NHI-PharmaCloud in Taiwan--A preliminary evaluation using the RE-AIM framework and lessons learned

San-Kuei Huang; Pen-Jen Wang; Wen-Fuh Tseng; Fei-Kai Syu; Miaw-Chwen Lee; Ru-Liang Shih; Mao-Ting Sheen; Michael S Chen

doi:10.1016/j.ijmedinf.2015.06.001

NHI-PharmaCloud in Taiwan--A preliminary evaluation using the RE-AIM framework and lessons learned

Int J Med Inform. 2015 Oct;84(10):817-25. doi: 10.1016/j.ijmedinf.2015.06.001. Epub 2015 Jun 22.

Authors

San-Kuei Huang¹, Pen-Jen Wang², Wen-Fuh Tseng², Fei-Kai Syu³, Miaw-Chwen Lee⁴, Ru-Liang Shih², Mao-Ting Sheen⁵, Michael S Chen⁶

Affiliations

¹ National Health Insurance Administration, Ministry of Health and Welfare, Taiwan.
² Medical Review and Pharmaceutical Benefit Division, National Health Insurance Administration, Ministry of Health and Welfare, Taiwan.
³ Division of Clinical Pharmacy, Department of Pharmacy, China Medical University Hospital, Taiwan.
⁴ Department of Social Welfare, National Chung Cheng University, Taiwan.
⁵ Taipei Division, National Health Insurance Administration, Ministry of Health and Welfare, Taiwan.
⁶ Department of Social Welfare, National Chung Cheng University, Taiwan. Electronic address: aping.chen@msa.hinet.net.

PMID: 26113462
DOI: 10.1016/j.ijmedinf.2015.06.001

Abstract

Objectives: The aim of this article is to present the preliminary impact of a medication monitoring program, PharmaCloud, in Taiwan and analyze the embedded factors that have contributed to the performance thereof. This article also compared PharmaCloud with similar international programs in order to draw lessons learned.

Methods: The five domains of the RE-AIM framework - reach, effectiveness, adoption, implementation, and maintenance - were examined using qualitative and quantitative data. A difference-in-differences model was applied to analyze the quantitative impact of PharmaCloud on drug utilization and drug expenses. The qualitative impact was evaluated by document analysis based on field reports from the participating medical institutions.

Results: Reach and adoption: although all of the major hospitals adopted PharmaCloud and some of the hospitals had high inquiry rates, more time and incentives are needed to raise the overall inquiry rate. Effectiveness: during the study period of 3 months, the number of medications per prescription declined in the intervention group was 0.15 more than that of the general population, and the drug expense per person declined in the intervention group was NT $567 (US $18.9) more than that of the general population. The potential savings could be between 2% and 5% of the total pharmaceutical expenditure. Medication duplication was found to have decreased more in the intervention group.

Implementation: a variety of innovations in care delivery are being developed in which the pharmacists play a more significant role. Maintenance: the embedded National Health Insurance would lend strong support for PharmaCloud to grow and thrive.

Conclusion: PharmaCloud owes its effectiveness to the embedded National Health Insurance (NHI) program, which is universal and provides a comprehensive benefit package including more than 16,000 prescription drugs. An effective medication program is one that operates under the principle of universality and comprehensiveness, facilitates innovations, and has a substantial level of interoperability with the intra-hospital health information systems.

Keywords: Health information technology; Medication monitoring programs; PharmaCloud.

MeSH terms

Clinical Pharmacy Information Systems
Cloud Computing / statistics & numerical data*
Electronic Health Records / statistics & numerical data*
Electronic Prescribing / statistics & numerical data*
Medical Order Entry Systems / statistics & numerical data*
Medical Record Linkage / methods
Medication Systems, Hospital / statistics & numerical data*
Taiwan
User-Computer Interface
Utilization Review