Saturday, September 15, 2012

Here Is The Sort Of Thing That Makes Medicare Dispensing Information Pretty Useless Clinically.

Here is a little story which has both good news and the opposite.
First the good news is that when I made my weekly visit to the NEHRS the system was actually up and apparently working. It all seemed to working just ‘tickety boo’ but is, as always pretty slow and tedious.
However there are two issues I noticed, one of which dramatically decreases the value of the system from a clinical perspective.
Looking at my medication record I found these two entries (out of a total of 9 entries from 3 prescriptions - one of which is wrongly allocated to myself rather than my wife.)
First we have this:
Generic Name: OMEPRAZOLE
Prescribed:  30-Jun-2012
Supplied:  01-Jul-2012
Form & Strength:  TABLET 20MG
Code:  08333N
Second we have this record.
Generic Name:  OMEPRAZOLE
Prescribed:  05-May-2012
Supplied:  06-May-2012
Form & Strength: TABLET 20MG (AS MAGNESIUM)
Code:  09110L
(Note I have left out the quantity and repeats fields as they are identical)
The point to observe here is that an identical (generically substitutable) medication finds itself with two different codes which I can find no relationship between. These are the same generic medicine and should have exactly the same code if there was any clinical common sense applied to the coding. Indeed it is quite probable the medications are simply different packages of tablets manufactured by the same pharmaceutical major (Astra Zeneca).
What this means is that the coding system used by Medicare is essentially useless for clinical research and clinical decision support as it is not apparent that each is the same medicine. If any medication coding and history is to be useful the functionally and chemically identical same medications need to have the same code - it is as simple as that.
The problem is of course, that the designers of the Medicare system were concerned with bean counting and not clinical utility. Using information which might be fit for one purpose for another purpose is always fraught with risk.
Less important is that the system is clearly the designed for those with 20/20 vision. While the print button is hard to see - the search and restriction functionality on the top left is even more obscure. Hard to know what the tiny symbols mean until you click them. To me the system needs much larger controls on the screen and it needs a clear warning to users to read the ‘help’ carefully. I have not seen such a warning and it would be really sensible to have it up in big clear type - or to send users here to browse:
It all seems to be there - it just needs highlighting.
Extremely disappointingly the search function does not look into document content - just the document type so you can’t search for all instances of ‘omeprazole’ for example. As the record acquires more records I suspect this search will be less than very useful.
As far as the drug coding is concerned this really is a shame that in even in the tiny sample I can see such silliness has been allowed.