Back in 2004, I began work to promote the use of electronic prescribing in an effort to ultimately promote patient safety and ensure the transparency of prescription medication therapy. At that time, all prescriptions were hand-written and once given to the patient, were left to that patient’s care to deliver to the pharmacy for eventual fill. This obviously left many opportunities for loss, theft, and counterfeit reproductions. In addition, the prescriber had no knowledge of whether or not a patient actually delivered the prescription to the pharmacy for fill. With the eventual mainstream adoption of electronic prescribing by 2009, we were able to witness better transparency of prescription delivery to the pharmacy, a decrease in the points of failure where nefarious individuals could attempt to counterfeit hand-written prescriptions; and, systemic data capture of a patient’s medication history. This was a significant paradigm shift yet many of us in the healthcare delivery and supportive community still feel there is opportunity to address the last mile of medication compliance.
Electronic prescribing may have been the ‘baby step’ in digitization of healthcare, but we have further progressed in the past ten years to wide spread use of electronic medical record systems, structured medical record data set analytics and initial efforts towards true interoperability. However, we have missed a critical step – true validation of recommended therapies; namely, medication therapy compliance. Although therapies may be administered in the hospital or by a healthcare professional, the majority of medications are prescribed for administration by the patient. Even when a patient is compliant with the explicit instructions of their therapy, the clinicians engaged with their care plan(s) have no way to monitor compliance on a daily, even weekly basis. Today, we have been able to witness more transparency in medication compliance; however we still are left guessing as to what happened to that patient once the medication 'has left the building'. This leaves a huge care gap that, despite all our advances with technology, we still have to address.
The last mile in clinical therapy compliance is a bumpy one, no doubt. Once a prescription has been picked up or delivered to the patient the entire healthcare team supporting that patient loses all transparency to whether or not the medication is being taken properly - or taken at all.