Lost or inaccurate medication information can cause patients and health care professionals significant difficulties [1-3] and lead to avoidable harm and costs [4-6]. Addressing these problems by improving timely access to and seamless communication of patient medication lists is a priority for medication safety everywhere [5,7]. However, personal, organizational, and contextual barriers often stand in the way, especially during transitions of care [8-10]. The growing burdens of chronic diseases and polypharmacy among aging populations add to these challenges. Thus, governments worldwide are investing in digital interoperability and data exchange systems to improve the quality of and access to information about patient medication lists [11].

Information systems in some countries support the management of digital shared medication plans (SMPs) based on treatment decisions and are usually embedded in patients’ electronic health records. These enable timely access to and updates of the list of medicines that a patient is currently taking by authorized health care providers. Some systems incorporate histories of recent changes in medication [12-14]. Other systems generate medication lists with administrative data from pharmacy dispensing records [15-17] or central prescribing databases [18]. The latter are less demanding for health care professionals but cannot ensure that the current treatment plan is up-to-date after changes have been made by patients, pharmacists, or other prescribers [18-20]. Furthermore, an SMP can encompass the administrative workflows of prescribing and dispensing [21]. The terms plan and list are used interchangeably in the literature. We prefer “plan” because it emphasizes the clinical focus on decisions and the active role of users. Patients and health care professionals can access plans through a web portal, a mobile app, or an established clinical information system. Health care professionals appreciate these systems [22-24], especially for medication reconciliation [25-27]. Digital SMPs have been implemented in Australia [28], Austria [23], Denmark [29], the United Kingdom [30], and Norway [26], among other countries.

Introducing a digital SMP poses significant challenges in health care settings worldwide, where fragmented and heterogeneous communication practices between health care professionals and patients are common. Switzerland exemplifies these challenges: prescriptions are the primary means of sharing medical orders but fail to account for changes when treatments are stopped. Moreover, medication plans are not consistently used by health care professionals and are often exchanged via email, fax, or on a piece of paper handed directly to the patient. This leaves patients largely responsible for managing their medication intake and sharing related information with health care professionals, relying on digital tools, handwritten or printed notes, or no tools at all.

Integrating a shared platform suitable for every actor is a complex challenge, which extends beyond ensuring medication data interoperability. Currently, despite the administrative, organizational, and management advantages of SMPs, medication list inaccuracies remain common because they are not systematically updated in health care services, over-the-counter medications are omitted, and patient-driven changes are inconsistently integrated [25,27,31]. Assigning the task of overseeing and updating medication lists can also be problematic. When general practitioners are solely responsible for this, specialist physicians, pharmacists, and nurses cannot document their changes and underlying reasoning because they can neither access nor edit the SMP [26,27,32]. Other systems require pharmacists to update SMPs when they provide medicines, give advice on over-the-counter medications, or conduct a medication review [23,33].

Currently, there are no national eHealth platforms that allow patients to change their medication plans independently [13,14,34], despite growing acknowledgment of how patients and families can contribute to improving medication safety [7,35,36]. Both digital and paper-based patient-held medication lists can strengthen patient self-management and enhance communication with their health care professionals [37-39].

This lack of patient involvement in established medication systems contrasts with the proliferation of smartphone apps for medication management [40] and web portals giving patients access to their clinical records and supporting their contributions to medication reconciliation [41-43]. This paradox should alert health technology developers and policy makers to the need for research and innovation in digital SMP design, use, and implementation. An SMP could leverage cooperation between patients and health care professionals to enhance the continuity of information and improve medication safety [14,27,44].

Some researchers have evoked the need to involve patients [25,27,31], but very few studies have sought out their opinions or tested the coproduction of medication plans [13]. Shifting to patient–health care professional coproduction would require considerable digital SMP redesigns in countries with established systems. However, Switzerland, having only recently introduced national shared electronic health records, known as “electronic patient records” (EPRs), has not yet implemented national e-medication or e-prescribing systems. One regional pilot project pointed out the poor engagement of patients whose SMPs provided no interactive features [14]. Finally, Switzerland’s eHealth interoperability framework provides an opportunity to design the digital capacity for coproducing medication plans and potentially inform similar developments in other countries [45].

