Problem: no connection between prescriptions and diseases

Prescriptions made in classic EHR systems have no context of “why” and “for what”. The only information about the reason for the prescription is an entirely optional field on the physical label informing the patient about the purpose of the medication. That is far from sufficient. The drawbacks due to the lack of a structured identification of the indication for the prescription are:

  • It’s harder to know when a medications is not needed anymore
  • It’s impossible to calculate recommended dosages and length of treatment
  • If recommendations change for certain diseases, the prescriptions cannot be tracked
  • Dangerous omissions due to confidentiality

Hard to know when not needed anymore

If a patient has multiple diseases and some medications may serve for more than one treatment, it’s sometimes very hard to figure out for which of these diseases it was originally intended. This way, it’s harder to know which prescriptions to review when one disease is cured or deemed resolved in some other way. Additionally, it’s a great time waster, since no doctor knows all indications of all medications by heart, so the lack of a formal link forces one to either ignore the medication and hope for the best, or waste time looking it up in a database, wade through the indications and check them against the possible diseases the patient may have, if you know them.

There is also good reason to assume that too many prescriptions are continued beyond their point of usefulness, simply because it’s too difficult to go through the review process. As long as they don’t cause actual harm, it’s easier to just leave them unchanged.

Impossible to calculate dosage and duration

Many medications have different recommended dosages and treatment durations depending on indication, and often depending on concomitant disease. For instance, antibiotics are often given with higher dosage and longer durations if it’s a recurrent infection or depending on locale. Some medications must be reduced in the presence of kidney or liver insufficiency. Without a disease concept in the EHR, none of these checks and calculations can be automated, even though they are well documented in pharmacological databases.

If recommendations change, therapies cannot be tracked

If the indication or recommended dosage for a particular medication changes, there is no way to find the cases where this recommendation change should be applied. The only method we have today is looking up every patient that gets the product and manually check the EHR to see if the change should apply. Needless to say, this is very rarely done, leaving far too many patients on treatment modalities that are outdated, and sometimes even detrimental to them.

Absurd and dangerous omissions due to confidentiality

Confidentiality in the medical records is currently applied to care givers, so that information originating from “hidden” caregivers is not shown to other caregivers without the patient’s permission. Prescriptions also have to be subjected to these rules, causing twisted and dangerous situations to occur. Examples:

  • Medication started by a “confidential” source becomes confidential. One can argue about the safety of this, but at least it’s consistent with the intention of the law.
  • Medication started by a “non-confidential” source is visible to others, but any changes to that medication such as an increase or decrease in dosage done by a “confidential” source is invisible, so the “non-confidential” source only sees the unchanged, erroneous, dosage. This is outright dangerous.

If the patient has a disease that is marked “confidential” but that forms a contraindication for some medications, there is nothing the EHR can do to prevent serious medical errors from occurring due to this confidentiality. The EHR has no “idea” exactly what is held confidential and which consequences this may have for other therapies, so it actively promotes dangerous prescription behavior.