Secure messaging seen as aid in medication reconciliation

Secure messaging has the potential to improve medication reconciliation and workflow at primary care clinics--plus, it can get patient questions answered more efficiently, according to a study published at the Journal of Medical Internet Research.

The study involved observation of how clinical staff use secure messaging as well as interviews with 15 primary care providers within a Veterans Affairs Healthcare System in Boston.

The providers were enthusiastic about the potential for improved medication management with secure messaging--largely because other staff members could handle it without their input.

They found medication reconciliation difficult--especially for cognitively impaired patients--and that the EHR system didn't necessarily help. It was difficult to see a clearly displayed reconciled medication list in the EHR, they said, a problem often magnified among patients being seen in subspecialist clinics or care outside of the VA.

The providers cited limited formal training in medication reconciliation, lack of a standard approach for in-person medication reconciliation and lack of time for it during patient visits.

Managing medication for patients with multiple chronic conditions or dementia was challenging and just asking them to bring in their pill bottles didn't necessarily work. They often relied on a caregiver or family member to corroborate the medication list.

Providers commonly suggested technology-based solutions involving the EHR and trained staff to improve the process.

"I think there can be electronic surveillance of medications or a mechanism to identify those patients who aren't refilling," one provider said, according to the study.

A majority of providers envisioned a scenario where a pharmacist or clinical staff member performed detailed medication reconciliation prior to the provider's visit. This could free up time during the patient visit to discuss clinical issues.

They believed that secure messaging could make answering patient questions easier.

"The electronic communication is wonderful. It avoids the whole issue of phone tag. It avoids the whole issue of someone having to give their message to another person, which often distorts the meaning of the request. The asynchronous communication makes all communication easier," one of the physicians said.

Less technically savvy and elderly patients could have trouble with the system, however, and slow network speeds could hamper widespread patient adoption of secure messaging, they said.

In addition to focusing physician time on the clinical issues at hand, EHRs can foster real-time patient-physician communication, physicians from the National Institutes of Health wrote recently.

And 85 percent of patients in recent survey said they want to communicate with their providers via email or secure messaging.

To learn more:
- find the article in JMIR

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