The over 65 population in America purchases and consumes more medications than any other age group. According to the Food and Drug Administration, they purchase more than 30 percent of all prescription medication and more than 40 percent of over the counter (OTC) medicines. Estimates are that as many as 90 percent of seniors use either herbal remedies or vitamins.

Interactions:Drug interactions are especially a concern for seniors. Some experts estimate that seniors take an average of four to five medications on a daily basis. If physicians aren’t aware of all medications a senior is taking, there is the potential for dangerous drug interactions.

To guard against an interaction, make a list of all medications, vitamins and herbal remedies that your loved one is taking. Also, beside each medication, write the contact information of the physician who prescribed the medicine. Some physicians may not realize how many other doctors their patients are seeing. Take this list to each doctor appointment and be sure that it is kept current.

Avoid Pharmacy Shopping:

With the rising cost of medications, many seniors choose to shop for the cheapest price without realizing the benefits of staying with one pharmacy. Poly-pharmacy, the “technical” name for pharmacy shopping, is often a source of confusion and drug interactions. The patient frequently overlooks the pharmacist as someone who can be of tremendous help to them. Pharmacists can often spot drug interactions, possible problems, and can possibly recommend OTC medications that can safely be taken with prescription medicines. Include the pharmacist’s information on the medication list that you provide toe ach doctor. When doctors call in a prescription, make sure that they use the same pharmacy each time.

Throw away Outdated Medicines:

Some people prefer to keep medications longer to save money on prescription costs. Don’t. Some medicines degrade over time with exposure to light and heat. Plus, you may need a different medicine the next time. If you rely on medications you have at home instead of advice from your physician, you could be headed for trouble. Be sure to call your physician before using medication that you have at home.

A special word about antibiotics: These are meant to be taken in their entirety when they are prescribed. Saving some for the next infection may cause serious health problems. Bacteria may become resistant to antibiotics and need even stronger medication the next time. Plus, for the second infection, a different class of antibiotics may be used in order to prevent resistance build-up.

Watch for Side Effects:

Seniors especially can be sensitive to new medications. Ask your doctor about possible side effects of the medication and how it may react with other medicines that you are currently taking. Most pharmacies hand out leaflets with information about drug side effects and when to contact the doctor. Read these leaflets and keep them in a safe place for future reference, especially if you have to take the medicine long-term. Caregivers need to be aware of how to cross-reference these and hand-carry them to the doctor if necessary to be sure that the right medication is being prescribed.

Borrowing or Lending Medicine:

A big concern for physicians today is taking medication intended for someone else. This is a dangerous practice that needs to be eliminated. Prescription medication should never be taken by anyone else than for whom it was intended. Other individuals have special medical histories and may also be taking other medicines that can cause serious drug interactions. By the same token, never give away your old prescription medication.

What if medication is left over and you want to donate it? The best advice here is not to donate it. Most places can’t accept medication donations and will only have to dispose of the medicine after you leave. If you think they may be able to use it, call ahead to find out. There are some outreach projects that are able to accept donated medications, providing that specific instructions are followed. Don’t assume that the charity will be able to accept your medication (or medical supplies even) without checking with them first.

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• Best practices as it relates to processing prescriptions electronically and
• Improving patient compliance with physician medication orders by utilizing electronic communications between the patient, pharmacist, and physician.

The Center educates clinicians and their staff on the best approaches to implementing prescribing technology and integrating it with the day-to-day workflow. The Center implements programs that accelerate the automation of the prescribing process. Core to automating the prescribing process is the adoption and use electronic prescribing technologies with physician-pharmacy interoperability as well as the testing of innovative approaches to improve patient compliance with prescribed medications.  Targeted research projects overseen by The Center will evaluate and establish best practices in support of these purposes.

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Clinical information systems and electronic medical records are used in hospitals and physician offices to record information about a patient’s condition, the treatment course, any prescription drugs the patient is taking (or should not take), vital signs, and so on. These systems have great potential to improve access to key healthcare information, boost patient safety, and reduce administrative costs.

However, the hospital setting holds a number of challenges. Consider a physician who, during the course of a day, visits two, three, even four hospitals to care for patients. Chances are, each hospital has its own proprietary system. It simply isn’t feasible for a physician to be fluent in every system out there. So the work slows down as the physician tries to remember how to enter or find a particular piece of patient data.

Pitfalls of hospital clinical information systems

In some cases, systems are so poorly designed and introduced that physicians refuse to use them. In 2002, at Cedars-Sinai Medical Center, physicians were so unhappy with a new order entry system that they forced the hospital to abandon it. In the worst cases, real harm can be done. Two studies in 2005 (one published in the Journal of the American Medical Association and the other in Pediatrics) indicated that poorly designed clinical information systems actually can lead to an increase in medical errors. This is ironic given that these systems are intended to reduce errors.

