SeniorMed: Connecting Patients to their Medication Records. David M. Rind, MD, ... site that allows patients access to their electronic medication lists via the ...
SeniorMed: Connecting Patients to their Medication Records David M. Rind, MD, Ju Han Kim, MD, Elizabeth A. Sturges, A. Alfredo Morales, Engr., MS, and Patricia M. Russell Center for Clinical Computing, Beth Israel Deaconess Medical Center Harvard Medical School Background. Healthcare Associates (HCA) is a multidisciplinary academic primary care practice at Beth Israel Deaconess Medical Center. Since 1989, providers at HCA have kept electronic patient records in the Online Medical Record (OMR), ' with essentially complete electronic charting since 1992. The OMR includes a medication list that provides for direct clinician entry of outpatient medication orders. Elderly patients are at particular risk for medicationrelated problems, such as side effects, confusion about how to take medications, and medication interactions related to polypharmacy. In an attempt to improve the care of elderly patients, we have undertaken the development of SeniorMed, a web site that allows patients access to their electronic medication lists via the WWW.
may be confused about which medications they are taking. When a medication is uniquely identified, SeniorMed will be able to display a picture of that medication. The SeniorMed Web site also provides links to other sites with medical information that may be useful to elderly patients. Evaluation. A series of focus groups to determine elderly patients' feelings about using the Web for medication information found a wide diversity of opinions about both electronic communication and computer use. Some elderly patients were concerned that electronic communication would present a barrier between them and their providers, while others felt that it would enhance communication. Some elderly patients who had never used computers were reticent to consider the idea, while others were excited at the prospect and felt they could learn from their peers. Elderly patients who were already using the WWW were particularly enthusiastic about using the Web to gain information about medications. We are currently beginning patient evaluations of the SeniorMed site itself.
System. SeniorMed utilizes protocols previously developed for W3-EMRS 2'3 and CareWeb.4 The system uses HL7 queries through a site server that communicates with the underlying OMR database, which is stored in an M database system. All communications are encrypted, and communication between the SeniorMed web server and patients using browsers is done using SSL version 2.
Conclusions. We believe that elderly patients, who are at high risk for medication-related adverse events, will be able to use and benefit from sites such as SeniorMed. Direct access to medication records may empower patients to be participants in their care.
SeniorMed has been designed to be usable by elderly patients with little or no computer experience, who potentially have limitations of eyesight. An initial series of screens determine patient preferences for font size and colors; this information is stored after first entry for future use when patients return to the site. Patients must be entered in a separate database before their records are Web-exposed, so as to allow careful access control. Patients have the option to log on using either a name and static password, or a timelimited password generated by a hardware token.
References
1. Safran C, Rury C, Rind D, Taylor WC. A computer-based outpatient medical record for a teaching hospital. MD Comput 1991; 8:291-9. 2. Rind DM, Kohane IS, Szolovits P, Safran C, Chueh HC, Barnett GO. Maintaining the confidentiality of medical records shared over the Internet and World Wide Web. Ann Intern Med 1997; 127:138-41. 3. Kohane IS, van Wingerde FJ, Fackler JC, et al. Sharing electronic medical records across multiple heterogeneous and competing institutions. Proc AMIA Annu Fall Symp. Hanley & Belfus, Inc. pp. 608-12, 1996. 4. Halamka JD, Szolovits P, Rind D, Safran C. A WWW of national implementation recommendations for protecting electronic health information. J Am Med Inform Assoc 1997; 4:458-64.
The SeniorMed site presents to patients their medication records as they are stored within the OMR. Patients can communicate additions, deletions, and corrections to their medication records back to HCA, but cannot directly alter the medication database. In addition, the SeniorMed site includes a messaging center that allows secure e-mail communications with the HCA team. Patients can report side effects or other concerns, and can request medication refills. SeniorMed uses a drug database to present alternate medication names to patients who
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