Abstract
Objective
The last decade has seen exponential growth in electronic health tools. However, only a limited number of electronic medication reconciliation tools have been developed and implemented in healthcare settings. Here, we present ConciliaMed, a mobile and web-based tool for healthcare professionals to reconcile the chronic medications of patients undergoing elective surgery.
Methods
A research team of pharmacists and internists worked together with a technology company to design and develop ConciliaMed. Evidence-based guidelines were collected for inclusion in the tool. A group of experts conducted a simulation with a preliminary version of ConciliaMed to identify bugs and technical improvements and to assess their satisfaction with the application. The final prototype of the tool was disseminated through clinical meetings and the Google Store.
Results
Four easy-to-use and interactive modules can be used to reconcile chronic medications through the app, while the web platform is designed for consultation and learning. A higher level of satisfaction with the tool was achieved by the test participants (4.67±0.58). The triggering of dose and duplication alerts for users or the integration of ConciliaMed with electronic prescription systems were some of the more requested adaptations by the test participants.
Discussion
The ability to generate an editable reconciliation report or transfer information between users are some of the features of ConciliaMed that encourage its use. The integration of ConciliaMed into the healthcare workflow is expected.
Conclusion
The web platform is freely available online (https://conciliamed.chronic-pharma.com), as is the mobile application through the Google Store, making it easily accessible to healthcare professionals.
Keywords: General Surgery, Medical Informatics Applications, Continuity of Patient Care
WHAT IS ALREADY KNOWN ON THIS TOPIC
The number of electronic-medication reconciliation (e-MedRec) tools available to healthcare professionals is still limited, although these professionals have shown their interest in using these tools.
MedRec strategies have been shown to have a positive impact on surgical patients, including the prevention of perioperative complications and the length of stay for cardiovascular surgery patients.
WHAT THIS STUDY ADDS
ConciliaMed is the first multilingual e-MedRec tool aimed at healthcare professionals, an easy-to-use and intuitive mobile app and website, free to download and available from the Google Store.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The integration of ConciliaMed into healthcare systems is expected to have a positive impact on the MedRec process by saving time and workload for healthcare professionals and improving patient safety.
Introduction
Medication reconciliation (MedRec) is the complex and multidisciplinary task of obtaining an accurate patient medication list that is consistent across transitions of care and well communicated among healthcare professionals, patients or their families. Patients are at risk for medication discrepancies during transitions between care settings. These discrepancies can prolong hospital stays and lead to increased rates of emergency department visits, hospital readmissions, healthcare utilisation and even death.1
Several studies have demonstrated the positive impact of the MedRec process on surgical patient safety.2 3 A retrospective study showed that MedRec was an excellent strategy for preventing perioperative complications in surgical patients chronically taking one or more medications.4 Additionally, a quasi-experimental study revealed that the implementation of a MedRec programme in adult patients undergoing elective colorectal cancer surgery achieved a significant decrease in the length of stay in patients >75 years of age and those with cardiovascular disease compared with the standard care practice.5 In this sense, a systematic review concluded that medication errors can be significantly reduced by various interventions, such as appropriate prescriber education or the use of computerised MedRec, so its implementation should be considered in all surgical settings.6
Paper-based systems have traditionally been used by healthcare professionals to perform the MedRec process, due to the low proportion of available electronic MedRec (e-MedRec) tools. In recent years, the integration of information technology (IT) in healthcare systems has generated great interest among clinicians, especially in terms of increasing decision-making according to patient well-being and improving healthcare units’ productivity.7 In fact, a systematic review of MedRec tools showed that a high number of healthcare providers positively evaluated the usability of IT in terms of improving clinician workload, patient safety or saving time in the MedRec process.8 For these reasons, the number of healthcare systems implementing and using a fully e-MedRec tool is expected to increase shortly.9
Thus, the purpose of this article is to describe an e-MedRec tool, called ConciliaMed, that allows healthcare professionals to easily obtain a reconciled and adapted medication list for patients undergoing elective surgery.
Methods
ConciliaMed is an e-MedRec tool aimed at healthcare professionals to support the MedRec process for patients taking one or more medications and undergoing elective surgery. This tool was developed as a mobile application (app) for Android systems and a website, from September 2020 to March 2024.
