EHR 'gaps' hinder patient medication adherence

Electronic health records and health IT are falling short when it comes to improving patient medication adherence, according to a new paper in JMIR Medical Informatics.

The authors, from Duke University Medical Center and elsewhere, warn that non-adherence is "common and costly" and "one of our largest public health issues." Health IT can help improve adherence, with tools such as electronic prescribing, clinical decision support, linkages between diagnosis and treatment plans, and the use of patient portals to improve communication.

However, health IT has four "gaps" or barriers that are impeding efforts to improve medication adherence:

  1. Interoperability, connectedness and reciprocity, which is "undeveloped." Patients can't connect self-monitoring data to a doctor's EHR; the systems don't capture medication refill rates or patient reports of side effects. Moreover, with 160 different medication adherence apps available, creating a system to connect all of them to EHRs is "daunting," the authors write.
  2. Inconsistencies in data definitions, which create gaps in the validity, accessibility and efficiency of the data sources. This also affects whether nonadherence should be "flagged" by an EHR and when.
  3. Inability to effectively use the National Drug Codes, because they aren't standardized in EHRs.
  4. Poor capture of medication management therapy in EHRs, which is often not available beyond the pharmacy.

Moreover, Meaningful Use Stage 3 as originally proposed would have included medication adherence and related measures; now such information is at the providers' discretion. Yet without better guidance, physicians may be reticent to include more of this information in their EHRs because the liability for nonadherence may shift from the patient to the provider. 

The authors suggest a system-based view of medication use, management and patient adherence. They recommend that interoperability be improved by designating common discrete fields reflecting medication management, develop consistent data definitions and create data capture in the EHR for medication therapy management.

"[T]hese potential solutions present an opportunity for collaborative work across key stakeholders, including patients, providers, pharmacists, payers, and health technology programmers, designers, and developers. Building broad, collaborative, and multidisciplinary working groups to address these issues is the next exciting frontier in health," the authors conclude.

Other studies have found that EHR data can help identify patients who don't fill their prescriptions, enabling physicians to follow up with them. EHRs may to help improve medication adherence further as more physicians turn to e-prescribing and capture medication data.

To learn more:
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