Table 17Summary of gaps and needs across key questions

Gaps and Needs in Evidence and KnowledgeStrengths and Substantial Evidence
 KQ1. Effectiveness: Medication Management Phases and otder Processes
Order Communication, especially two-way e-communication
Dispensing
Administering
Reconciliation
Education and training for professionals and patients
System wide MMIT applications
Prescribing*
Monitoring
 KQ1. Effectiveness: Research Metdods
Controlled trials with comparative groups
Trials with strong methods regardless of research method used
Trials of whole systems and also components of MMIT
Studies with outcomes important to patients
Studies with population based outcomes
Studies that address issues related to evaluation of complex interventions
Pragmatic trials
Multicenter trials
Studies done by others besides developers
Qualitative studies, especially of patients and families
Evaluations of the evidence content of MMIT applications
Knowledge translation (translational research) studies
Understanding applicability of MMIT applications in relation to the complexities of MMIT systems
Research teams or consultations that include clinicians, researchers, and informaticians as well as all major stakeholders
Observational studies
Descriptive studies
Studies that measure changes in process
Studies done in one institution or location
 KQ1. Effectiveness: Participants and Settings
Nurses
Pharmacists and other pharmacy personnel
Other health professionals
Patients and families especially in home situations
Children
Pharmacies, especially those outside of hospitals
Long term care facilities
Community
Homes
Specialty clinics
Population based studies
Physicians*
Hospital based settings
Primary care/ambulatory care settings
 KQ1. Effectiveness: Healtd IT Systems
Fully integrated MMIT systems
MMIT used by nonphysicians
MMIT used by patients and families (patient-based systems)
MMIT in relation to health information exchange systems
CDSS*
CPOE
 KQ1. Effectiveness: Reporting
Reports of harms and other unintended consequences of MMIT systems and system integration
Lack of consensus on terminology related to IT and MMIT
Lack of standardization in reports of studies of MMIT despite having published standards
 KQ1: Effectiveness: Outcomes and otder study endpoints
Usability studies, especially those that can be generalized or transferred
Workflow effects on both functional and dysfunctional groups before implementation
Unintended consequences, with emphasis on major ones
Changes in process
 KQ1: Effectiveness: Costs and Economics Studies
Strong and full economics studies that include both costs and consequences
Cost and economics studies of non-CDSS and CPOE systems
CDSS
CPOE
 KQ3: Value Proposition for Implementers and Users
Full economic analyses
Personal values of multiple stakeholders and what makes them decide to buy or use a system
Patients and their families and their values
Effectiveness research and pragmatic trials with an emphasis on outcomes important to patients
The effect of MMIT on risk mitigation
 KQ4: System Characteristics
Reporting and standardization of reporting of system characteristics, feature sets
Head to head comparisons of systems taking into account their features and characteristics
Health information exchanges and MMIT
 KQ5: Sustainability
Operational definition of sustainability accepted by multiple stakeholders
Studies that measure and report sustainability that are comparative across many groups and issues
 KQ6: Two-way EDI
Studies of complete two-way EDI
Studies of the effects of e-Prescribing on pharmacists, pharmacy personnel and patients and their families
The effects of e-Prescribing on hospital and primary care physicians
 KQ7: RCTs of CDSS
Strong trials on clinical outcomesTrials of CDSS
*

substantial strength

From: Results

Cover of Enabling Medication Management Through Health Information Technology
Enabling Medication Management Through Health Information Technology.
Evidence Reports/Technology Assessments, No. 201.
McKibbon KA, Lokker C, Handler SM, et al.

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