Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada

Abstract

Objective: (1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE.

Methods: A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process.

Results: There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list.

Conclusions: Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.

Figure 1.

Schematic illustration of the data flow and access options to the HIE. Retail pharmacies (∼1900) send data on every dispensation of a prescribed medication for a given patient to the central data warehouse through their PMS (1). Access to data is possible for clinicians and their staff using a web-based Viewer application (2), to view data and print the ‘current’ medication list), a certified EMR application (3), to view and/or import data) or a certified PMS application and (4), to view and/or import data). Because the Canadian provinces offer a universal national health system, every patient in the province has a national health insurance number from which a medication list is automatically created in this central data warehouse. EMR: Electronic medical record; PMS: Pharmacy management system.

Figure 2.

Screen shot of the viewer application. Demo patients, image obtained from the online training accessible here http://www.ti.msss.gouv.qc.ca/DSQ-Documents-de-soutien.aspx (accessed October 10, 2016).

Figure 3.

Distribution of users and access numbers for 2015. Top 1% accessed HIE ≥ 4038 times, 1%–5% accessed ≥1580 and less 4038 times, 5%–10% accessed ≤ 867 and less than 1580 times, 10%–25% accessed ≥315 and less than 867 times, 25%–50% accessed ≥87 and less than 315 times and bottom 50% accessed less than 87 times.

Figure 4.

Access for HIE according to healthcare setting (A) and tool used (B, C, and D). Acute care settings include hospitals; Primary care settings include medical clinics, family health groups, and local community health centers. EMR: Electronic medical record; PMS: Pharmacy management system.

Figure 5.

Median number of access for HIE by user per month

Figure 6.

Discrepancies between the community pharmacy drug list and current medication list from the HIE (n = 463) according to medication type. Vitamins and supplements category includes sodium and potassium supplements, calcium supplements, Vitamin D, Vitamin B, Multivitamins (only when prescribed and dispensed by the pharmacy); Other category (15.8%, data not shown) includes all products with <3% of discrepancies: antigout agents, bone resorption inhibitors, 5 α-reductase inhibitors, PDE5 inhibitors, oral antineoplasic agents, antihistamines, muscle relaxants, antivertigo agents, benzodiazepines and z-drugs, oral corticosteroids, androgens and thyroid agents, haematopoietic agents.