We aimed to explore and leverage the potential for patients’ contributions to SMPs. We used an experience-based co-design (EBCD) methodology to identify value propositions for a digital tool enabling patients, family caregivers, and health care professionals to coproduce and co-manage medication plans within Switzerland’s existing national eHealth architecture. We worked with polypharmacy patients, family caregivers, health care professionals, and digital health and quality experts.

We used the coproduction in health care services framework model [46,47] and the Montreal Model [48] to embrace 3 types of coproduction: coproduction within our research team itself, coproduction to improve health care delivery, and coproduction during clinical interactions. Both models highlight the collaborative nature of health care services, emphasizing the need for greater patient involvement in research and innovation. The Montreal Model specifically underscores patients’ and family caregivers’ experiential knowledge. It describes their involvement as a continuum across various domains. Overall, the coproduction paradigm provides a valuable lens through which one can investigate the need for and benefits of collaboration between health care professionals, patients, and their relatives in daily practice.

The research team included a pharmacist with a master’s degree in health care service innovation (BB) and a physician with expertise in quality improvement, patient safety, and the coproduction of health care services (CvP). Both worked for the health authorities of the Canton of Vaud, one of the cantons making up the Swiss Confederation. Other members comprised a philosopher-ethicist, a health psychologist specializing in the sociology of technology (FB), and a sociologist (AK), all of whom worked at the University of Lausanne’s Participatory and Collaborative Action-Research Unit. There was also a physician specializing in digital health (AG) and a pharmacist specializing in medication safety (PB). The team had significant experience in qualitative research.

In total, 4 patients and 1 informal caregiver who had all participated in workshops about the rollout of a regional EPR system [49] were included as co-researchers in the study. They contributed to the study design; the preparation, facilitation, and debriefing of focus groups; and the writing and presentation of a synthesis for all the participants during the co-design workshops.

This study was conducted in the cantons of Vaud and Geneva in the Swiss Confederation’s French-speaking region between October 2020 and February 2021. Interviews, focus groups, and the EBCD workshops took place according to the COVID-19 regulations that were in place at the time and in calm settings at the University of Lausanne, Geneva University Hospitals’ innovation center, and Lausanne University Hospital.

The launch of a regional EPR platform for the secure storage and exchange of health data, as mandated by federal law, was in preparation in the region [55]. In total, 8 “communities” implement and manage EPRs in different regions of Switzerland. Currently, these EPRs function solely as repositories for clinical documents (Clinical Document Architecture level 1), generally PDFs, but the development of capabilities for sharing structured data within the national interoperability framework is underway. Medication and vaccination plans are priorities because of their implications for patient safety and clinical practice.

Our study was conducted in coordination with one of these communities, named CARA [56], which was piloting the development of a new SMP approach [57]. In cooperation with national bodies, it will apply international Integrating the Healthcare Enterprise pharmacy profiles [58] and the Swiss medication data exchange format based on the Fast Healthcare Interoperability Resources Foundation’s Health Level 7 specifications [59]. The architecture prepared by a formal national working group respects the patient-centered, decentralized design required by federal law. Technical details have been published previously [45].

The Swiss health care system is fragmented and has no national guidelines or policies for practices such as medication reconciliation and interprofessional communication. Legal reforms to safeguard the rights of polypharmacy patients to a medication plan and enhance medication safety have been proposed but have not yet been implemented, and the debate about them is ongoing [60].

Patients were invited to participate in the study if they (1) were capable of managing their medications autonomously (ie, they were not institutionalized), (2) regularly took ≥3 medications, and (3) had experienced transitions of care, such as hospital admissions and discharges that involved changes to medications. Family caregivers could participate if they regularly supported such a patient in taking medications.

Recruitment emails were sent to existing pools of volunteers affiliated with a regional consumer rights association, patients and family caregiver associations, and a local university hospital. The emails introduced the study topic and outlined the inclusion criteria. Once individuals had expressed interest to the concerned person in their respective organizations, the research team received their contact details and followed up via email or telephone, as preferred, to propose dates for the focus groups (scheduled 1 month in advance) and the co-design workshop with health care professionals (scheduled 2-3 months in advance). This follow-up step also confirmed their eligibility, interest, and availability.