Design and development of ConciliaMed
An agile development methodology was established to plan the development of ConciliaMed (figure 1) like other authors used in the development of similar e-MedRec tools.10 This agile model consisted of the division of the project into four dynamic phases (preparation, design and development, test and dissemination) and focused on continuous collaboration and improvement.
Figure 1. Cronogram of the development of the ConciliaMed project phases.
Preparation phase
A systematic review8 was conducted to identify and describe all available e-MedRec tools aimed at healthcare professionals. This review showed that only two of these tools were focused on the perioperative setting, so ConciliaMed was developed to address an unmet need of healthcare providers. In addition, a list of features associated with high user satisfaction mentioned in this review, such as user-friendly language or animation (pictures, colours and icons), were also considered for inclusion in the tool. After that, a multidisciplinary research group consisting of pharmacists and internists conducted an extensive review of the scientific literature. This search resulted in a total of six guidelines and protocols for the perioperative management of chronic medications.11,16 These guidelines and six therapeutic interchange guidelines from healthcare centres (unpublished) were used as sources of information for the development of the tool. Our multidisciplinary team met regularly during this phase to brainstorm (interactive modules or generating a reconciliation report aimed at both healthcare professionals and patients/caregivers) to ensure that the requirements of implementing these features were met.
Design and development phase
The first stage of this phase involved the drawing of the conceptual model of the tool, defining the technological scenario (web platform and mobile app), user registration and grouping all the content collected during the preparation phase in a database. The second stage concluded with the inclusion of the selected functionalities and data in each module both the app and the web platform. In order to verify the successful development and implementation of ConciliaMed, the researchers followed some of the recommendations made by authors with expertise in this field.17 During this process, a technology company called ‘Solutia Digital Health’, with expertise in healthcare software solutions, collaborated with the research team to design and develop the software using the MÉTRICA V.3.0 methodological framework from the High Council of Informatics18 adopted by the Regional Government of Andalusia (Spain). The technology company worked closely with the research team, through sprints or deliveries, which allowed researchers to monitor the progress of the development of the tool and to create the initial prototype of ConciliaMed. At this stage, each member of the research group analysed the implemented functionalities and modules in the preliminary prototype through screenshots to refine the app in the next sprints.
Test phase
Similarly to a previous study,10 we collected user feedback by evaluating usability and satisfaction with the tool. The preliminary prototype of the tool was tested by a convenience sample of pharmacists and researchers who were not members of the research group and who had expertise in MedRec. Before testing, they received instructions from the ConciliaMed user manual. This phase consisted of using the application on simulated patients to identify necessary technical improvements or bugs. The researchers and the technology company received feedback from users through the results of the satisfaction survey included in the app and incorporated suggested changes to improve the application’s usability.
Dissemination phase
The tool was disseminated locally through clinical sessions and nationally and internationally through the Google Store. The integration of a seven-question satisfaction survey (online supplemental figure 1) in the app allowed us to monitor and analyse user satisfaction and app usability (scores ranged from 1 to 5). In 2022, the researchers obtained the certification of the intellectual property of the app.
Results
ConciliaMed is an interactive mobile and web tool that allows healthcare professionals to perform the MedRec process for elective surgical patients. The app is available for free on the Google Store, and the website is accessible online at https://conciliamed.chronic-pharma.com. ConciliaMed has been developed in the Spanish and English language.
Registering on the app or website is easy. Healthcare professionals must complete all required fields in the mobile app, including their name, surname, email address, date of birth, gender, job and healthcare centre. Once submitted, a username and password will be sent to the user’s email address. With these credentials, healthcare professionals can access both the application and the website.
Mobile app
The ConciliaMed app is structured into four main interactive modules, (figure 2) which can be used independently:
Figure 2. Homepage of ConciliaMed app and modules: (A) perioperative management of chronic medication, (B) therapeutics equivalents, (C) my reconciliation reports, (D) my documents of interest. FAQs, frequently asked questions.
Perioperative MedRec module
This is the main module of the app that provides recommendations to healthcare professionals or patients/caregivers regarding the perioperative management of the patient’s medications (figure 3).
