Supporting a Medication Management Model with Digital Documents

Medication management is an approach to addressing medication-related adverse patient events. We have formulated a model of essential medication-related information components to support pharmacists undertaking this task, because there is currently little technology to support such decision-making. We believe the system should identify necessary components but not mandate their presence because of the dilemma of missing information. A possible additional answer lies in supporting communication and acknowledging the contribution of knowledge, rather than attempting to provide all possible information. Our model underpinned a document-centric approach, using XML-based XForms, to develop a decision support tool. This allowed rapid development of a simple dynamic tool that shows promise for simple decision support in the health environment

The availability of unavailable information.

Currently, developers of decision-support systems try to integrate these systems with the electronic medical record. The drawback is a limited amount of recorded medical data. System developers who face the choice between designing an integrated 'non-inquisitive' system and an integrated 'inquisitive' system need insight into the availability of information that is being missed by the support system. Therefore, we have investigated in a simulation study, the reasons why information that was being missed from the electronic medical records of patients with asthma/COPD by reviewers, had not been recorded by general practitioners. Important reasons were: the physicians had not recorded the information explicitly, they assumed the requested information to be common knowledge, and the information was available elsewhere in the electronic medical record. Also, we investigated the reasons why information that was being missed, could not be made available by the physicians. Important reasons were: the decision had been made by another decision maker, or the physician had not recorded the information at the time of the encounter. In addition to insight into the availability of missing information, system developers need to have insight into the significance of this information for the quality of the decision support, before the final choice between a non-inquisitive and an inquisitive design can be made