We aimed for diversity of experiences, diseases, gender and age. To achieve this, we also contacted individuals already involved in existing initiatives directly, such as peer support, teaching, or research projects. Our initial goal was to organize 3 to 5 local groups of 5 to 9 participants each, for a total sample size of approximately 15 to 30 individuals.

The inclusion criteria for health care professionals were (1) previous participation in improvement projects on medication management, transitions of care, or care coordination; or (2) involvement in medication prescription, delivery, or management in their current occupation. They were recruited through the professional networks of the authors.

Data were collected through individual interviews, focus groups, and workshops with patients, caregivers, and health care professionals per the 4 phases of EBCD. Guides were prepared for each phase by the research team and refined between interviews (Multimedia Appendix 1). Focus groups in phase 2 were based on the patient vignettes built up from the available literature and narratives collected in phase 1. The focus groups with health care professionals were guided by the key touch points revealed by the focus groups with patients’ informal caregivers.

At least 1 coresearcher participated in each focus group, asking follow-up questions and taking notes that were shared with the team. Coresearchers participated in preparing and debriefing each focus group and workshop during team meetings. The division of tasks is provided in the Authors’ Contributions section.

We conducted an in-depth thematic analysis of our transcriptions per the recommendations of Braun and Clarke [61]. Two researchers independently coded the different series of patient focus groups in parallel. They compared codes and discussed disagreements regarding the raw data until they reached a consensus. One then finalized the coding for the 5 focus groups. Subsequently, we developed themes (also using personal notes and intermediate outputs from the co-design process) that had repeatedly been raised, discussed, and validated by the research team and by the workshop participants. The review, definition, and final naming of the themes were done iteratively by the authors. Analyses were structured using MaxQDA software (VERBI GmbH). We followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines [62].

A professional interpreter translated selected citations for this paper from French to English. Bilingual team members verified the content.

Our regional ethics review board formally confirmed that it did not need to review and approve the study, as per the Swiss Federal Human Research Act (Req-2020-00591). Each participant received oral and written information about the study and signed the consent form before participation. The consent form specified that, after recording, transcripts would be deidentified, and no personal statements would show names for any purpose. To ensure a safe and open environment for discussion, participants were asked not to share specific sensitive personal information; instead, they were encouraged to draw on their experiences to guide their contributions. At the beginning and end of each discussion, participants were reminded to ensure the confidentiality of the content shared. All data were securely stored within the research university’s information system. Transportation costs were reimbursed according to university guidelines based on public transport fares. Parking costs at the university site were also covered. No other financial compensation was provided; however, participants were offered an aperitif after the workshop.

Between August and October 2020, we recruited 31 individuals (patients: n=18, 58%; caregivers: n=3, 10%; health care professionals: n=10, 32%) with a broad range of experiences regarding medication management plans from a variety of care settings (Table 1).

We formed 2 local groups of patients and caregivers, one less than initially planned, but COVID-19 complicated the recruitment of people with respiratory diseases.

Individual interviews in phase 1 lasted from 43 to 71 minutes. Focus groups in phases 2 and 3 lasted from 115 to 130 minutes, and EBCD workshops lasted from 120 to 210 minutes. Table 2 summarizes the participation in each phase of the EBCD workshops. Three individual interviews were conducted as a backup for participants who could not attend a focus group.

The subsequent sections highlight the main results from our analysis of the discussions with participants in phases 1 to 3, summarized in Textbox 1. Recommendations for action codeveloped with participants during phase 4 are briefly described in the Recommendations for Action section, alongside the value propositions.

The thematic analysis of each value proposition for the joint management of SMPs resulted in 4 themes and their subthemes, as summarized in Textbox 1.

During the final co-design workshop, participants reached a consensus on three key actions to advance toward the joint management of SMPs: (1) the cocreation of an accessible and empowering platform for SMPs that accommodates diverse patient population groups, (2) the promotion of best (clinical) practices that emphasize the use of collaborative SMPs with patients and health care professionals working in partnership, and (3) stakeholder dialogues to establish the necessary enabling environment.

