A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

Abstract

Objective: Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the "patient app" and the "MedRec app." This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app.

Methods: We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients.

Results: Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness.

Conclusions: Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in "real-world" conditions. To achieve adoption and sustained use by patients, the app should meet patients' needs while also efficiently improving the quality of MedRec.

Figure 1.

Patient app screenshots. Upper row: Left: Patient medication list = list compiled from different sources available on the ReHN. For each medication, patients can choose the right option: No, Yes, etc. Right: Patients can also add medications to the list by clicking on one of the icons. Finally they can add information concerning recent antibiotic intake and allergies. Middle row: If patients click on the magnifying glass, they can see details of date of prescription, indication, dose and frequency, larger pillbox picture, etc. Lower row: Left: After clicking on one of the icons (upper right), patients can start typing a medication’s name and the system shows existing medications and box pictures. Right: After selecting the right medications, patients can indicate for what purpose (indication) they are taking the medication and who prescribed it.

Figure 2.

Screenshots: a patient logged onto his/her Regional eHealth Network (ReHN) page. Upper row: Patient’s welcome page with his name in the upper right part of the page. Patient’s list of documents with patient’s medication lists (ie “schema de medication”) published on the ReHN by the patient app. Lower row: Patient medication list published by the patient. The column status shows the option chosen by the patient in answer to the question: “Are you currently taking this medication?”

Figure 3.

Patient flow and related measurements. Abbreviations: BPMH = Best Possible Medication History; eID = Electronic identity card; IT = information technology; ReHN = Regional eHealth Network; SUS = System Usability Scale.