HIEs maintain a more accurate medication list than ED records

Health information exchanges offer the potential to offer doctors in the emergency department a more accurate list of medications that a patient is taking than the drug list recorded by the triage nurse and ED staff, according to a new study.

Research conducted in Montreal compared patients' community pharmacy-dispensed medications--those purchases are all recorded in a database called the Régie de l'Assurance Maladie du Quebec (RAMQ)--with the drug list the ED staff compiled. Pharmacy records identified 41.5 percent more prescribed medications than were noted in the ED chart, according to the study published at the Journal of the American Informatics Association.

The number of prescribed drugs and the number of pharmacies used were associated with discrepancies, but not age, sex, number of hospitalizations or communication problems. The mean age of the patients studied was 63.1 years and 59.2 percent were women. Of them, 45.7 percent had four or more prescribing physicians, and 7.5 percent used four or more pharmacies, and 26.1 percent were taking more than 12 prescription drugs.

Patients using more than 12 drugs were almost three times more likely to have more drugs documented in pharmacy records that were not noted in the ED chart. Using more than one pharmacy was associated with more than a threefold increase in the risk of having more medications listed in pharmacy records.

Some groups of drugs were more likely to be omitted in the ED records: anxiolytics, analgesics, gastrointestinal drugs, and asthma medications. Patients are more likely to "forget" these drugs in self-reported surveys of medication use, the authors note, yet discontinuing them poses the threat of an adverse event.

Surescripts, the largest health information network in the United States, recently added 19 entities to its network, including Cerner, the Health Information Exchange of Illinois, Iowa and Maine, Quest Diagnostics and the University of Pittsburgh Medical Center.

According to Surescripts' annual National Progress Report and Safe-Rx Rankings, unveiled in May, more than 38,000 physicians (69 percent) used e-prescribing in 2012. Nearly half of all office visits (48 percent) resulted in electronically generated medication history requests, up from 31 percent in 2011.

To learn more:
- read the research