Our findings underscored the importance of explicitly recognizing and promoting the co-ownership of medication plans. The value of digital SMPs lies in making it easy for patients, family caregivers, and health care professionals to create and update medication plans, for example, via the possibility of adding over-the-counter medications. Apart from improving the quality and safety of medication management, this could strengthen interprofessional and patient collaboration, enhance medication self-management, and facilitate innovations in care coordination and medication safety. To succeed, the co-management of medication plans must be integrated into clinical practice and supported by interactive information systems that can be tailored to individual capabilities and preferences. The value propositions from our analysis and the recommendations for action defined by the participants are summarized in Figure 1.

The core value of digital SMPs lies in facilitating the navigation of a patient’s current medications and medication history. Both patients and health care professionals would benefit from a clear overview of recent changes and the possibility of distinguishing between changes made by the patient and health care professionals. Additional features, such as reminders to administer medication, self-management guidelines, patient education resources, self-monitoring tools, and secure messaging, could further enhance the practical and safety values of such systems. For patients who might be less comfortable updating their medication plans alone, guided assistance should be provided, such as scheduling medication reviews or reconciliation appointments where a health care professional can verify and upload information. Preparing a well-structured, shared outline of how these appointments might work could enhance patient involvement and empowerment, improving the efficiency of clinical interventions. Certain digital patient mobile apps offer some of these features [40,63] and could be incorporated into a web-based SMP platform for patients that would facilitate effective collaboration between them and health care professionals.

Our findings challenge the prevailing prescriber-centric paradigm of existing SMP platforms that do not ensure the accuracy and safety of medication information. For example in Denmark, a world leader of digital medication information, 78% of hospitalized patients had at least 1 discrepancy between their actual medication intake and the documented list in the national shared record that can be accessed by health care providers. Nearly half of these discrepancies were due to changes made by patients, that were not known and registered by the physicians [31]. More recent initiatives in neighboring Nordic countries continue to use SMPs that limit active contributions of patients [21]. Once we understand the limitations of SMPs managed solely by physicians [24,27], a more collaborative approach seems to be worthy of further exploration.

The co-management of SMPs could be a game changer in ensuring the accurate transfer of information at care transitions, enabling synergies, and benefitting from the accumulated efforts of all the stakeholders. Reconciling discrepancies in medication lists and dealing with their consequences cost health care professionals precious time [1,8]. An SMP would facilitate information flows along patients’ clinical trajectories [18,26,64]. Information system interoperability, supportive digital functionalities, and patient involvement are known facilitators of broad-based medication reconciliation [8,65,66]. Accordingly, the World Health Organization promotes collaborative medication management involving patients and their families as partners [7]. Nevertheless, determining whether SMPs effectively reduce discrepancies requires further research and evaluation.

Patient-held medication lists are widely endorsed as a strategy to improve medication safety [7,37]. Patients actively manage and communicate medication information, and they prevent and mitigate medication errors [2,35,67]. Compared with other patient tools [37,63], the added value of an SMP lies in its 2-way link between patients and health care professionals and in the secure web-based storage of current medication lists and histories of changes. A partnership with patients that goes beyond holding lists could enhance the effects of such systems [36,68].

Indeed, an expanding body of evidence supports the argument for patients managing their medication plans. Patient-held medication lists have made them feel empowered and increased their self-confidence [22,37,39]. Involving patients in digital medication processes has facilitated medication reconciliation [63], saved time, and reduced medication errors [66,69,70]. Likewise, access to clinical notes has benefitted communication, trust, and medication adherence [71-73]. One quasi-experimental study showed that giving patients access to shared records through a platform integrating their interactions with health care professionals improved medication adherence [71]. The ability to edit lists seemed to be more motivational than read-only access [14,34].

Notwithstanding the potential advantages of shared medication lists [38], their implementation requires very careful attention. Variable levels of health literacy and a general lack of engagement are recognized as barriers to implementation and use. In one German study [74], <50% of patients had a comprehensive understanding of the medication plan that their general practitioner was legally obliged to share with them. Thus, strategies for medication management must be thoughtfully designed and implemented to accommodate diverse users and preferences [63]. Co-designing systems with the aid of patients with diverse backgrounds and integrating artificial intelligence solutions could prove pivotal to the successful adoption of such tools and may help avoid any unintended exacerbations of health inequalities due to digitalization.

