Healthcare providers in today’s environment are committed to promoting patient safety while providing access to the most reliable and innovative treatments. Medication reconciliation, which is defined by The Joint Commission as “the process of comparing a patient’s medication orders to all of the medications that the patient has been taking,” is designed to prevent drug-related errors — including adverse interactions, overdoses or allergic reactions — and can assist healthcare providers, especially during care transitions when patients are most likely to receive new medications or alternative doses.
Fortunately, nearly all healthcare providers reconcile medications at some point — and often many points — during the care cycle. In fact, a recent survey of more than 100 hospital pharmacy services and medical records personnel conducted by Emdeon found that fully 99% of these organizations comply with The Joint Commission’s definition of medication reconciliation.
Of those surveyed, 91% said they perform medication reconciliation when a patient is admitted to a hospital, 84% upon discharge, 69% upon admission to the emergency department and 68 percent when a patient is transferred from one hospital unit to another. And many respondents indicated that their organization utilizes more than one avenue for acquiring the data, including patient queries, information from the admitting physician, via an electronic health record or other means.
|When is medication reconciliation performed||Response|
|Emergency department admission||69%|
|Hospital unit transfer||68%|
Also, an interesting statistic around medication reconciliation is that it takes an acute caregiver an estimated 19 minutes to manually reconcile a patient’s medication. When performing the reconciliation electronically, it can take as little as two minutes. This can present a huge increase in productivity for medical personnel.
In spite of the seemingly thorough efforts toward medication reconciliation, there continues to be relatively high instances of medication discrepancies that could prove harmful to patients and costly for hospitals. That might explain why 33% of those surveyed rated their medication reconciliation effectiveness as “fair,” compared with only 31% who indicated it as “good.” Similarly, the largest portion of respondents — 38% — felt the accuracy of their medication reconciliation method was simply “fair” verses the 26% who rated it as “good.”
Industrywide collaboration is key
Medication reconciliation is poised for reinvention. Even today’s technology solutions are rooted in costly, inefficient methods. For example, patient medication records are most often acquired on a per-transaction basis and delivered to the provider upon request. What if healthcare providers had real-time access to their patient’s claims-based medication history within their EHR or other preferred access point without needing to go through traditional protocols? It would likely promote efficiency and reduce or eliminate costs from the medication reconciliation process.
New, innovative technologies are promoting connectivity between clinicians, pharmacies and patients to assist in medication reconciliation. For example, master patient index software can be designed to intelligently match patients with the medications prescribed to them over time and at different locations. And e-prescribing modules that support interoperability among diverse systems throughout the healthcare provider community can facilitate automated medication management and drug utilization review programs that could alert those providers to potential drug-to-drug or drug-to-allergy interactions.
In effect, technology is the easy part. The greater challenge will be to bring all constituents together with an information-sharing objective. The reality is that everyone benefits from a smooth medication reconciliation process. Perhaps healthcare’s transition to patient-centered care models, such as the accountable care organization, will be the spark plug for a new era of medication reconciliation. With government and commercial payers alike providing incentives for quality improvements while conversely penalizing for poor clinical outcomes (e.g., Medicare’s 30-day readmission rules), healthcare providers cannot afford medication-related errors that can be prevented with an effective application of technology.
Delivered within a clinician’s workflow, real-time medication reconciliation services also will enhance healthcare provider efficiency, allowing them to devote more time to patient care and less time to administrative tasks. And healthcare providers have the opportunity to participate in shared revenue programs for the delivery of the patient medication history information.
Of course the most important beneficiary of technology-enhanced medication reconciliation is the patient. With more accurate information at the point of care, healthcare providers will be equipped to reduce the medication errors — duplicate prescriptions, incorrect dosing and drug omissions — that have taken such a costly toll on human life.
Senior director of clinical services, pharmacy services division
Lathe Bigler serves as Emdeon’s senior director of clinical services for the pharmacy services division. His focus on developing layers of competitive advantage and increasing market growth are instrumental in Emdeon’s advancement in the exchange of electronic prescriptions and other clinical information. Bigler has more than 15 years of experience in the healthcare and information technology fields, and has held roles in marketing, product management, business development and industry relations with such corporations as NDC Health, Midmark Diagnostics, DrFirst and AltaPoint Data Systems. Bigler has a bachelor’s degree in marketing and business administration.