Figure 3. Perioperative management of the chronic medication module. (A) A medication search by ‘brand name’ or by ‘drug’ sorting medication alphabetically with units in milligrams (mg) and ‘oral’ route of administration already fixed. (B) An example of a patient medication list, which can be edited (adding or deleting drugs). Additionally, it shows the buttons of ‘perioperative management of chronic medication recommendations’ on the left below and ‘generation of the reconciliation report’ on the right below.
First, the user must enter and save some patient information before the MedRec process can take place. Information about the patient’s allergies or intolerances should also be inserted. The app then assigns a randomised alphanumeric code to identify each patient. A medication finder is provided to manually enter the patient’s medication list by ‘brand name’ or ‘drug’. A detailed dosage schedule and route of administration are required for each medication, and there is a free text option for comments. Once the medication list is introduced, recommendations for managing the patient’s medications before, during and after surgery are available to healthcare professionals, but only preoperative information is provided to patients. Finally, the app allows users to generate a reconciliation report that can be saved, edited, printed or sent to other healthcare professionals, patients and caregivers via message or email.
Therapeutic equivalents module
In this module, users can enter the ‘brand name’ or ‘drug’ in a drug searcher to find the corresponding therapeutic equivalent, including its dosage regimen and route of administration. The purpose of this module is to make it easier for healthcare professionals to search for therapeutic equivalents of drugs taken by patients (online supplemental figure 2).
My reconciliation reports module
This module contains all the reconciliation reports created and saved by the users (online supplemental figure 3). An identifying icon of ‘healthcare professional’ or ‘patient’ is available to easily recognise the recipient of each report once the reconciliation report has been saved. For those reports that are intended for patients, a brief explanation of what a MedRec process consists of appears in the heading of the reconciliation report. In addition, the entire list of the patient’s medications can be edited, allowing healthcare professionals to discontinue, modify or add new medications if necessary. An example of a reconciliation report is included in online supplemental figure 4.
My documents of interest module
This module summarises three recent guidelines for the perioperative management of chronic medications.11 12 14 However, international guidelines that were also used as sources of information13 15 16 are expected to be updated in this module in future versions of the tool due to the global availability of ConciliaMed. The Structured History of Medication use questionnaire19 is also included in this module to guide healthcare professionals in interviewing patients or caregivers to obtain the most current medication list.
Satisfaction survey and frequently asked questions
Healthcare professionals can also complete a seven-question survey to assess the usability and their satisfaction with the app, including a free-text field for comments. Each question can be rated from 1 to 5, being 5 the highest score. The results of the satisfaction survey are sent to the researchers for evaluation, and the feedback received is used to periodically generate a list of potential improvements so that necessary adjustments can be made. Users can also formulate a question for the researchers, and if it is considered to be common, it will appear in a list called frequently asked questions (FAQs) to help other users use the tool correctly.
Website
On the website, users can consult their reconciliation reports, which are classified by date and can be downloaded freely. They can also explore the documents of interest included in the app or the therapeutics equivalents module for learning and consultation. Moreover, there is a FAQs module, where all the users’ queries about the app are submitted to be consulted (figure 4). For the administrator profile only, the website allows us to manage all the data related to user registration and update the information included in the tool. Additionally, the satisfaction survey results can be exported to Excel for analysis and evaluation by the research team.
Figure 4. ConciliaMed website (user profile) and its modules: (A) my reconciliation reports, (B) therapeutic equivalents, (C) documents of interest, (D) frequently asked questions.
Test phase
Table 1 shows the main features of ConciliaMed and summarises the changes and requirements suggested by the participants in the test phase. Five pharmacists with expertise in MedRec of patients undergoing elective surgery tested the app. Three of them completed the seven-question satisfaction survey (online supplemental figure 1). The mean score of all questions was 4.62±0.67, with a global satisfaction with the app of 4.67±0.58. All the users rated the design of the app with the highest score (5). Lower scoring categories were those related to the website usability and ease-to-use of the perioperative management module (4.33±1.15). Speeding up the MedRec process and expanding the information on the perioperative management of certain drugs were the most demanded adjustments suggested by users in the pilot phase. Most of these suggestions were incorporated into the app after approval by the researchers. Some other technical improvements that required major changes in the app will be considered in the development of the next updated versions of the tool.
