Electronic Health Record

A New Frontier: Using Pharmacy Claims Within the EHR To Conduct Medication Reconciliation in Primary Care Practice

Study Type/Setting
Methods
Outcomes
Recommendations
Source
Retrospective cohort study

 

Setting: Primary Care
- Medication listed in the primary care office EHR vs pharmacy claims data available through the EHR
- Identified and characterized the discrepancies between the 2 lists - 14 primary care sites providing care for over 100,000 people and the surrounding communities
- All practices share an EHR; providers can request aggregated pharmacy claims data in real time within the EHR
- The majority of patients (468 of 609; 76.8%) had at least 1 medication discrepancy.
- Patients with a discrepancy were more likely to have had a hospitalization in the past year
- Aggregated pharmacy claims data available within the provider EHR can be used to identify discrepancies at the individual level in a multi-payer setting.
- Availability of this information in real time should be made a priority
No open access version available
Author:
Comer D, Couto J, Aguiar R, Wu P, Elliott D.
Comer D, Couto J, Aguiar R, Wu P, Elliott D. A New Frontier: Using Pharmacy Claims Within the EHR To Conduct Medication Reconciliation in Primary Care Practice.
Value in Health. 2014;17(3), p.A123.

 

Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial

Study Type/Setting
Methods
Outcomes
Recommendations
Source
Cluster-randomized trial

 

Setting: Primary Care
N=541; 267 Intervention vs 274 controls
- 11 primary care practices that used the same Personal Health Record (PHR)
- Intervention practices received access to a medications module promoting patients to review their documented med, identify discrepancies and generate ‘eJournals’
- The proportion of medications per patient with unexplained discrepancies was lower in the intervention arm vs the control (42% vs 51%)
- Discrepancies between documented and patient-reported medication regimens can be reduced with a PHR medication review tool linked to the provider’s medical record
Schnipper et al
Schnipper JL, Gandhi TK, Wald JS, et al. Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial. Journal of the American Medical Informatics Association. 2012;19(5):728-734.

An effort to improve electronic health record medication list accuracy between visits: Patients’ and physicians’ response

 

Study Type/Setting
Methods
Outcomes
Recommendations
Source
A study to evaluate the efficacy of a secure webbased patient portal

 

Setting: Primary Care
- N= 163 patients;
- 84 Patient Gateway users vs. 79 non-users
- Sending PCP a clinical message providing patient-reported information vs. no clinical message
- A lower % of PG users’ drug regimen was reported to be correct than those of PG nonusers (54% vs 61%)
- Notifying physicians of medication discrepancies via email had no effect
- Med lists in EHRs were frequently inaccurate
- Patient access to PG was not associated with more accurate medication lists in EHR
- Clinical messages to physicians containing patient-provided medication updates did not result in physician updating the med list in EHR
Staroselsky et al
Staroselsky M, Volk LA, Tsurikova R, et al. An effort to improve electronic health record medication list accuracy between visits: Patients’ and physicians’ response. International Journal of Medical Informatics. 2008;77(3):153-160. doi:10.1016/j.ijmedinf.2007.03.001

 

Accuracy of the medication list in the electronic health record—implications for care, research, and improvement

Study Type/Setting
Methods
Outcomes
Recommendations
Source
Retrospective chart review

 

Setting: Outpatient
- N=180 patients w/ inflammatory bowel disease (IBD); 379 IBD medications
- Medication list vs. clinical narrative
- 6 gastroenterology centers
- There was a range in the accuracy of medication list compared to the clinical narrative
- Variation by center (90%-50% agreement between the med list and clinical narrative)
- Analytic or care decision should not solely rely on medication order data
- This information may be helpful for site seeking to improve data quality
Walsh et al 
Walsh KE, Marsolo KA, Davis C, et al. Accuracy of the medication list in the electronic health record—implications for care, research, and improvement. Journal of the American Medical Informatics Association. 2018;25(7):909-912. doi:10.1093/jamia/ocy027