6 Tips to Ensure that Electronic Medication Reconciliation Has the "It" Factor

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Six tips to improve medication reconciliation.

After years of reading study after study, virtually everyone knows that exercise is essential to good health. However, according to statistics from the Centers for Disease Control and Prevention, fewer than two in 10 Americans get the recommended levels of exercise, and more than a quarter of U.S. adults do not devote any time to physical activity.1

Medication reconciliation falls into a similar easier-said-than-done trap. Even though several studies regarding the need for comprehensive medication reconciliation have been published and the value of medication reconciliation is widely recognized, many healthcare providers have difficulty when it comes to actually getting the job done correctly.

The end result? According to the Institute of Medicine's "Preventing Medication Errors," the average hospitalized patient is subject to at least one medication error per day — making such errors the most common patient safety errors.2 Perhaps even more disconcerting, more than 40% of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients. And, of these errors, about 20% are believed to result in harm.3,4

Like exercise, everyone knows that medication reconciliation is important. However, just like those 30 minute sessions on the treadmill, fitting medication reconciliation into clinicians' everyday workflow is difficult.

Indeed, clinicians are struggling to find efficient ways to manage the medication reconciliation process at each transition in care — admission, at transfer points and discharge. In fact, due to these challenges, medication reconciliation has been one of the most frequently deferred meaningful use stage 1 menu objectives in attestations by eligible hospitals. With escalating meaningful use requirements and the fact that medication reconciliation is now required for stage 2, hospital leaders are apt to be searching for strategies that will ensure that medication reconciliation is performed consistently and effectively.

Electronic medication reconciliation can help. But it has to be done right. Here are a few ways that well-designed electronic solutions can bring the all-important "It" factor to medication reconciliation, ensuring that it becomes a successful habit:

1. It has to be time efficient. First and foremost, electronic medication reconciliation can't take more time than manual medication reconciliation. As such, medication reconciliation systems need to be built with the end-user in mind. Until information technology systems start making clinician workflow and efficiency a top priority, there will be little impact on patient safety. Simply put, if the electronic medication reconciliation process does not save time, it simply will not be adopted.

2. It has to engage. Listing medications and potential warnings is just the beginning. To succeed, electronic medication reconciliation systems need to enable communication across the entire healthcare team. 

3. It has to educate. In addition, these systems need to offer meaningful information that can help caregivers increase patient understanding of medications. In other words, if the system can help caregivers explain why certain medications are or are not appropriate, then clinicians will be more likely to use the systems during the normal course of patient care.  

4. It has to be integrated. Medication reconciliation must be integrated into the overall ordering and medication management processes. It is not practical to ask physicians to "do orders" and then turn around and "do medication reconciliation." Instead, orders and medication reconciliation need to be included in the same process.

5. It has to be readily available. Clinicians work in a mobile environment — and are increasingly relying on mobile tools. As such, clinicians are seeking to reconcile medications from a variety of devices — from desktops to laptops to tablets to smartphones.

6. It has to create value. Medication reconciliation systems need to create a quantifiable pay-off. Most importantly — and most obviously — the systems need to lead to reduced medication errors. But there are many other potential benefits as well including: Improved medication history completion rates, reduced time spent on medication reconciliation, reduced phone calls between caregivers during the medication reconciliation process, increased patient compliance with discharge medications, easier tracking of prescriptions provided to patients and enhanced communication among the entire healthcare team.

1 New CDC Report Says Many Americans Get No Exercise. http://www.hss.edu/newsroom_cdc-americans-get-no-exercise.asp
2 Aspden P, Institute of Medicine (US) Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors. Washington DC: National Academies Press; 2006. http://www.nap.edu/openbook.php?record_id=11623
3 Rozich JD, Howard RJ, Justeson JM, et al. Patient safety standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004;30 (1):5–14. http://www.ncbi.nlm.nih.gov/pubmed/14738031
4 Gleason KM, Groszek JM, Sullivan C, et al. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;61:1689–95

Dewey Howell, MD, PhD, a practicing family physician turned healthcare information technology software developer, is vice president of clinical applications at First Databank, based in South San Francisco, where he focuses on developing highly usable and valuable health IT applications to support medication-related decisions. Dr. Howell also leads product development for FDB MedsTracker®, a medication reconciliation application he designed and developed in 2005. Dr. Howell joined FDB in August 2013, through the acquisition of Design Clinicals, a healthcare information technology company he founded that was dedicated to providing clinician-friendly solutions for improving medication reconciliation and the delivery of patient care.


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