Table 1. Main features of ConciliaMed, users’ opinions and subsequent adjustments during the test phase.
| Functionalities | Items | Users’ opinions | Additional adjustments | Future technical enhancements |
|---|---|---|---|---|
| Visual design | Identification of the four main modules of ConciliaMed through the use of logotypesIdentification of healthcare professional or patient icons to identify recipients of MedRec reportsSeparate perioperative management information for each medication into boxes for ease of understanding | ‘Clear and viewable messages are provided to the users’‘It is difficult to read the information of reconciliation report’ | The reconciliation report was enlarged to maximise the visualisation on the mobile screen | Different colours to differentiate preoperative and postoperative recommendations in the perioperative management module |
| Usability | Easy-to-use, interactive and user-friendly modulesAutomatic generation of perioperative management recommendations of chronic medication and therapeutic equivalents using the appEdition, printing, saving and sending reconciliation reports to healthcare professionals or patients/caregiversMedication searcher sorting drugs alphabetically | ‘We were able to navigate into the tool without assistance’‘It is necessary to fix some fields of medicines to reconcile more quickly’‘It is an intuitive and user-friendly app’‘It is an easier and faster way to reconcile chronic medication than manual reconciliation’‘It is necessary that some fields were already filled to speed up the MedRec process’ | Dosage in milligrams and oral route of administration were prefixed for all medicines but they could be modified manually, if necessary | Triggering of e-MedRec alerts to users (ie, duplicities, maximum dosage)Grouping of drugs in different categories (ie, pharmacologic class, indication or dosage)Automatic introduction of patient medication list into the app from electronic medical records |
| Content and reliability |
|
‘It would be helpful to users to expand the sources of information because MedRec information about some drugs is missing’‘MedRec information is not correct in some medicines’ | Some MedRec information was included due to the experts’ recommendations and checked by researchers (heparins, dexketoprofen, fentanyl).Some bugs were corrected after checking users’ recommendations | To include more guidelines or protocols to obtain more MedRec information about some drugs |
| Interoperability | Sending the reconciliation report to the patient/caregiver or other healthcare professional through mobile or email | Interaction with dispensing patient medication pharmacyExtracting data from a patient clinical’s history directly | ||
| Ratings and user satisfaction | A satisfaction survey consisting of 7 questions aimed at users to evaluate the tool | To modify any question from the satisfaction survey if it is necessary from the feedback received from users | ||
| Accessibility and inclusiveness | Tailored and comprehensive messages depending on the recipient of the reconciliation report | ‘Some information could be deleted from patient reconciliation report to enhance patient understandability’ | Some messages aimed at patients were modified to improve patient/caregiver understandability of medication | |
| Availability on the market | Mobile/website version | Integration into the electronic prescribed system in healthcare centres |
MedRec, medication reconciliation.
Discussion
This study presents ConciliaMed, an intuitive and easy-to-use e-MedRec tool designed as both a mobile app and a website for healthcare professionals. The app allows users to perform the MedRec process with the support of four interactive modules integrated into the tool, as well as to evaluate the usability and satisfaction with the app. Some features of ConciliaMed have been implemented to facilitate the MedRec process, such as the generation and output of specific reconciliation reports for patients and caregivers, or the transfer of information between healthcare professionals. Most participants in the pilot phase rated the tool positively in terms of usability and satisfaction, but there is still room for improvement. The website can also serve as a user guide and a platform for the research team to regularly update the tool’s content.
