Health Information Exchange of Medication Lists

Abstract

Nurses report significant gaps in communication among patients discharged from the hospital with home healthcare (HHC) services. The aim of this pilot study was to quantify the contents of HHC admission packets used to guide nurses' first home visit after hospital discharge. We evaluated 20 randomly selected charts of older adults admitted to HHC after a hospitalization for heart failure. Admission packets contained nearly 50 pages of material, which frequently included duplicate documents printed from the hospital-based electronic health record (EHR). Despite the plethora of documents, most packets omitted key information, such as patients' cognitive and functional status, and even discharge summaries, which would be relevant and actionable for HHC nurses. Moreover, admission packets contained multiple, often discordant, EHR-generated medication lists, which makes reconciliation challenging for nurses and puts vulnerable patients at risk for adverse drug events. Overall, there is an urgent need to improve health information exchange between hospitals and HHC agencies, which will simultaneously promote nurse efficiency and patient safety.

Discharge Communications for Older Patients Between Hospital Healthcare Providers and Home Healthcare Providers: An Integrative Review

“…Among the 7 studies included in this review, 27-30,32-34 4 were conducted in the United States, 27-30 2 in Norway, 32,33 1 in Denmark 34 (See Table 1). All 7 studies used a descriptive research design.…”

“…26 Five of seven studies collected data from nurses 28,29,32-34 , 1 study was provided by skilled home healthcare coordinators, 27 but 1 study collected data from patients’ charts, 30 not healthcare providers. For data collection, interviews, 27-29,32-34 observations, 27,33,34 documents review, 30,33 and surveys 28,29 were used. Table 1 described the methods of discharge communication and the limitations of discharge communication.…”

“…27,29 Three studies included the role of intake nurses who were hired by home healthcare agencies and worked at the agency. 27,29,30 The intake nurses’ role was to prepare admission packets, that can inform home healthcare nurses in preparation for their first home visits after the patient’s discharge from a hospital. The packets include a face sheet, clinical summary, discharge summary, other EHR-generated note types, hospitals orders for home healthcare agencies, medication list, and referral note.…”

“…The packets include a face sheet, clinical summary, discharge summary, other EHR-generated note types, hospitals orders for home healthcare agencies, medication list, and referral note. 29,30…”

Issues of Version Control in EHR-Generated Clinical Summaries for Patients

“…For example, geriatricians and nurses identify EHR-related challenges to safe transitions, including multiple discharge medication lists with unexplained discrepancies among them. 5,6 Challenges related to version control are magnified for patients because inconsistent information creates frustration with care coordination and may delay essential care. 7 Finally, research teams using retrospective study designs must address version control to “accurately assess how EHR-generated documents affect patient care.…”