Many of the systems installed in hospitals in recent years are not only proprietary, they can be horrendously expensive. It’s not unusual for a 500-bed hospital to spend $150 million US to install a clinical information system. And hospital CIOs can tell you that the cost of acquiring such a system is small in comparison to training costs.

Imagine the expense to pull hundreds of highly-paid, in-demand clinical workers (from physicians down) from their responsibilities and put them through many hours of training. And keep in mind that training might be duplicated by physicians when they work at other hospitals. Physicians already commit time and expense to acquire and learn how to use the clinical systems in their own offices.

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An alternative: Design systems around physicians

It would be ideal if physicians could walk into a hospital and use the same password and log in that they use at other medical facilities. They would see an intuitive, familiar interface that has data about patients from other hospitals or from other doctors the patient has seen, whatever is relevant. As a bonus, such a system could be rules-based, depending on who signs in. Physicians could choose from a set of options about how to use the system. Nurses could choose from another set of options. Pharmacists and other medical technicians could choose from a third. This ideal system could be based on software that is more intuitive and adaptable than many systems on the market today. And every system doesn’t have to be identical or part of a larger system that attempts to tie all hospitals together or handle all tasks with a single company solution.

Such a solution is already in use by tens of thousands of ambulatory physicians who work in practices outside the four walls of the hospital. Called electronic medical records (EMR) systems, these systems streamline and automate the everyday activities of clinicians such as documenting patient visits, ordering lab tests, viewing results, and billing for services. EMR systems also enhance patient safety by alerting physicians when they fail to follow best-practice guidelines or prescribe a drug that can cause an adverse reaction in the patient.

TouchWorks EHR software designed by Microsoft partner Allscripts is one example of how ease-of-use and intuitive design can benefit the healthcare industry. Designed to work with mobility devices such as Pocket PCs and standard desktop and notebook computers, the Web-based TouchWorks EHR enables a physician to create electronic patient records in his or her office, and then easily access them using the Microsoft Internet Explorer Internet browser in a hospital setting—either through portable computers or a personal computer. Patient records, charges, drug interactions, lab orders all can be easily recorded and saved.

TouchWorks also helps control costs by enabling physicians or physician groups to purchase only those modules that meet a particular business or clinical need.

TouchWorks isn’t designed to replace the big, hospital-centric systems now found in many hospitals. But it shows how a flexible, modular system that is centered on physicians’ needs can begin to streamline and simplify how medical records are collected and kept. And TouchWorks doesn’t try to force all clinics to use the same suite of products. As Dr. Peter Geerlofs, Allscripts chief medical officer, tells me, “The monolithic approach doesn’t meet market demand. The world is going to a best-of-breed place, where people can use the best products for particular clinic needs. In TouchWorks, our architecture supports a plug-in concept, so it can be used with third-party devices and software, or particular bits of code.”

In the years to come, we could see adaptable systems that work across geographic or hospital system lines, what Geerlofs calls a decentralized federated model. In such a system, all clinical data stays within the hospital or physicians’ system that first created it. But it’s tracked by some type of record-locating service, which knows where information for particular patients is stored and enables physicians to call it up when needed (provided security parameters are met). This way, even records in New York can be read by physicians in California should a patient move or end up needing medical services far from home. Now, for example, Allscripts markets a records tool called HealthMatics ED in use by over 150 emergency departments nationwide. The data can be linked between hospitals in a community, making it faster and easier to recognize emerging problems such as a widespread virus.

Thanks to initiatives now underway to make every electronic medical record interoperable, no matter what hospital a physician visits, he or she can quickly figure out how to use it, and perhaps be able to take advantage of a common log in. I compare this challenge to that of creating airplane reservation sites. All of the major airline and travel sites look a little bit different—sometimes a lot different. But they all work very much the same. And once you use one, it’s a safe bet you can use the rest. Electronic medical records systems can profit from this example.

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WASHINGTON – Consider it the other drug problem: Millions of people don’t take their medicine correctly — or quit taking it altogether — and the consequences can be deadly.

On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week. It calls the problem a national crisis costing billions of dollars.

The government is preparing new steps to try to persuade patients and their doctors to do better.

But with contributors that range from too-hurried doctor visits to confusing pill bottles, there’s no easy solution.

“We go into this with some humility,” says Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an “in your face” campaign to improve medication adherence. “It’s really pretty appalling how badly we do.”

This goes far beyond the issue of affording prescriptions. Often people buy their drugs but misunderstand what they’re supposed to take, or how. Or forget doses. Or start feeling better and toss the rest of the bottle. Or skip doses for fear of side effects.

It’s not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is former President Bill Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery to avoid a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.

Supervising TB patients and their pills

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