Digital support for ward pharmacists | 5 Questions for… Prof. Dr. André Scherag and Dr. Daniel Neumann on the start of the INTERPOLAR studies

The INTERPOLAR Project of the Medical Informatics Initiative (MII) investigates how IT solutions can support the work of ward pharmacists. After almost two years of preparation, the INTERPOLAR project is now entering its practical phase: in a multi-phase study, the Medication Therapy Safety (MTS) Cockpit will be implemented on 48 wards at eight university hospitals and used as a tool for medication analysis on randomly selected wards. The goal is to increase medication safety and make the best use of scarce hospital resources. In this interview, Prof. Dr. André Scherag, Deputy Network Coordinator, and Dr. Daniel Neumann, Scientific Project Manager at INTERPOLAR, give an insight into the background of the INTERPOLAR studies and the use of the MTS Cockpit.

The INTERPOLAR project aims to investigate whether ward pharmacists benefit from IT support in their medication analysis. What steps are planned for the project?

Prof. Dr. André Scherag: The project is divided into three phases: Preparation, Implementation and Evaluation. In the preparation phase, we need to clarify the regulatory and legal framework. For example, we need an ethics and study protocol for the studies and the work planned for them. Another task awaits us in the area of documentation, which needs to be harmonized across the stations. The “trigger lists” need to be updated and standardized. These lists indicate, for example, which drugs should not be combined. The study itself will take place in two phases. First, standardized documentation will be introduced, and then ward pharmacists will gradually receive digital support. Currently, some sites already have the technical requirements to start with the documentation.

Dr. Daniel Neumann: We spent a lot of time understanding the workflows and medication analysis of the ward pharmacists. We developed and coordinated comprehensive process models. We used these to make decisions about medications and the information needed to make them. This enabled us to develop the information for IT solutions in collaboration with the Federal Association of German Hospital Pharmacists (ADKA) and the Medical Informatics Initiative. Each site is now working on implementing the IT support and connecting to the data integration centers before patient documentation can begin.

INTERPOLAR will be a cluster-randomized study, which means that results will be compared between wards rather than between patients. Why did you choose this approach?  

Prof. Dr. André Scherag: Patient-related randomization would be difficult because ward pharmacists are permanently assigned to certain wards. In one ward, some patients cannot be treated with IT support, while others remain without it. Randomization at the ward level helps to ensure that ward-specific factors do not influence the results too much. The stepped-wedge design also allows us to better manage logistical challenges. This allows us to better estimate how much extra work the ward pharmacists will have to do. We can also see how the results change over time.

Dr. Daniel Neumann: Our study focuses on healthcare and the best possible use of ward pharmacists to improve patient safety. This all happens on the wards. That’s why it makes sense to include ward pharmacists in the study and to randomize them to the wards.

The Medication Therapy Safety (MTS) Cockpit will be implemented on participating university hospital sites. How exactly will it be used?

Prof. Dr. André Scherag: The MTS Cockpit will be implemented in two steps. First, ward pharmacists will document potential medication problems and make recommendations to the treating medical team. In the documentation, the ward pharmacists indicate where the problem occurs, what recommendations have been made and what needs to be changed. The attending physician must then decide whether to make the change. Sometimes there is a reason that is not obvious to the ward pharmacist as to why the medication was given on purpose. For example, there may be an even worse risk that needs to be prevented. In a second step, the MTS Cockpit will provide the ward pharmacists with digital information to help them identify patients they have not yet focused on during the medication analysis itself.

Dr. Daniel Neumann: The MTS Cockpit gives ward pharmacists a structure and an overview of their daily activities. Until now, they have documented but not systematically tracked what happens with medication problems. The cockpit is designed to create more transparency and enable more targeted tracking. In addition, for the first time in Germany, we will be able to document medication problems that have occurred and how they have been solved. This is very important for further research in the area of medication therapy safety, pharmacovigilance and IT support for clinical processes.

What challenges do you expect to face in implementing such an IT solution?

Prof. Dr. André Scherag: The people who will be using our IT solution must first accept it. That’s why we involved the ward pharmacists in the development process right from the start. We will only be able to see if there are any other hurdles once the application has been introduced into clinical practice. There could also be difficulties with the local implementation of the software components, which were mainly developed in Leipzig. However, we will not know all of this until the trial is conducted.

Dr. Daniel Neumann: Another point is that the MTS Cockpit operates independently of the hospital information systems. This can be challenging when ward pharmacists have to work with two parallel systems. It is important to communicate effectively with the ward pharmacists in advance. Of course, this requires them to be highly motivated to participate. Only then can IT support function properly after implementation.

Please complete the following sentence: I think the INTERPOLAR project is important for improving medical care because…

Dr. Daniel Neumann: …for the first time it will be possible to look at systemic research between the healthcare system and IT support. In this way, the demonstrably important support provided by ward pharmacists can be better integrated into everyday clinical practice.

Prof. Dr. André Scherag: …it hopefully shows that digital tools can help everyone involved. There are fewer and fewer experts, but more and more elderly, multimorbid patients. The INTERPOLAR project offers a solution.