There is a great deal of attention paid to medication adherence these days. From its cost to the social factors that control it to the policies that contribute to it, adherence and its impact on healthcare’s efficiency and effectiveness are being examined under a microscope.
One area in which many hospitals are looking to support adherence initiatives is medication reconciliation, which refers to the systematic approach of creating a list of all medications a patient is taking at the time of admission, including drug name, dosage, frequency and how it’s taken.
When patients come into a hospital, a complete list of that information is useful for doctors to reduce the number of potential adverse drug events and provide the right medication at every transition point along their care journey, from admission and transfers to discharge.
According to The Leapfrog Group Hospital Survey, medication discrepancies occur for up to 70% of patients during the discharge or admission phases. It’s estimated that around one-third of those discrepancies can cause harm and as much as 40% of all hospitalized patients experience an adverse drug event.
Leaders See the Problem, Search for Solutions
A recent survey from the Association of Medical Directors of Information Systems asked Chief Medical Information Officers (CMIOs) about how they see medication management efforts in hospitals.
The results indicate that over 80% of CMIOs have faith that their organization’s medication management practices are having a positive impact on patient safety efforts. At the same time, however, 75% said that problems with the medication reconciliation process continue to plague operations.
A tool that should provide a solution is the electronic health record (EHR). However, to date, efforts to integrate the EHR into a process that currently mixes paper and electronics have stumbled due to EHR usability and interoperability with providers down the line in the continuum of care.
The Agency for Healthcare Research and Quality (AHRQ) lives within the U.S. Department of Health and Human Services and has been supporting efforts to investigate the use of EHRs in reconciliation in recent years. The research projects have focused on reducing adverse drug events, preventing readmissions and improving care coordination, clinical workflow, patient-physician communication issues and decision making.
AHRQ has awarded a number of grants over the years, but has reported issues with EHR system readiness, care transitions and the use of data that patients provide. Their research finds that while full automation of medication reconciliation through the EHR is ideal, those systems have lacked the functionality, data standards and the level of interoperability needed to implement such a strategy.
In one case, researchers implemented a social knowledge network (SKN) system designed to allow clinicians to report issues with reconciliation tools and discuss solutions. The biggest problems highlighted by the project included care coordination, patient education and workflow disruption.
The latter was particularly problematic, according to an article from EHR Intelligence. The research showed that clinicians struggled to understand who would take responsibility for certain tasks that establish medication history. They expressed skepticism regarding the accuracy of medication lists at the point of discharge from inpatient facilities, thus complicating the process of patients transitioning to outpatient facilities or back into the community.
The system, known as EHR MedRec, is currently being tested and improved incrementally with the goal of developing evidence-based medication management strategies through the EHR.
