 10, 2007 at 7:55 AM
Reply to posting from doctorg, Dec 4 at 11:09 PM

Yes, ensuring that guidance is sufficiently suited to all care settings and roles is one of our biggest challenges. Amongst the many parameters being considered, we are starting the journey by focusing on those that are most generic across all care settings and roles so that guidance will be relevant in most situations and for most people.

We are indeed considering the use of formularies in prescribing and there are plenty of challenges around 'levels' or 'types' of formularies, how restrictive they should or shouldn't be and what level of visibility is appropriate during the prescribing process.

Guidelines for treating given conditions belong to a functional area that we call "Knowledge Support". Knowledge support will be available from all functional areas, though of course it is particularly relevant in planning care and medications. Since this area is so large and complex, it is being addressed alongside medications and we are keeping a close eye on how knowledge support should integrate into all areas.
Dec 10, 2007 at 8:08 AM
Reply to posting from apg123, Wed at 9:23 PM

Providing templates for prescriptions is certainly on our list. Certain specific attributes of a medication will define what other attributes you want to define. For example, if you are prescribing an infusion, you will want a different set of input controls than if you are defining a regular medication - as you point out. The templates can have this 'intelligence' built in so that they present sets of input controls that may be dependent on previous selections. Our aim is to support a flexible solution that allows any of the attributes (and thus the template) to be changed at any point. Of course we have to do this within certain technical limitations.
Feb 1, 2009 at 9:36 PM
Edited Feb 2, 2009 at 9:07 AM
Frankly speaking, I expected to see some thing more deep through medical practice and more enriched by medical and/or health knowledge. Off course making some user controls for interface design is good but it is far from providing common clues to man machine interface problems in clinical practice. Going through day to day problems of EHR/ PMS design and implementation reveals a list of hundreds of common but hard to overcome problems. They can be seen in every medical practice and solving each of those using Microsoft tools can help several small to medium size companies working on Microsoft platforms to join you, jump ahead  and take competetive edge. Accomplishing each one needs in depth clinical knowledge, practice evaluation, adoption with several standards and robustness to satisfy academic evaluations on 'Usability and safety'. I think that your current project frame is more a technical effort and needs to upgrade to a more pervasive framework who shapes and coordinates different analytic, academic, development and evaluation efforts. Planning to form a development community may be considered. Here are some titles that I think deserve to include under the title of "Health Common User Interface" : 1- An autmoatic precordinate SNOMED CT concept processor, 2- Prescription item visualizer, 3- Medical event visualizer 4- Timelined event  control   5- Appointment item  6-Sceduling synchronizer  7- Standardized alarm control etc.

Abbas Shojaee