Implementation of a Bioinformatics and Medication Management Research Network to Increase Medication

1
Implementation of a Bioinformatics and Medication
Management Research Network to Increase
Medication Safety
Gene D. Morse, PharmD, Werner Ceusters, MD,
Russell Bessette, MD, Thomas Furlani, PhD, Ranjit
Singh, MD, Amy Hayward, BS, James Notaro, RPh,
PhD, Linda Catanzaro, PharmD, Cara Felton,
PharmD, Karl Fiebelkorn RPh, MBA, Anthony
Billitier, MD, Daniel Porreca, Edward Dombroski,
RPh, MPA, PD
New York State Center of Excellence in
Bioinformatics and Life Sciences University at
Buffalo, AHRM Inc Clinical Support Services
HealtheLink Patient Safety Center, New York
State Department of Health
Methods Bioinformatics and Medication Management
Abstract
Project Status
Bioinformatics and Information Technology
Applications
A number of reports, in particular those from the
Institute of Medicine (IOM) have identified the
opportunity to enhance the quality of our health
care system. The 2006 IOM report Preventing
Medication Errors concluded that there are at
least 1.5 million preventable adverse drug events
that occur each year and account for over 7,500
deaths. One approach to this challenge is to
transition the current medication use system to
one that integrates information technology
through the use of ePrescribing, bar code
technology and digital personalized medication
histories. We hypothesize that 1) medication
errors can be reduced by making greater use of
information technologies in prescribing and
dispensing medications and, 2) medication errors
can be reduced by ensuring drug information is
communicated clearly and effectively to providers
and patients. Our pilot proposal will establish a
collaborative research network and identify the
key bioinformatics infrastructure components that
will facilitate the design and implementation of
a protocol to quantify the influence of joining
ePrescribing and bar code technology. An
additional unique feature of this proposal will
be the designation of the prescribed medication
using the RxNorm standard developed by the
National Library of Medicine. The goal of the
pilot project will be to implement a protocol
with the New York State Center of Excellence in
Bioinformatics and Life Sciences as the NYSDOH
Patient Safety Center-designated Coordinating
Center for an ePrescribing demonstration project
to compare medication safety outcomes with and
without the use of novel information technologies
during the ePrescribing process. The pilot
project will examine 1) systems and data
transfer methods used at each collaborating site,
2) novel design criteria for an ontology that
will facilitate data collection and
interpretation, and 3) the use of a web-based
approach to facilitate communication among
investigators. The pilot project will provide the
opportunity to develop a multi-institution group
that will collaborate on a series of
bioinformatics research projects with the initial
protocol using ontology to investigate approaches
to enhance medication safety.

• Establish a multi-disciplinary approach to reduce
  medication errors and enhance patient outcomes
• Identify a bioinformatics infrastructure to
  design and implement research
• Initial efforts to examine
• Data transfer methods across health systems
• Designing an ontology to facilitate data
  collection and interpretation
• Web-based approach for communication among
  investigators
• Establish a Coordinating Center through the
  designation of the NYSDOH Patient Safety Center.
• Outlook
• Complete analysis to determine optimal approach
  to organizing the collaborative group of
  practitioners (ex. hospital,
  community pharmacy) and IT applications
• Information to be collected from each site will
  include units with
• Electronic health records with e-Prescribing
  capabilities
• Investigators who are interested in collaborative
  research
• Practitioners interested and capable of providing
  patient outcomes
• Software and hardware able to contribute to
  research activities

Clinical Presentation
EHRs
Bar Coding
Supercomputing
Physical findings, Imaging, Laboratory
Disease Diagnosis
Evidence-based Pharmacotherapeutics
PHRs

Initiate Medication Regimen
Continued Medication Management
Health and Economic Outcomes



Medication Prescribed

Background
ePrescribing
Bar Coding
Medication Discontinued
Research opportunity

• Pharmacotherapeutic individualization considers
  patient-specific factors to optimize therapeutic
  interventions
• Patients pharmacokinetic characteristics,
  pharmacodynamic responses, and pharmacogenomic
  variation
• Patients ability to understand and participate
  in their treatment
• These factors provide the rationale for profiling
  drug-drug interactions and therapeutic drug
  monitoring (TDM) programs
• Pharmacogenomic testing identifies patients who
  may be at individual risk for drug-drug
  interactions, developing serious adverse events,
  or experiencing a sub-optimal response to therapy
• Clinical use of genomic testing requires
  additional investigation in order to identify the
  patients who will benefit most and educating
  clinicians on the optimal use of that testing
• Multiple data storage sites (hospitals, medical
  practices, pharmacy records, insurance databases)
  illustrate the need for integrating automatic
  approaches to augment the rate and accuracy of
  data interpretation
• The Institute of Medicine has recently advocated
  for greater integration of information technology
  and multi-disciplinary approaches to reduce
  medication errors and improve patient safety

Proposed organizational relationships and
informational technology systems to contribute to
the regional MMRN hubs
Multi-professional integration Opportunities
that exist for innovative, multi-disciplinary
research focusing on bioinformatics and
technology applications in medication management
Discussion
Collaborators

• Medication management is an important part of
  the healthcare system requiring integration of
  bioinformatics, a multi-disciplinary
  approach, and the inclusion of pharmacists as
  part of the health care team facilitating
  pharmacotherapeutic individualization
• Pharmacotherapeutic individualization is an
  approach to drug therapy that emphasizes the
  characteristics of each patient
• Pharmacokinetics, pharmacodynamic responses,
  and pharmacogenomics are recognized as integral
  aspects of medication management
• Our new collaborative research group will
  focus initially on the integration of electronic
  health record technology interfaced with
  e-Prescribing systems
• The MMRN has identified the components of the
  regional hubs that will be included in conducting
  research projects and integrating data, with
  an emphasis on investigating bioinformatics and
  medication management research questions

• Bioinformatics and Medication Management Research
  Network (BMMRN)
• New York State Center of Excellence in
  Bioinformatics and Life Sciences
• Patient Safety Center, New York State Department
  of Health
• AHRM Inc
• HealtheLink, the Western New York Clinical
  Information Exchange (WNYCIE)
• Office of the Erie County Commissioner of Health