The Accuracy of Medication Data in an Outpatient Electronic Medical Record

Abstract

Medication records in an outpatient EMR may have significant levels of data error. Based on an analysis of correctable causes of error, the authors conclude that the most effective extension to the EMR studied would be to expand its scope to include all clinicians who can potentially change medications. Even with EMR extensions, however, ineradicable error due to patients and data entry will remain. Several implications of ineradicable error for MDSSs are discussed. The provision of a free-text "comments" field increased the accuracy of medication lists for clinician users at the expense of accuracy for a MDSS.

Discrepancies in the Use of Medications

“…20 While the extent of medication discrepancies in our study was higher than in previous reports, this difference likely reflected the meticulous effort given to correct identification of medications taken and the uniqueness of our study in using the patients' medication bottles rather than patients' diaries, computer printouts, or pharmacy records to verify the presence of discrepancy. 21,22 Consistent with the report of Monson and Bond, 23 we found that the more drugs a patient takes, the more likely that there will be a discrepancy. 21 The existing literature on medication use and misuse has primarily focused on one aspect of discrepancy, namely patient compliance, which assesses the failure of patients to adhere to prescribed medications.…”

“…21 The existing literature on medication use and misuse has primarily focused on one aspect of discrepancy, namely patient compliance, which assesses the failure of patients to adhere to prescribed medications. Our study highlights the larger picture of discrepancy and extends the previous work of Wagner and Hogan 22 demonstrating that what medications a patient takes does not depend on volition alone. Other factors, such as miscommunication among physicians or between physicians and patients, can play an important role, as suggested by other reports.…”

Primary care provider perceptions and use of a novel medication reconciliation technology

“…68 The apparent distrust of patient-furnished information and lack of enthusiasm for encounter-based medication review raises concern that providers may favour clinic records over interviews when compiling a medication list, despite ample evidence showing that clinic medication lists are frequently inaccurate. 23,25,27,34,66,67,69,70 To this end, we need instruments that measure provider attitudes towards patient-centred care, shared decision making and MR. In addition, quality improvement specialists need qualitative research to completely understand deeply embedded and selfreinforcing beliefs that might undermine MR interventions.…”

Pharmacy Information (PHARM) Systems

“…In a study of the accuracy of medication records stored in electronic patient records of an outpatient geriatric center of the University of Pittsburgh School of Medicine, Wagner and Hogan [ 217 ] found that 83 % represented correctly the drug, dose, and schedule of the current medication. The most frequent cause of errors was the patient misrepresenting a change in medication.…”