Cloud eRx module targets adverse events

Personalized e-prescribing tool uses analytics, genomics to prevent unintentional overdosing
By Anthony Vecchione
10:49 AM
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When it comes to preventing adverse drug events, some suggest that traditional evidence-based prescribing must be enhanced with "person-based" approach rooted in specific data. One Web-based technology may help do that.

[See also: E-prescribing makes huge gains]

Adverse drug events and fatalities are more likely to occur in patients who take multiple medications. The frail elderly are particularly vulnerable. Studies have shown that a high percentage of hospitalizations in the elderly are attributed to unintentional overdoses.

According to medication safety experts, this means that the patient inadvertently takes too many doses, and/or takes the proper doses but the body cannot effectively clear the drugs from the system. That could cause build-up and lead to ADEs.

[See also: Adverse incident reporting system reduces risk of error]

One New Jersey-based company has developed a cloud-based medication risk mitigation platform designed to help reduce ADEs.

Cal Knowlton, CEO and founder of Moorestown, N.J.-based CareKinesis, Inc., says its EireneRx technology, is a front-end e-prescribing module that can bolt on to any electronic medical record; when a physician prescribes using EireneRx, it gives the prescriber information about a patient and the medications they are taking.

"It allows the physicians or nurse practitioner to gain information that they can either use or not, as they are prescribing," says Knowlton. "It is dynamic, so if I change from this drug to that drug, it's a different sedative burden or a different anticholinergic burden, etc."

In addition to these two components, the e-prescribing module embodies another dozen personalized components that change as the prescriber enters a medication, or then tries a different medication.

Joseph J. Filippoli, senior vice president and chief information officer at CareKinesis, says EireneRx is also a medication management system that can include integration to a pharmacy dispensing system: "It's a hosted EMR ePrescribing platform, it's not a full EMR.

EireneRx, said Filippoli, takes away some of clinicians' the repetitive work and systematizes it.

"The bottom line is that in standard practice of medication management, there's a lot of stuff that people do with their brains and their repetitive hands and minds but in this case we can actually take what they do and automate it," said Filippoli.

The basic EireneRx product is a cloud-hosted medication management system that uses Amazon Web Services.

"We are a significant installation and we have redundant east and west landscapes with Amazon," said Filippoli. "It's very fault tolerant and we scale-up based on traffic and need and we turn up the dial on the horse power as demand grows."

EireneRx, according to Filippoli, is HIPPA-compliant, heavily secure and is a meaningful use Stage 2-certified e-prescribing module.

It presents an array of germane medication decision support factors, along with the complete medication profile and conditions, at the point-of-prescribing (as the prescription is being written).

"The PharmDs also are available real-time via secure instant messaging, to help translate or interpret the decision support feedback, when necessary," said Filippoli. "We're providing warnings, alerts, evidence and science-based personalized guidance at the point of prescribing. It hones the prescribing down to a very precise practice, before a prescription is sent to a dispensary."

George Brett, MD, medical director for LIFE Programs at Mars, Pa.-based Lutheran Senior Life, has been using EireneRx for the past two years.

"I can write a prescription faster on EireneRx than I could if I brought out Rx pad and pen," he says. "It's very user friendly and it's fast. It has great drop-down boxes so you can select your medication strength, diagnosis and where you want it sent."

Lutheran Senior Life is a Program of All-inclusive Care for the Elderly (PACE) facility that cares for the frail elderly who visit the community center several times per week. Brett said that, on average, each patient at his PACE center takes 10 to 13 medications. Brett said that medication errors have dropped off significantly as a result of EireneRx.

"As you go to write a new prescription, they have listed over to the right hand side a column, made up of rows that talk about things that could be going on with a patient such as drug interactions, pharmacogenomics, and other person-based as well as evidence-based medication risk components," says Brett.

Tom Wilson, president of Charleston, S.C.-based Jack Russell Software, a wholly owned subsidiary of CareKinesis and the chief architect of EireneRx, says one of the benefits of using the cloud is that it's a real-time, coast-to-coast replicated system that's redundant.

"So for example, if the Virginia data center were to have an interruption, we would be able to push the folks to the west coast San Francisco data center because we have complete redundancy," says Wilson.

The technology department at Jack Russell, according to Wilson, focuses on managing its infrastructure with development tools in the cloud and their product teams primarily work with JavaScript, RubyonRails, AngularJS, NodeJS, CouchDb, MySQL as its data source.

Wilson says feedback from EireneRx customers has been great. A recent usability study that surveyed first-time customers rated the product very high on the usability scale.

"We were early adopters of the cloud, a lot of customers were worried and they had to get used to having their data not in the same building as they were," he says.

But Wilson said that it has had the opposite effect and users now feel more liberated. For instance, prescribers like the idea of being able to review information and not have to drive to the office.

"The cloud enables us to get all that information to the clinician so that the patient can benefit from having the prescribers having all the knowledge in front of them to do the best prescribing as possible," said Wilson.

Another important component of EireneRx is the real-time application of pharmacogenomics – information regarding the genes that we inherit from our parents that are important to metabolizing drugs.

"A simple cheek-swab determines the persons genotype for drug-metabolizing enzymes," says Knowlton. "With these results, as well as the other components, our PharmDs in our two call centers instantly provide guidance for the physician's consideration regarding the entire medication regimen. We use secure instant messaging between the MDs and PharmDs, to the tune of tens of thousands of messages each month.

"Because our patients are on multiple chronic medications, beyond the medication safety associated with our dynamic, medication risk mitigation prospective e-prescribing platform, concordance and adherence are also particularly important," he adds. "While medication safety through personalized prescribing is key, however, what good is safe prescribing if the patient does not take the medication properly?"

EireneRx provides concordance analysis, adherence analysis, and on-line adherence aids such as multi-language translation with a health literacy focus. Concordance analysis, according to Knowlton, lets you know if the person actually believes that they should be taking a medication, whereas adherence analysis lets you know if they actually are taking the medication.

Another capability, he says, is "we apply science using competitive inhibition guidance to determine when a person ought to be taking each medication."

In other words, if a person is taking 10 meds and three of them are using the same enzyme (i.e., from the same gene) to become polar (or water soluble) so the water soluble drugs can make their way to the kidneys to be excreted, the question becomes which medication gets to the gene first.

"This applied science based upon competitive inhibition, lets us provide meaningful guidance regarding what medications ought to be taken when during the day," says Knowlton – noting that this very personalized approach reduces the "unintentional overdosing" that leads to ADEs, which are commonly due to improper administration or inappropriate mixing or spacing of medications during the day.

Science is now providing ways to personalize the medication regimen and to personalize the dosing of the medications, all with the goal of mitigating medication risk by collaborating with prescribers at point of prescribing, he says: "We reduce adverse drug events, falls, ER visits and hospitalizations with this system."