gms | German Medical Science

Introduction: Healthcare systems (HS) are multi-faceted, interconnected and interdependent structures where all organizational levels need to exchange information in order to fulfil tasks. Online Consumer Medication Information Systems (OCMIS) form an integral part of the pharmaceutical sector in any HS. OCMIS are rarely subject to regulation, but need excellent usability in order to ultimately benefit the consumer [1]. Information quality is crucial for OCMIS in order to assure safety and facilitate medication and treatment adherence [2]. Nevertheless, OCMIS have been characterized in the past as incomprehensible [3], incomplete, inaccurate, misrepresented, and even potentially harmful [4].

In Europe, a set of ISO norms for the Identification of Medicinal Products where developed providing internationally harmonized specifications as basic infrastructure for OCMIS. On a national level, Austria has established a standardized medication list as part of their electronic patient record [5], France created a public medication register [6] and Germany introduced a nationwide medication plan based on semantical standards [7].

In Chile however, an emerging middle-income country in Latin-America [8], the number of OCMIS is growing due to increasing digitalization within the pharmaceutical sector [9]. Governmental policies promote a rational use of- and facilitate equal access to medications and respective information [10], but neither the pharmaceutical sector nor local OCMIS have been analysed in this regard.

Methods: In order to characterize the pharmaceutical sector of the Chilean HS a semi-qualitative, multi-layered Structural Analysis and Information Flow Model (SAIFM) was established based on a literature review and expert interviews. The SAIFM visualizes interdependencies between stakeholders regarding control structures and information flow.

Subsequently, OCMIS within the pharmaceutical sector were reviewed systematically, focussing on features such as completeness, update rate, information models, usage of interoperability standards, medication classifications, query capabilities, recommender systems, and georeferencing.

Results: Four Abstraction Layers (AL) were considered within the SAIFM: governance (3 governmental entities), production & distribution (1 governmental entity, 4 private entities), healthcare provider (≈350 hospitals, ≈3.000 pharmacies, ≈40.000 practitioners, ≈2.500 pharmacists) and consumer. Both limited control and information flow within and between AL were detected.

9 web-based OCMIS were benchmarked and presented heterogeneity in data quality, update rates and completeness. This creates an information asymmetry for quality, -availability and -pricing of medications.

Discussion: The SAIFM enabled derivation of information requirements and key-features for OCMIS. Limited use of a common data model and interoperable communication interfaces prohibit secondary use, contributing to information fragmentation within the HS and leading to potential impairments for decision making.

European countries already addressed the issue using a terminology-based data model and standardized communication. Chile has now the unique opportunity to learn and improve upon these experiences in order to create effective OCMIS, eliminating remaining information asymmetries.

Conclusion: This case study helps to understand the pharmaceutical sector and enable steering of OCMIS development if necessary. The provision of a common, interoperable information model and communication interface as a single source of truth could alleviate the information asymmetry present within the pharmaceutical sector, finally improving information flow between stakeholders within the HS and thus benefiting all stakeholders involved.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.