Medication Monitoring for Vulnerable Populations via Information Technology (MMITI)

This project demonstrated the ability of an interoperable health information exchange and an electronic health record (EHR) to provide useful quality and safety measures for the vulnerable populations served by two Baltimore Medical System (BMS) Community Health Center (CHC) clinics. The project used a set of national consensus measures and identified the organizational culture issues that linked these measures to their corresponding goals. The project's intervention included a monitoring bulletin provided to physicians every other month to inform them of patients who required therapeutic monitoring tests for one or more of the quality measures. The team also evaluated the relationship between contextual factors, e.g. teamwork and the safety climate at BMS, and the assessments providers made of the usefulness and actionability of EHR quality and safety data.

The main objectives of the project were to:

1. Develop and implement via EHR accurate quality and safety measures focused on medication monitoring for vulnerable populations that are served by BMS CHC. Explore factors that influence accuracy of EHR-derived measures.
2. Develop and implement EHR-based quality and safety measures of medication monitoring for vulnerable populations that are served by BMS CHC that are useful to clinicians and senior leaders.
3. Develop and implement EHR-based quality and safety measures of medication monitoring for vulnerable populations that are served by BMS CHC that impact patient outcomes.
4. Evaluate the relationship between contextual factors (teamwork and the safety climate at BMS) and provider assessments of EHR quality and safety data as useful and actionable, and evaluate whether deployment of these measurement efforts will improve teamwork and safety climate at CHC.

The study found that automatic queries of EHRs to identify patients eligible for quality measures are feasible and potentially far superior to manual reviews of EHR data. However, only one to five providers described reports of quality measure data as being useful. The percentage of patients who received monitoring after being identified in the bulletin was not associated with provider attitudes about the usefulness of the bulletin. Individuals at risk for medication–related toxicity were found to frequently go unmonitored. The study also found that provider‐specific bulletins are able to enhance receipt of recommended monitoring among target patients.