Medication reconciliation improvements needed: report

Medication reconciliation, a standard operating procedure at hospitals, remains a process in need of work, according to a report based on a study of 19 hospitals released by the National Institute for Health Care Reform.

Medication reconciliation was first added to the hospital accreditation process by the Joint Commission in 2005. After a suspension in 2009, a “streamlined, more flexible requirement” was restored in 2011, the report authors note.

Med/rec requirements also were added to the Stage 2 meaningful-use criteria of the federal electronic health-record incentive payment program that became effective for some hospitals on Oct. 1, 2013, and for physicians and other eligible professionals on Jan. 1, 2014.

Not surprisingly, then, all 19 hospitals studied with EHRs also used them to support med/rec. But more than a third of these hospitals also “used a hybrid paper-electronic reconciliation process, typically because the hospitals were dissatisfied with early versions of medication reconciliation tools offered by their EHR vendors,” the researchers said.

The med/rec functions of some of the more advanced EHR systems could interface with those hospitals' admissions and discharge systems “to improve legibility, reduce data re-entry and support more patient-friendly discharge instructions,” the report authors said.

And, many hospitals had “at least some access to external electronic sources of medication histories,” they said. More than half could access medication information from affiliated physicians with EHRs. More than a third could access medication histories from claims data, “predominately through the Surescripts prescription network.”

“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 report authors said.

The report quoted one survey respondent from a hospital that had connected its med/rec system to its affiliated physicians' EHRs with unsatisfactory results. “There was a lot of junk in there,” the respondent said. “Their (medication) lists were not clean or up-to-date … everyone lost faith in it, so no one looks at it any more.”

Attending physicians most often had ultimate responsibility for the med/rec process, but in a minority of hospitals surveyed, consulting specialists were responsible for the medications they prescribed, according to the report.

Hospitals still need to improve access to reliable medication histories, the authors said, as well as refine EHR usability, engage physicians and routinely “share patient information with the next providers of care.”

The 13-page report was issued by the institute, but was prepared by researchers working under contract with it at the now defunct Center for Studying Health System Change, which merged in December with Mathematica Policy Research.

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