Hospital IT execs: EHR med reconciliation a challenge

With heavy pressure to reduce readmissions and improve patient outcomes, hospitals increasingly are relying on the medication reconciliation technology in their electronic health record systems to administer the right medication to the right patient at the right time, and to coordinate new drugs with those that a patient may already be taking.

"Electronic health records help enhance the accuracy of the process by providing tools to accurately capture the patient's previous medication history, better manage the process of ordering new medications or discontinuing previous ones, and generate instructions for the patients," Ferdinand Velasco, M.D. (right), chief health information officer of Texas Health Resources, a 25-hospital health system in the Dallas/Fort Worth area, told FierceEMR.

But the use of the technology is still evolving, and the process is proving to be a challenge.

FierceEMR spoke exclusively with several hospital IT executives regarding their efforts to use EHRs to conduct medication reconciliation.

Naperville, Ill.-based Edward Hospital, for instance, uses an EHR system that boasts "pretty robust" functionality for medication technology, according to CIO Bobbie Byrne. That, she said, includes a home medication list, tools to convert the medications to inpatient orders or provide substitutions, and features to continue the medications after discharge and generate prescriptions.

While medication reconciliation occurs within the core EHR, such systems can integrate history data from other providers and eventually health information exchanges, according to Velasco.   

Results still not perfect

Using EHRs for medication reconciliation, however, is not without its challenges. For example, the electronic process can take longer than what clinicians are used to.

"It takes only milliseconds in a physician's brain," Byrne (left) said. "Here, you're documenting that mental process."

It's also more complicated, and not foolproof.

"This process is dependent on the nurse or physician going to the medication reconciliation activity and identifying the current status of each med, every time the patient moves throughout the system," Mary Beth Mitchell, chief nursing informatics officer at Texas Health Resources, told FierceEMR. "Also, patients are often poor historians, so getting an accurate medication list is also difficult." 

Medication reconciliation itself also is more difficult these day, Byrne said, because patients have more chronic diseases and are on more medications than they were 20 years ago. "Now it's common for a patient to be on 10 to 15 meds [before even coming to the hospital]," she said.    

There's also the problem of over-reliance on the automation in the EHR.

"It's a struggle because it requires perfect information in the system about medications," Byrne said. "It's garbage in, garbage out."

The technology itself isn't perfect, either. For instance, querying a drug database from a system regarding patient prescription history may provide too much information on medications that the patient is no longer on. And federal law still makes it difficult to electronically prescribe controlled substances, which prevents such subscribing from working smoothly with EHRs, Byrne said.

"Vendors are working on enhancements to smooth out these road bumps," she said.

Hospitals also are adopting additional strategies to improve their electronic medication reconciliation, such as providing patients with access to their own health record via the Internet to enter their medication history directly, Velasco said. Texas Health, he added, also is starting to pull medications into the EHR from a direct feed to the pharmacies.

"This tells us exactly what medications the patient has purchased," Mitchell (right) said. "It is not perfect, but does give the caregiver additional information."

Another tactic that many hospitals, including Edward, found has improved medication reconciliation is the use of pharmacists in the emergency department to collect more accurate medication lists from patients to input into the EHRs.

"It's an investment but it's worth it," Byrne said.

Overall, Velasco, Byrne and Mitchell are pleased with the progress their hospitals have made by using their EHRs to reconcile medications to reduce errors. So much so that Byrne wouldn't think about going back to paper.

"Stay away from paper," she said. "A note that says 'continue all home medications' is not medication reconciliation. And it may not be safe."

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