The recent CrowdStrike outage caused widespread disruption to the health-care system, forcing hospitals to urgently pivot toward paper as health records, including medication information, could no longer be updated online.
This was not the only cybersecurity incident to affect patients in Canada. Earlier this year, a cyberattack on London Drugs resulted in the temporary closure of 79 pharmacies due to data theft.
Since patients, especially those with complex medical needs, often find it difficult to remember their medication routine, this prompts the question: Should patients maintain their own personal medication record?
With a health system that is in crisis, and very few Canadians being able to find a family doctor, people are more often to rely on emergency rooms. “I find myself in the emergency room almost once a month, and I can barely remember what medications I take,” says Chris, a 67-year-old-man from Toronto. These urgent emergency care needs with inconsistent healthcare providers may create transitions in care that can be dangerous because of an incomplete view of the person’s healthcare journey, including their medication history.
Though the federal Liberals have proposed a bill to securely share patient records and ensure health system interoperability to “help take the blindfolds off of practitioners,” according to Health Minister Mark Holland, these changes won’t happen overnight.
Clinicians often are limited to incomplete and at times fragmented medication information. In Ontario, while clinicians have access to Connecting Ontario Clinical Viewer as a clinical database, users cannot see mediation records outside of medications reimbursed by the government. As a result, real-time access to medication histories can become challenging, and communication between pharmacists and other healthcare professionals often rely on phone calls and faxes.
For this reason, interruptions in community pharmacy services can lead to miscommunications and medication errors during transitions in care. For patients, creating a personal medication record can be critical to ensuring medication safety. This is to ensure safe transitions of care.
In urgent cases, access to timely care and the right medications is vital. Patients need their emergency doctors and pharmacists to have the necessary background information to make well-informed recommendations.
For example, when a patient is admitted to a hospital, pharmacists and physicians work together to prepare a Best Possible Medication History (BPMH). This history is stitched together from what patients know about their medication routine, online portals that may have fragments of medication history and community pharmacy records.
Cyberattacks can be alarming, especially when they affect health-care access
The BPMH helps clinicians understand what medications the patient should be taking as they are admitted to the hospital. Possessing a recently printed medication record would establish an accurate, up-to-date BPMH.
When a patient leaves the hospital, we use the BPMH to reconcile what is new for the patient and what changed throughout their course of stay. Conducting a BPMH is critical because transitions of care are prone for medication error. Without the clear communication of changes to medications upon discharge, a patient could go home on a higher dose of insulin than intended.
Cyberattacks can be alarming, especially when they affect health-care access. However, there are proactive measures patients can take to safeguard their information. Recognizing the importance of monitoring personal health-care records underscores the need for steps to ensure access during critical moments.
When consolidating a personal medication record from the various documents provided by healthcare providers, patients should ensure they include:
- The date each record was last updated
- Medication allergies or intolerances
- Medication name (ideally both brand and chemical name e.g. Tylenol and acetaminophen respectively)
- Dose (e.g. 500 mg)
- Frequency (e.g. twice a day)
- Route of administration (e.g. by mouth)
- Categorization as to whether it is a routine medication or an “as needed” medication
- The purpose of the medication
- Details on any non-prescription medications, vitamins, or natural health products
For patients, it’s important to work with health-care professionals to develop accurate, up-to-date records so they can be best prepared. In Ontario, patients who receive a medication review (MedsCheck) from a pharmacist should receive a personal medication record that can be kept up-to-date for this purpose. Ensuring the record is correct will be paramount for providing information that can be used to support care.
We encourage patients to prepare themselves for instances where their medical record may be unavailable and needed for urgent care. However, lack of data orchestration to compose a consolidated personal medication record is a symptom of a health system in crisis and must be addressed at the policy level. Our recommendation is intended to support urgent scenarios considering an increasing rate of system outages.
By creating a personal medication record, patients will find themselves empowered with the ownership of their information for the moments they need it most.
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