We argue for a system design that empowers the collaboration of all the stakeholders in medication management. Such an approach needs effective leadership and change management to accompany the required organizational and sociocultural adaptations to clinical practice. In processes like this, trust between stakeholders and in the technology is critical for successful system implementation and use [14,75]. However, trust cannot be decreed. Notably, the inability to correct obvious errors in a medication list may create mistrust [76]. Finally, a shared platform may promote good practices and aid advocacy for medication safety being “everyone’s business” [77]. SMP systems involving every stakeholder can be disruptive, and we hope that our value propositions will encourage experimentation and open innovation in the field.

By engaging with patients, caregivers, and health care professionals, we leveraged coproduction and diverse participant experiences to elicit innovative value propositions for a digital SMP system. Collaborating with coresearchers and a multidisciplinary research team provided complementary perspectives and enhanced reflexivity throughout the study. Exchanges within parallel groups, composed of participants with profound experiential and professional knowledge, enriched the discussions on medication management. Experienced participants were rapidly able to contribute effectively to the focus groups and EBCD workshops, motivated by the rare opportunity to discuss with both patients and health care professionals. In future codesign initiatives, we recommend including additional meetings with participants if fostering group dynamics and collaborative engagement requires more time. Interestingly, our approach cultivated a sense of shared responsibility among the participants, as observed in earlier co-design processes [78]. Most (21/31, 68%) of the participants have since continued working on the implementation of SMPs and EPRs in different advisory and networking groups.

One limitation of this study was its relatively small and selected group of participants. They will likely be early adopters [79]. Thus we may have overlooked some issues affecting more disadvantaged patients or uninterested health care professionals. Second, EBCD relies strongly on group dynamics and iteration, which may hinder the replicability of our findings. We mitigated these limitations by ensuring the diversity of participants, including some who had experienced critical situations or supported others during such times. Participants also seemed sensitive to the issue of equity as they frequently pointed it out during the interviews and workshops. Finally, the specificities of the health context in Switzerland might limit the transferability of our findings to other settings. However, the basic clinical process of managing and sharing complex information about medications is universal. Thus we are confident that our value propositions can be useful for other settings.

Future research should examine how the coproduction of medication plans changes the management of clinical information and investigate the implications for professional responsibilities and task division [80,81]. In addition, the potential for unintended consequences needs to be studied [82]. Our study’s value propositions could be used in logic models and midrange theories for the implementation and evaluation of medication systems.

Moreover, our value propositions and functionalities should be tested under a variety of conditions, including with diverse, vulnerable groups of medication users and in high-risk situations. Ongoing studies [34,44,63] and a planned proof-of-concept project in Switzerland [45] will provide additional empirical results.

Policy makers and technology vendors must establish the conditions for leveraging the potential of SMP systems to improve medication reconciliation across health care institutions and organizations [83]. In doing so, decision makers must acknowledge the complexity of medication management and invest in adaptable solutions that can accommodate collaboration between health care professionals and patients. We argue for the development of interoperability frameworks enabling the collaborative management of a digital medication plan, with patients as partners. Community Medication Prescription and Dispense profile of Integrating the Healthcare Enterprise [58] supports this by focusing on clinical decisions and treatment planning as its core; however, most public authorities in the world do not currently endorse it. Switzerland’s concept of interoperability in the context of its EPR system is based on the Community Medication Prescription and Dispense profile and Health Level 7 Fast Health care Interoperability Resources specifications [45,57]. The proof of concept and a pilot are currently being implemented by CARA and first volunteering health care providers and their technology providers.

Modern SMPs should function as digital platforms with adaptable features that facilitate joint medication management and empower patients to be true partners. They should promote and not hinder patient engagement while embracing the shared responsibilities of patients and health care professionals. This shared responsibility should also encompass public health authorities and technological stakeholders, who each play a critical role in creating the conditions for the efficient and safe use of SMPs in daily practice. Introducing SMPs could strengthen partnerships, enhance patient self-management, and improve interprofessional collaboration. SMPs and their use must be tailored to patients’ different levels of health and digital literacy and their personal preferences. The value propositions identified in this study should provide inspiration and guidance for stakeholders and researchers on how to enhance the coproduction of medication management by health care professionals and patients via digital technologies.