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Technology can prevent the over- and under-medication that is more common than most people think
Pills at the Teva factory in Har Hotzvim, Jerusalem (illustrative photo; credit: Nati Shohat/Flash90)
Pills at the Teva factory in Har Hotzvim, Jerusalem (illustrative photo; credit: Nati Shohat/Flash90)

There are some things in medicine that are considered mundane and incredibly straightforward. When a doctor writes a prescription, there are a number of assumptions made. One expects the doctor to prescribe the correct medication for the given medical condition. One expects that the dose of the medication be correct and appropriate for the given patient. For example, an older patient, or patient with kidney disease, might need a different dose of a medication in order to get the full benefit with minimal side effects. One expects the doctor to make sure that the patient does not have a known allergy to the medication. Also, there is the expectation that the doctor will make sure that the new medication does not negatively interact with other medications that the patient is already taking. One expects the doctor to write for a sufficient number of pills so that the patient will not have to return every week. On the other hand,  it is important that the doctor not prescribe too many pills as this might  lead to misuse and severe medical complications. For example, when dealing with a  depressed patient, the doctor must be careful not to prescribe too much of a medication that may be used as part of a suicide attempt.

After all of this, there is the expectation that the patient will actually go to the pharmacy to fill the prescription. If the cost of the medication is too high, and the doctor did not consider this and discuss this issue with the patient, the prescription may very well never leave the patient’s pocket. Then, there is the expectation that the pharmacist will hand the patient the correct medication, and not misread the medication’s name and give the patient a pill that is totally inappropriate or even dangerous.

Finally, there is the hope  that once the patient actually has the correct medication in his or her hands, that he or she will follow the instructions on the prescription and take the correct number of pills, the correct number of times per day,  for the correct number of days.

I have purposely described this process in extreme detail to make the point that each and every step is a potential point of failure. And yes, if you count up the number of steps required for a patient to get the medication they need, it may seem almost miraculous that patients do get properly treated. From the following link, I quote the (frightening) statistic: “Medication errors are very common and it has been estimated that as much as one in five dosages are given incorrectly”. This statistic is consistent with regular yearly reports of huge numbers of patients who suffer and die from medication errors. One would think that this matter would have already been dealt with in the strictest of ways. Sadly, this is simply not true.

For anyone following this blog, it should come as no surprise that I will describe solutions that are technology-based. The reason that the solution will be based on software and specialized hardware, is because human beings are fallible. At 2 o’clock in the morning, with five patients ringing bells because they are in need of assistance, and while working on an understaffed shift, it really is nearly impossible NOT to make a mistake. Contrarily, technologies tend not to get tired or distracted. When having to make sure that the tiny writing on the surface of the medication tablet is consistent with the medication ordered by the doctor, the risk of human error is simply too high.

What options exist for making sure that the patient is getting the correct pill? More so, can a single technology also help with all of the other steps that I listed above? The simple answer is, yes.

One possible approach is still not in use but will be soon. There is a technology called RFID or radiofrequency identification. Simply put, each individual tablet and pill could have a very small electronic tag stuck to its surface, during the manufacturing process. When the nurse lifts the tagged pill up in the air, an RFID scanner could automatically check the identification of the pill. The software could then make sure that this is the correct pill for this specific patient. The software could also double check that the patient is not allergic to this medication and is not taking any other medications that could conflict with this pill. Also, the use of the pill would be flagged and recorded against the inventory for the department. So, when the department runs low on this pill, an automatic order would be sent down to the pharmacy and the medication would be restocked in the department. The fact that the patient actually swallowed the pill could be verified  by a scanner over the patient’s abdomen. The software would also record the times at which the medications were given. All of this information would be stored within the hospital’s EMR and would [or at least should] be available to the patient’s own EMR or that of the patient’s primary care physician.

With such a system in place, could a robot distribute medications? The answer is a definite “yes” and this technology will also be available relatively soon.

The article I linked to above speaks of a whole different approach to identifying a medication. As noted in the article, “The MedEye system looks like a desktop computer, but that contains a camera that scans medication that is dropped into the tray. It then uses computer vision to identify, verify and register all the medications that are given. This can happen right next to the patient at the bedside, thus virtually eliminating the risk of medication errors during administration.”

Whether a hospital uses RFID technology or the MedEye system or another technology for reducing medication errors, the key is that human error, related to this particular part of healthcare, will soon be eliminated. There will be tremendous cost savings to the healthcare system by virtue of not having to deal with the complications of giving the wrong medication. And most importantly, patients will benefit from safer care.

There are unfortunately other types of errors that occur on a frequent basis within the medical world. These other types of errors will need their own technological solutions. But these solutions will come and more so, will become standard across the world. It may still take a while for every health care service to adopt these safety ensuring technologies. But it will happen.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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