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Discussion
This study presents ConciliaMed, an intuitive and easy-to-use e-MedRec tool designed as both a mobile app and a website for healthcare professionals. The app allows users to perform the MedRec process with the support of four interactive modules integrated into the tool, as well as to evaluate the usability and satisfaction with the app. Some features of ConciliaMed have been implemented to facilitate the MedRec process, such as the generation and output of specific reconciliation reports for patients and caregivers, or the transfer of information between healthcare professionals. Most participants in the pilot phase rated the tool positively in terms of usability and satisfaction, but there is still room for improvement. The website can also serve as a user guide and a platform for the research team to regularly update the tool’s content.
Numerous authors have observed the growth of e-health apps across various disciplines.20 21 However, there are still gaps in the MedRec setting, as a recent systematic review reported that only a few computer-based e-MedRec tools have been developed to date for healthcare professionals.8 In this sense, the design of ConciliaMed as a mobile app represents an alternative option for healthcare professionals to perform MedRec electronically. To guarantee the reliability of the tool,22 researchers included evidence-based content in ConciliaMed. Additionally, information about the perioperative management of pharmacotherapeutic groups, such as immunosuppressants and monoclonal antibodies, with limited data, was also included in the tool.15 16 This content was carefully reviewed by researchers and various experts in MedRec to create a sophisticated e-MedRec tool. In addition, some authors stated that obtaining feedback from users could be useful to identify changes and improvements in e-health apps.23 Following this recommendation, we included a satisfaction survey in the app whose results will allow us to analyse periodically all the users’ requirements to make ConciliaMed more attractive and adapted to healthcare professionals. In another study, confidentiality and security in mobile apps were considered a major concern for stakeholders.24 In the case of our tool, data privacy is aligned with legal regulation, and anonymisation of patient information through an alphanumeric code minimises the risk of sharing confidential information.25
Improving the usability and comprehensibility of e-MedRec tools is essential to increase user satisfaction.26 In this scenario, the authors of the ‘MedRec true’ app embedded some video tutorials and documents in the app as a supporting tool to facilitate users’ navigation.27 In ConciliaMed, the ‘frequently asked questions’ module allows users to ask questions about the content or management of the app to the research team. Moreover, the ‘my documents of interest’ module allows healthcare professionals to quickly access current evidence-based guidelines as needed. A printed discharge prescription list given to the patients was one of the most original features related to the usefulness of the RightRx tool.10 In this sense, the main strength of ConciliaMed is the generation of an editable reconciliation report with a comprehensive language adapted to both patients or caregivers and healthcare professionals. These reports help to improve the patient’s understanding of his or her own medication list prior to surgery and allow healthcare professionals to make the MedRec process more accurate.
Despite the increasing use of IT worldwide, there is still a lack of support and use of this technology by healthcare workers.28 For that reason, some innovative features have been developed in the last few years to increase user engagement with e-health tools.29 One study showed that synchronisation of data from health-related apps to other devices, such as smartwatches or other apps, could be a positive factor in increasing user satisfaction.30 Automated retrieval of information from patients’ electronic medical records (EMR) into e-MedRec tools is an essential strategy to maximise patient safety and to review accurately their medication before surgery. For this reason, ConciliaMed is expected to be embedded into local software to extract patient information from EMR. ConciliaMed is currently available in Spanish and English and on the Google Store. In the next updates of the tool, it will be available on the iOS Store, which could lead to greater visibility worldwide. Finally, understanding the users’ needs will be essential to facilitate the dissemination and promotion of ConciliaMed in other healthcare centres as well as the design of this tool could serve as a methodological guide for other authors to develop an electronic health tool.
Limitations
The limitations of ConciliaMed include the need for healthcare professionals to manually enter all patient medication lists into the tool, as it cannot extract information from electronic health records directly. However, the researchers have prefixed some fields, such as dosage regimens in milligrams or oral route administration, to speed up the MedRec process until the tool can be integrated into electronic health records effectively. The recommendations for managing certain pharmacotherapeutic groups during the perioperative period, such as antiplatelets or antihyperglycaemics, may vary among guidelines. In this context, we have added the word ‘individualise’ at the end of these perioperative recommendations, so that they can be adapted by the healthcare provider, thanks to the free-text option for comments. In addition, healthcare professionals can access all perioperative management guidelines in the ‘my documents of interest’ module to review complete information as needed. In the English version, the names of the drugs can be searched in the Spanish language in the perioperative management module, but they could be translated into English in the therapeutics equivalents module. Additionally, the app was only tested on simulated patients, so a full evaluation of the tool with patients undergoing elective surgery is expected in the near future to ensure that the needs of healthcare professionals are addressed in future versions of ConciliaMed.
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