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VA Integrated Medication Manager (IMM)

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ClinicalTrials.gov Identifier: NCT01787175
Recruitment Status : Completed
First Posted : February 8, 2013
Results First Posted : June 23, 2016
Last Update Posted : June 23, 2016
Sponsor:
Collaborator:
Agency for Healthcare Research and Quality (AHRQ)
Information provided by (Responsible Party):
University of Utah

Brief Summary:
The purpose of this study is to advance the science of healthcare informatics and to improve medication management through the development of a new approach to the electronic medical record called the Integrated Medication Manager (IMM).

Condition or disease Intervention/treatment Phase
Electronic Health Records Other: Integrated Medication Manager Not Applicable

Detailed Description:

In an attempt to address problems patient non-compliance with quality goals barriers to access and integration of health information that impede achievement of treatment goals, the VA is developing a new approach to the electronic medical record. The VA is moving away from the paper-chart metaphor and towards an integrated representation of the patient's status and care process across time. One of the first steps in the development phase has been to explicitly relate patient conditions, therapies, and goals in the domain of pharmacotherapy. This is called Integrated Medication Management and draws on Hollnagel's Contextual Control Model. Providers will be able to plan care and create orders directly in the context of these explicit relationships. This application will be implemented nationwide through a web interface embedded within the existing Computerized Patient Record System (CPRS), the graphical user interface to VA Information Systems (VistA).

Aim 1: Identify cognitive components of providers' therapeutic decision making in the field.

Aim 2. Refine and evaluate the Integrated Medication Manager using simulation studies.

  • Aim 2.a. Refine interfaces and logic of the Integrated Medication Manager.
  • Aim 2.b. Compare the performance of the Integrated Medication Manager and usual CPRS.

All hypotheses (below) test the use of IMM versus usual electronic medical record (EMR).

  • Speed of decision-making will be faster.
  • Accuracy of data interpretation (clinical assessment) will be higher.
  • Appropriateness of therapeutic plans will be higher.
  • Efficiency of gathering information will be higher.
  • Common ground measures will be higher.
  • Appropriateness of therapeutic plans will be higher when relevant data is outside the usual time horizon.
  • Appropriateness of therapeutic plans will be higher when complex associations among patient therapies and goals exist.
  • Appropriateness of therapeutic plans will be no lower when relevant data is not captured by the displays of the IMM.
  • Appropriateness of therapeutic plans will be higher when highly salient data is not germane to the most important problem.
  • Appropriateness of therapeutic plans will be higher when cognitive load is high due to interruptions.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 58 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Veterans Affairs Integrated Medication Manager
Study Start Date : October 2007
Actual Primary Completion Date : March 2011
Actual Study Completion Date : March 2011

Arm Intervention/treatment
Experimental: Integrated Medication Manager
Experienced providers that participated in the EHR simulations. Half of the providers were assigned to use the new Integrated Medication Manager (intervention) during the simulation. The other half were assigned the VA's CPRS to use (standard EHR). Providers were randomly assigned which system to use.
Other: Integrated Medication Manager
A theory based electronic health record. Half of the provider participants were assigned the IMM to use. The other half were assigned the VA's CPRS EHR to use for the simulation. Providers were randomly assigned to a EHR to use.
Other Name: IMM

No Intervention: Standard EHR
Experienced providers that participated in the EHR simulations. Half of the providers were assigned to use the new Integrated Medication Manager (intervention) during the simulation. The other half were assigned the VA's CPRS to use (standard EHR). Providers were randomly assigned which system to use.



Primary Outcome Measures :
  1. Amount of Time to Complete Assessment and Plan [ Time Frame: 10 minutes ]
    Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan.

  2. Accuracy of Written Assessment and Plan in Terms of Control and Status [ Time Frame: 10 minutes ]
    Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan. The primary outcome evaluated participants' recommendations for treatment of patient conditions. Participants reviewed a total of 10 patient cases and received a score between 0 and 3 points for each issue within each patient case. The final score for each participant was a proportion between 0 and 1. The proportion represented the sum of all points assigned to the participant, divided by the total number of points possible. Higher values on the scale represent greater accuracy of the written assessment and plan.


Secondary Outcome Measures :
  1. Identification of Planned Monitoring and Follow up Encounters in Assessment and Plan [ Time Frame: 10 minutes ]
    Each participant had 10 minutes maximum to review the patient case and write an Assessment and Plan. . The secondary outcome evaluated participants' recommendation about future monitoring of patient conditions. Participants reviewed a total of 10 patient cases and received a score of 0 or 1 point for each issue within each case. The final score for each participant was a proportion between 0 and 1. The proportion represented the sum of all points assigned to the participant, divided by the total number of points possible. Higher values on the scale represent a greater proportion of appropriate monitoring recommendations made.



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Practiced in primary care for at least two years
  • Third year residents with two years of residency in internal medicine or family practice
  • Do not have to be currently practicing

Exclusion Criteria:


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01787175


Locations
United States, Utah
VA SLC Health Care System
Salt Lake City, Utah, United States, 84148
Sponsors and Collaborators
University of Utah
Agency for Healthcare Research and Quality (AHRQ)
Investigators
Principal Investigator: Jonathan Nebeker, MD, MS University of Utah

Publications:

Responsible Party: University of Utah
ClinicalTrials.gov Identifier: NCT01787175     History of Changes
Other Study ID Numbers: 5R18HS017186-03 ( U.S. AHRQ Grant/Contract )
First Posted: February 8, 2013    Key Record Dates
Results First Posted: June 23, 2016
Last Update Posted: June 23, 2016
Last Verified: May 2016

Keywords provided by University of Utah:
Medication Therapy Management
Clinical Decision Support Systems
Medical Informatics
Patient Care Management
United States Department of Veterans Affairs