While electronic health records (EHRs) can help standardize medication reconciliation for hospitalized patients, data quality, technical problems and workflow issues continue to pose challenges, according to a new qualitative study from the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).
Designed to reduce errors, medication reconciliation is a systematic way to ensure accurate patient medication lists at admission, during a hospitalization and at discharge. Previous research has found unintended medication discrepancies are common, affecting up to 70 percent of hospital patients at admission or discharge, with almost a third of discrepancies potentially causing patient harm.
Despite hospital accreditation and other requirements, use of medication reconciliation 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 and the value of medication reconciliation as a clinical tool to improve care.
Conducted for NIHCR by researchers at the former Center for Studying Health System Change (HSC)—Joy M. Grossman, Ph.D., Rebecca Gourevitch and Dori A. Cross—the study examined how 19 hospitals across the United States were using EHRs to support medication reconciliation.
According to the study, 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.
The study’s findings are detailed in a new NIHCR Research Brief—Hospital Experiences Using Electronic Health Records to Support Medication Reconciliation— available here.
Other key findings include:
- 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
“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,” according to the study.