Saturday, April 10, 2010

Caregivers could use help of medication records automation

Family caregivers and those with medical powers of attorney should be aware that some pro-activity is necessary in working with an elder’s physicians.

Specialists nearly always ask for lists of medications, but these need to be kept up manually at every visit. And generally family caregivers need to be pro-active is learning about the medications, asking about generics, cross-reactions, side-effects, schedules, and other issues.

This becomes even more true when someone changes physicians, or even sees a different physician at the same office during a vacation period. Different physicians often have varied views on how many medications actually work. And as human beings, physicians are often influenced by how they perceive the caregiver and the dynamics of the family.
This is also the case if the elder person goes into Hospice, which is supposed to be possible when the expected lifespan for a diagnosis is less than six months. Hospices sometimes change medications, because life-extending treatments (especially surgeries or chemotherapies) may stop. However, medication which extends life without causing significant side effects or discomfort should, as a matter of ethics, always be continued. Life expectancy in practice is often very difficult to predict from laboratory results and patients will vary widely, sometimes based on their own motivation and the perceived motivation of the family. Some medication is offered under hospice that is not offered under normal Medicare: sometimes oxygen is offered earlier, and some controlled substance painkillers are offered, to be used in individual cases with telephone permission from nurses. Medicare typically pays completely only for medication related to the hospice admission diagnosis, but other appropriate medications are still covered by Part D (with the notorious but shrinking “doughnut hole” or coverage gap) in a normal manner.

The president’s plan for improving health care records as part of health care reform needs beefing. All physicians ought to have access to a centralized database (mainframe, secured, HIPAA compliant, and separate from the Internet) of medications. Such a database should be updated when prescriptions are filled, and it should include information on the physical location of refills at various pharmacy branches. This would make medication management much easier for caregivers in complex situations. However, some people will fear loss of privacy and possible invitation to government intrusion, which I maintain is there already because of Medicare anyway.

CNET has an article from May 2009 about automation of medical records at Kaiser Permanante here.

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