While electronic health records (EHRs) can help standardize medication reconciliation for hospitalized patients, data quality, technical problems and workflow issues continue to pose challenges, according to a study from the nonprofit National Institute for Health Care Reform (NIHCR).
Conducted for NIHCR by researchers at the former Center for Studying Health System Change (HSC), the study examined how 19 hospitals across the United States were using EHRs to support medication reconciliation--the process of comparing a patient's medication orders to all of the medications that the patient has been taking.
The study found that while hospitals reported EHR vendors have been adding and enhancing medication reconciliation functionality over time, more than one-third of the hospitals in the study still used a partially paper-based process at admission, discharge or both.
The hospitals with fully electronic processes at admission or discharge had implemented EHR medication reconciliation modules, which like paper forms, allow comparison of medication lists at those transitions.
In these cases actions taken on each medication are then automatically converted into orders, substantially streamlining the workflow by eliminating the need to re-enter data.
"Respondents in our study had invested significant time and resources to improve usability and engage physicians in the medication reconciliation process," researcher Dori Cross told eWEEK. "Pilot testing and training on the medication reconciliation module leading up to implementation, as well as a number of customizations and system updates based on user feedback, were common and effective strategies across the hospitals we spoke with."
Cross noted systems that better support and enhance provider decision-making provide added value to previously paper-based processes and are going to drive greater use of the technology, while usability can be improved by EHR vendors continuing to pay attention to and improve user interface design, and more sharing of EHR use best practices.
According to the study, key challenges to effective medication reconciliation include improving access to reliable medication histories, refining EHR usability, engaging physicians more fully and routinely sharing patient information with the next providers of care.
"Technologies won’t be used consistently and to their fullest extent without buy-in from physicians and other clinical staff; that buy-in or engagement is driven largely by how much providers perceive direct, meaningful benefits to efficiency and quality of patient care," Cross explained. "Intuitive and easy to use EHR systems make the link between technology and improved care delivery more explicit."
In addition, hospitals with fully electronic processes at discharge also were able to take advantage of the discharge medications in the EHR to electronically generate legible and more patient-friendly discharge instructions and electronic prescriptions.
"As our paper stresses, medication reconciliation processes are only as good as the quality of the data feeding in; data quality can be compromised in several different ways," Cross said. "Information can be factually inaccurate or absent, which are obviously both concerns."
She noted another critical issue is that the right information is buried somewhere in the record but is not easy to find or use.
"More information isn’t always better. Data needs to be timely and usable for providers to trust the information and incorporate it in to their patient’s record and their decision-making," Cross said.