It is widely recognized that information technology can improve medical care and patient safety, but questions remain about how best to achieve this. The proposed research will provide important results about how to integrate decision support into clinical practices to improve the quality and safety of medication management for persons with chronic illness. This proposal describes a program to investigate the feasibility and impact of novel approaches to clinician decision support in multidisciplinary ambulatory care, emphasizing high-risk transitions of care. We have developed technology to support shared medication management for persons with chronic conditions. We will use this health information technology to facilitate clinician decision making and improve outcomes for patients and providers in the management of chronic conditions. Specifically, in this project we will develop and evaluate: 1) Meaningful presentation: Enhance clinician cognitive performance in medication management tasks by exploiting the underlying semantics of medication lists to improve the organization and presentation of medication list information;2) Assisted reconciliation: Implement medication list management tools that are integrated into clinician-specific and taskspecific workflows to support medication reconciliation, at high-risk transitions as well as in ongoing ambulatory care;3) Distributed decision support: Increase the effectiveness of medication management activities of clinicians in multiple roles by improving their coordination and communication through the use of shared medication management tools;4) Web-based clinical decision support: Employ evolving standards and architectures to link external, machine actionable, evidence-based clinical information in context-appropriate and user-appropriate ways to support shared medication management by clinicians practicing in ambulatory settings. We expect improvements in medication management by providing the means to effectively share medication information, by sharing the benefit of corrections or improvements to the regimen made by any team member but visible to all the others, and by providing clinicians using the system with access to evidence based information at the time and place it is needed.
