Medication reconciliation is not a trivial task in improving the quality and outcomes of health care. Practice Fusion CMO, Robert Rowley MD outlines the role of PHRs in medication reconciliation
Keeping accurate lists of all the medications prescribed to an individual by all the various healthcare providers involved in that care has historically been a vexing challenge. Generally, a given doctor knows what medications his/her own office has prescribed for a patient, but medications prescribed by others (specialists, hospital emergency departments, etc.) has often gotten “lost in the translation.”
Clearly, medication confusion poses a significant risk in health care. In this day of widespread use of Electronic Health Records (EHR) systems by healthcare professionals and hospitals, electronic prescribing (eRx) is built to catch drug-drug and drug-allergy interactions and alert the prescriber about them. But that only works to the extent that the prescriber knows about all the medications a patient is taking.
Medication Reconciliation – the process of identifying all the medications a patient is taking, comparing one’s own listing with external lists from hospitals, other providers, or the patient directly – is a key element in healthcare improvement. Conducting Medication Reconciliations, in fact, is one of the core criteria for Meaningful Use Stage 2 (core measure 14).
How can a doctor gather all the data?
In the era pre-EHRs, doctors used various methods of gathering medication lists about patients. Sometimes it was simply asking a patient to bring in all the medications to the next visit, irrespective of who prescribed them, so that a global list can be built.
Sometimes, lists of revised medications after a specialist visit are sent as part of the correspondence between clinicians. For example, a primary care physician may receive a note from a cardiologist after a patient exam, and medication changes prescribed by the cardiologist is sent back to the primary care doc (ideally). This is fairly hit-and-miss, voluntary, and far from being universally systematic (unless they all share a unified medical record system, as might be the case for an Integrated Delivery Network, such as Kaiser or the like).
The hope of Meaningful Use Stage 2, which comes into effect in 2014, and for which EHR vendors are building updated products for Stage 2 Certification in 2013, is that medication lists can be exported and imported easily between different systems, somehow. The standard file formats (CCDs and CCRs) have been defined, though ways to send such files securely is still a technology in evolution.
The role of a Universal PHR in all this
Though it is early in its evolution, the field of Universal Personal Health Records – consumer-centered products that can connect to EHRs from the patient side – is starting to emerge. These next-generation products are not tied to any specific EHR, yet can pull data from any EHR into a central patient-governed location.
If they become widespread in use, a Universal PHR can be a place where medication data can be pulled from each of the EHR-using doctors a patient sees, and mashed into a unified list. If there are medications missing, a patient can also elect to self-enter items that are not in a doctor’s system. Such a system can also create the summary upload file (the CCD or CCR) for export to the doctor’s EHR, if that system is capable of consuming it. Otherwise, a formatted message can be created for sending via secure messaging to the doctor (the use of secure electronic messaging to communicate with patients is core item 17 of Meaningful Use Stage 2).
[See also: PHRs: What Problem Are We Trying to Solve?]
Medication Reconciliation is not a trivial task
If one shifts the burden of mashing-up the medication lists from different doctors into one global list, and places that burden on the patient’s PHR, it can be overwhelming, confusing, and therefore fail in adoption and engagement.
The task before those of us designing Universal PHR systems is to be able to abstract the medications from the different connected EHR sources, collate them (showing the source of the medication data), and do so in the background. The user interface must be easy and inviting, and the hard work needs to be in the background. And the ability to export one’s full list to a doctor’s EHR system – either by direct data-insertion via a CCD or CCR file, or by a secure message from the patient to the doctor resulting in the doctor manually needing to edit his/her medication lists – needs to be done by the simple click of a button.
Conclusions
Medication Reconciliation is an important task in improving the quality and outcomes of health care. It is critical in the coordinated care settings that surround most patients who see multiple practitioners – the segment of society with chronic illness, on multiple medications, seeing several clinicians, and generating most of the cost in health care in the U.S.
Perhaps the best approach is to create a patient-centered place to download all the lists kept by each doctor, mash them together into a coherent global list, and report that list to each of the doctors seeing the patient. That is one of the important roles of a Universal PHR, as this technology starts to take its place in the U.S. healthcare landscape.
Dr. Robert Rowley blogs regularly about clinical and technical insights into health IT where this article was first posted.
