More than 11,000 adverse drug events were reported to Health
Canada in 2005, but the actual unreported numbers are much higher,
according to IBM Canada research.
Many of these incidents could be prevented if doctors had the
right information at their fingertips.
Unsafe practices - such as inappropriate prescriptions,
inadequate monitoring, and harmful drug interactions - take their
toll every year.
The Ottawa-based Canadian Pharmacists Association (CPhA) seeks
to offer them that. The CPhA recently launched its e-Therapeutics
portal, an online knowledge management system that delivers
up-to-date and unbiased drug information to healthcare
practitioners.
Developed in conjunction with Markham-based IBM Canada, the
portal aggregates several disparate, largely paper-based sources
into a centralized e-repository.
Many factors contribute to adverse drug events, says Neil
Stuart, a partner in IBM Canada's healthcare practice. The sheer
number, range and complexity of drugs available today feed into the
problem.
Stuart says drug therapy management is particularly difficult
when patients are handed-off from one physician or specialist to
another for treatment. And the aging demographics of Canadian
society means more and more people need treatment for chronic
conditions such as diabetes, cardiovascular disease and arthritis.
"Particularly with senior patients who are taking multiple drugs,
it's hard to manage the effects without some kind of knowledge
tool."
The difficulties of keeping up with the latest information are
acute for general practitioners such as family physicians. They
must cover the entire gamut of illnesses, says Stuart. But the
volume of material available is overwhelming. Medline, for example,
a leading online database provided by the U.S. National Library of
Medicine, indexes about 4,000 articles annually on coronary disease
alone. "If a physician were to spend 15 minutes on each article, he
would require 115 8-hour days just to stay current - and that's
just one disease," says Stuart.
In addition to volume, e-Therapeutics also removes the biases
that may exist in other sources.
"This issue relates to pharmaceutical companies and the
significant amount of influence they have on the prescribing of
medication," says Dr. John Maxted, associate executive director of
the Mississauga-based College of Family Physicians of Canada. "They
spend a lot of money on these drugs and research, and then of
course they're going to want to recover their investments by trying
to sell their products. To be fair, they are required by law to
outline all the contraindications and side-effects of their
medications - but they also want to sell them."
To eliminate this bias, the CPhA uses 130 authors - all experts
in their medical specialty areas - to develop content for
e-Therapeutics. What they come up with, in turn, is cross-reviewed
by panels of clinical authorities, says Diane Conrad, director of
product management, adding that the CPhA receives no funding from
pharmaceutical companies.
In addition, the portal eliminates the ambiguity that U.S.-based
sources (which often list medications under different brand names
than what are found in Canada) may introduce, she says.
The CPhA's compendium of pharmaceutical information, a massive
tome that physicians call the "blue bible", has long been a
reliable source of information, says Maxted. Having a searchable,
online version of the reference work incorporated in e-Therapeutics
is a godsend. "When you're seeing 30 to 50 patients a day in family
practice, you can't spend a lot of time looking up information or
you'll never get through your day," he says.
E-Therapeutics is one component of the larger effort to drive
Canada's healthcare system into the electronic age. "About 70 per
cent of physicians have Web access at the office, 45 per cent have
a medical warning system on their PDAs, and only about 14 per cent
have electronic medical records," says Maxted. But this situation
is changing rapidly, says IBM's Stuart. "An increasing number of
medical schools are requiring their students have PDAs because
they're building PDA use right into the curriculum."
Integration of e-Therapeutics with other medical systems will be
a big focus in the future. "Many provinces are in the process of
introducing pharmacy information networks, which are transactional
systems that manage the interface between prescribers and retail
pharmacies," says Stuart. "It would be terrific if this product
could be embedded in that."
There are many projects planned under the auspices of Canada
Health Infoway, a MontrC)al-based not-for-profit organization that
invests with public sector partners across Canada to develop a more
efficient healthcare system. "What physicians are really looking
for is a single point of access to get all their information, so
integration of e-Therapeutics will be a huge benefit," says
Conrad.
She pointed out that discussions at a recent healthcare
conference focused not just on electronic health records that
reside at one clinic, but longitudinal records that span multiple
institutions and that provide a history of a patient's health and
interactions with the healthcare system over the years. "Pulling
all that information together is very complex, and there is much
work to be done."
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