Numerous authors have observed the growth of e-health apps across various disciplines.20 21 However, there are still gaps in the MedRec setting, as a recent systematic review reported that only a few computer-based e-MedRec tools have been developed to date for healthcare professionals.8 In this sense, the design of ConciliaMed as a mobile app represents an alternative option for healthcare professionals to perform MedRec electronically. To guarantee the reliability of the tool,22 researchers included evidence-based content in ConciliaMed. Additionally, information about the perioperative management of pharmacotherapeutic groups, such as immunosuppressants and monoclonal antibodies, with limited data, was also included in the tool.15 16 This content was carefully reviewed by researchers and various experts in MedRec to create a sophisticated e-MedRec tool. In addition, some authors stated that obtaining feedback from users could be useful to identify changes and improvements in e-health apps.23 Following this recommendation, we included a satisfaction survey in the app whose results will allow us to analyse periodically all the users’ requirements to make ConciliaMed more attractive and adapted to healthcare professionals. In another study, confidentiality and security in mobile apps were considered a major concern for stakeholders.24 In the case of our tool, data privacy is aligned with legal regulation, and anonymisation of patient information through an alphanumeric code minimises the risk of sharing confidential information.25
Improving the usability and comprehensibility of e-MedRec tools is essential to increase user satisfaction.26 In this scenario, the authors of the ‘MedRec true’ app embedded some video tutorials and documents in the app as a supporting tool to facilitate users’ navigation.27 In ConciliaMed, the ‘frequently asked questions’ module allows users to ask questions about the content or management of the app to the research team. Moreover, the ‘my documents of interest’ module allows healthcare professionals to quickly access current evidence-based guidelines as needed. A printed discharge prescription list given to the patients was one of the most original features related to the usefulness of the RightRx tool.10 In this sense, the main strength of ConciliaMed is the generation of an editable reconciliation report with a comprehensive language adapted to both patients or caregivers and healthcare professionals. These reports help to improve the patient’s understanding of his or her own medication list prior to surgery and allow healthcare professionals to make the MedRec process more accurate.
Despite the increasing use of IT worldwide, there is still a lack of support and use of this technology by healthcare workers.28 For that reason, some innovative features have been developed in the last few years to increase user engagement with e-health tools.29 One study showed that synchronisation of data from health-related apps to other devices, such as smartwatches or other apps, could be a positive factor in increasing user satisfaction.30 Automated retrieval of information from patients’ electronic medical records (EMR) into e-MedRec tools is an essential strategy to maximise patient safety and to review accurately their medication before surgery. For this reason, ConciliaMed is expected to be embedded into local software to extract patient information from EMR. ConciliaMed is currently available in Spanish and English and on the Google Store. In the next updates of the tool, it will be available on the iOS Store, which could lead to greater visibility worldwide. Finally, understanding the users’ needs will be essential to facilitate the dissemination and promotion of ConciliaMed in other healthcare centres as well as the design of this tool could serve as a methodological guide for other authors to develop an electronic health tool.
Limitations
The limitations of ConciliaMed include the need for healthcare professionals to manually enter all patient medication lists into the tool, as it cannot extract information from electronic health records directly. However, the researchers have prefixed some fields, such as dosage regimens in milligrams or oral route administration, to speed up the MedRec process until the tool can be integrated into electronic health records effectively. The recommendations for managing certain pharmacotherapeutic groups during the perioperative period, such as antiplatelets or antihyperglycaemics, may vary among guidelines. In this context, we have added the word ‘individualise’ at the end of these perioperative recommendations, so that they can be adapted by the healthcare provider, thanks to the free-text option for comments. In addition, healthcare professionals can access all perioperative management guidelines in the ‘my documents of interest’ module to review complete information as needed. In the English version, the names of the drugs can be searched in the Spanish language in the perioperative management module, but they could be translated into English in the therapeutics equivalents module. Additionally, the app was only tested on simulated patients, so a full evaluation of the tool with patients undergoing elective surgery is expected in the near future to ensure that the needs of healthcare professionals are addressed in future versions of ConciliaMed.
Conclusion
ConciliaMed is the first MedRec app and website for healthcare professionals to obtain a reconciled medication list of patients undergoing elective surgery. The tool integrates four main modules and different functionalities, making it an intuitive and easy-to-use app. The website allows updating and managing all the data included in the tool. The app is available in Spanish and English and on the Google Store. Both the website and the mobile app are free of charge.
Supplementary material
Acknowledgements
We thank all the clinical pharmacists who participated in the piloting phase and provided their support and feedback to researchers to obtain the final version of the tool.
Footnotes
Funding: This work was supported by the Instituto de Salud Carlos III, the Spanish Ministry of Science and Innovation (DTS20/00052) and was partially funded by the European Development Regional Fund 'A Way to Achieve Europe'.
Provenance and peer review: Not commissioned; externally peer reviewed.
Patient consent for publication: Not applicable.
Ethics approval: Ethics approval was obtained from the Research Ethics Committee of the University Hospital Virgen del Rocio and University Hospital Virgen Macarena (1089-N-21) in 2021. Only simulated patients were tested in this study, so a informed consent was not required.
Data availability statement
Data are available in a public, open access repository.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
Data are available in a public, open access repository.