Design and Implementation of an Application and Associated Services to Support Interdisciplinary Medication Reconciliation Efforts at an Integrated Healthcare Delivery Network

Abstract

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.

Effect of Patient- and Medication-Related Factors on Inpatient Medication Reconciliation Errors

“…Lastly, because both study sites utilize PAML-building software in their EMRs the error rates may be lower than in other hospitals. 35 …”

“…20 Scores range from 0-36 and were categorized as adequate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), marginal (17)(18)(19)(20)(21)(22), or inadequate health literacy (0-16). We treated health literacy as a dichotomous variable in our analyses (inadequate/ marginal vs. adequate).…”

Limited Health Literacy is a Barrier to Medication Reconciliation in Ambulatory Care

“…[1][2][3] The inpatient setting, in particular, is the context where reconciliation has usually been described. Through the process of medication reconciliation, health care providers can improve patient care by reducing adverse drug events and medication errors (by conflict or unintentional omission) that account for $3.5 billion in hospital costs each year.…”

An exploratory study of user resistance in healthcare IT

“…Festinger (1957) states: "[t]he resistance to change would be a function of the satisfaction obtained from the present behaviour" (p.26). Poon et al (2006) observed that the use of non-interoperable HIT systems was likely to negatively impact workflow and productivity.…”

“…Furthermore, Poon et al (2006) also asserted that the income of healthcare providers was directly tied to their productivity but not to their quality. Consequently, dissatisfaction with productivity and workflows is likely to cause resistance to change especially in an era of decreasing reimbursement (Poon et al, 2006).…”