EHRs key to medication reconciliation
Electronic health records have a big role to play in improving hospitals' medication reconciliation, a new study finds, but challenges related to data quality, technology and workflow remain.
[See also: Barcoding still a key tool for safety]
Medication reconciliation is a systematic way to reduce medical errors by ensuring accurate patient medication lists at admission, during a hospitalization and at discharge. Unintended discrepancies are common, with some research finding they affect as many as 70 percent of hospital patients at admission or discharge – with almost one-third of those potentially causing harm.
Still, despite hospital accreditation and other requirements, use of med rec technology has lagged for many reasons – including insufficient physician engagement, which stems, in part, from lack of professional consensus about which physician is responsible for managing a patient's medication list, according to the new report from National Institute for Health Care Reform.
NIHCR is a nonpartisan, nonprofit organization launched by United Automobile Workers, Chrysler, Ford and General Motors. Between 2009 and 2013, it contracted with the Center for Studying Health System Change to conduct objective research and policy analyses of the organization, financing and delivery of healthcare in the U.S.
Conducted for NIHCR by researchers Joy M. Grossman, Rebecca Gourevitch and Dori A. Cross, this study examined how 19 hospitals nationwide were using EHRs to support medication reconciliation.
They found that key challenges to effective medication reconciliation include improving access to reliable medication histories, refining EHR usability, engaging physicians more fully and routinely sharing patient information with the next providers of care.
"Enhancing ways for key stakeholders – patient safety advocates, policy makers, researchers, EHR vendors, hospitals and clinicians – to share the best EHR designs and hospital implementation strategies will be key to realizing the potential safety and efficiency benefits of EHR-based medication reconciliation," they write.
The NIHCR Research Brief, "Hospital Experiences Using Electronic Health Records to Support Medication Reconciliation," also finds:
- While hospitals reported that EHR vendors have been adding and enhancing medication reconciliation functionality over time, more than a third of the hospitals in the study still used a partially paper-based process at admission, discharge or both.
- Many hospitals had at least some access to external electronic sources of medication histories to generate more accurate pre-admission medication lists, for example, from affiliated physicians practices' EHRs. But use of this feature varied, reflecting mixed views on whether the added information was reliable enough to be worth the effort to incorporate it into the record.
- The hospitals with fully electronic processes at admission or discharge had implemented EHR medication reconciliation modules, which like paper forms, allow comparison of medication lists at those transitions. Actions taken on each medication are then automatically converted into orders, substantially streamlining the workflow by eliminating the need to re-enter data.
- Hospitals with fully electronic processes at discharge also were able to take advantage of the discharge medications in the EHR to electronically generate legible and more patient-friendly discharge instructions and electronic prescriptions. Less commonly used features included the capability to incorporate the same medication list into the discharge summary and electronically share discharge medication information with the next providers of care.