Project: MOXXI

2005
Canada health infostructure partnerships program (CHIPP)

Synopsis

McGill University in Montreal and several partners are using secure information and communication technologies to enhance the safety and effectiveness of drug prescribing and dispensing practices and to promote proper use of medications among patients.

The MOXXI project's electronic prescribing, integrated drug and disease management system linked doctors, pharmacists, patients and external sources of information on drug monographs and alerts. The over all objective was to reduce the risk of drug-related illness and to improve the management of chronic diseases, such as asthma, that depend heavily on regular and appropriate medication use.

Policy and Research Implications

The MOXXI project, as a primary goal and ongoing vision, aimed to enable the best health care for the Canadian population. Since drug costs represent the largest expense in the health care system, improving the appropriate use of medication would generate global benefits. The earliest benefit of electronic prescribing is the decrease in medication errors caused by illegible scripts, incorrect doses and drug-drug interactions with potential for drug-related illness. These improvements in medication errors result in cost avoidance as an early return on investment. However, an electronic prescribing system can also leverage improved medical care quality when drug-disease interactions and chronic disease management in added. The MOXXI results validate the Institute of Medicine 2000 Report (Crossing the Chasm) recommendations for the widespread deployment of electronic prescribing.

The MOXXI project identified a number of major findings, and these are presented in greater depth in the project's final report, available at the CHIPP website, or by contact the MOXXI project lead (this information is available at the end of this synopses).

Major Finding 1: an integrated drug management system that retrieves information on prescriptions dispensed to patients from community based pharmacists is a necessary requirement for physicians to use an electronic prescribing system, and to enhance the safety and quality of prescription drug therapy. However, there are considerable barriers to developing the interfaces necessary with community-based pharmacies to permit exchange of information between physicians and pharmacists;

Major Finding #2: Primary Compliance: with the MOXXI system, the rate of primary medication (filling first prescription) can now be tracked and interventions designed;

Major Finding #3: Utility of proxy information sources: the MOXXI e-scribe system tested a new approach to generate individual patient health conditions automatically from existing electronic data sources (prescription and billing data). The approach has implications for the transition from paper-based health records to eventual computerized records;

Major Finding #4: Private-public partnerships are essential for continuing success: when a system such as the MOXXI e-scribe project is deployed to a larger group, business practice savvy and a breadth of resources that exists in the private sector have to be tapped.

Major Finding #5: One size does not fit all: Out in the field there are myriad combinations of modern hardware running antiquated software, substandard infrastructure installations, unusual user preferences and habits. The clinical user may also have a different perception and expectation of what an applications can and cannot do. The implication of this finding is that more thought and resources need to be dedicated to the installation and training of clinical systems into these environments.

Major Finding #6: Clinician input and feedback is essential: Physicians' and pharmacists' ongoing input are required to provide feedback for quality assurance, auditing, and design and implementation of future functionalities. Methods to assist this process may include: website/paper/phone surveys, users groups, and focus groups.

The Future

One of the challenges with research and development projects is to transfer the innovations created through the research and development process into a solution that can be applied to the population and sustained. After ten years of developmental work, culminating in the third phase of this project as funded by CHIPP, it was evident that the innovations developed could not be transferred or generalized on a broader scale without a business team. As a result, MOXXI Medical Inc. was created. MOXXI Medical Inc. has developed a business plan, built strategic partnerships, and raised funds for the purposes of implementing the MOXXI solution in Canada and internationally. In addition, the following target areas were identified for research and development:

• The incorporation of adverse drug reaction reporting and pharmaco-surveillance into the stop and change order function of the MOXXI Integrated Drug Management system;
• The development and evaluation of a micro-policy platform for introducing multi-tiered first, second, and third line drug formularies into the electronic prescribing program;
• The implementation of pharmocogenomic screening to guide the selection of drugs and doses;
• The integration of lab and diagnostic information along with prescription drugs; and
• The development of an automated detection system for symptoms that may be related to an adverse drug reaction to provide an early warning system for physicians regarding adverse drug effects in individual patients.

For more information on the MOXXI Project, please contact:

info.moxxi@mcgill.ca or visit the  MOXXI Project website.