Enhancing Clinical Decision Support Applications for Community Pharmacist-Delivered Medication Therapy Management

Medication therapy management (MTM) is a service or group of services designed to identify and resolve medication therapy problems (MTPs), such as medication non-adherence, and enhance patient care. MTM is typically documented by community pharmacists in an MTM vendor’s web-based platform that offers clinical decision support (CDS) tools. These applications provide integrated alerts to assist the pharmacist with assessing MTPs. Use of CDS, such as these alerts, provides an opportunity to optimize MTM, improve health outcomes, and reduce the economic burden of medication-related problems. While CDS tools have been shown to improve specific care processes in other healthcare contexts, limited research exists regarding the use of these tools in community pharmacies.

To address these gaps in current research, a research team from the Purdue University College of Pharmacy evaluated how CDS tools for MTM have historically been designed and delivered in community pharmacy practices. The data from the evaluation were then used to make actionable recommendations for design improvements to MTM platforms.

The specific aims of this project were as follows:

• Evaluate the extent to which computerized CDS for community pharmacist-delivered MTM aligns with established human factors principles. 
• Assess the usability of MTM computerized CDS for community pharmacists, as well as pharmacists’ perspectives on the usefulness and usability of these technologies for patient care. 

Alerts were provided by participating pharmacists from two MTM vendor platforms and analyzed by the research team. Of 77 alerts submitted, nearly half were related to medication indication, safety, and adherence, and the rest related to effectiveness or cost. Twenty-four alerts were chosen for evaluation. Using a modified heuristic evaluation tool, each alert was assessed for eight overarching human factor principles: visibility, color, alarm philosophy, prioritization, text-based information, proximity of task components being displayed, corrective actions, and placement. Principles generally met were visibility and color, while the remaining principles were deemed areas for opportunities in improvement or unable to be assessed.

To assess end-user perspectives, pharmacists participated in usability testing and semi-structured interviews. Usability issues noted were related to workflow, alert display, and alert system reliability. Semi-structured interviews revealed challenges to both usability and usefulness of MTM alerts, including system integration issues, concerns with redundant alerts, MTPs that were not identified by alerts, and MTMs alerts that were false alarms. As a result of these reported challenges, design recommendations for MTM vendor systems were identified to assist in more effective care delivery. These recommendations can be found in the research team’s publication “Alerts for Community Pharmacist-Provided Medication Therapy Management: Recommendations from A Heuristic Evaluation” in the December 2019 edition of BMC Medical Informatics and Decision Making.