Getting Medication Reconciliation Done Right in the EHR

Doing medication reconciliation correctly in the EHR is important for record keeping purposes, but even more so for his patients' health and wellbeing, said Ashutosh Goel, a practicing physician with Kalamazoo, Mich.-based health system, Bronson Healthcare Group.

"There are [medication reconciliation] errors at the point of care - that's when a large percentage of errors happen. If you were a patient, you wouldn't find it very easy to understand what medications you should be taking. And that leads to problems with compliance," he said.

But figuring out medication reconciliation within the context of the EHR is a challenge. That's because medications aren't always presented within the context of the patient visit. For example, if a patient is on three different classes of drugs, there may be no way for a physician to see that in the EHR, he said. Goel traces that problem to a lack of decision support tools within the typical EHR.

Physicians are an essential part of getting this right, but they're time-limited, since they're expected to see 20 to 30 patients in an 8-hour day, said Goel. That's why his practice's patients now receive what's called a "chart prep" call two to three days before their appointment. During that call, either a medical assistant or a care coordinator will discuss the patient's goals and expectations in terms of medications and tests that need to be done. Once this is done, the patient's reconciled medication list is updated in the practice's EHR.

It also helps that many area practices use the same EHR as Goel's practice, so that means Goel and the rest of his clinical team can query within the EHR to access a more comprehensive medication list for patients.

More than 50 percent of the practice's patients engage actively with the patient portal and have the ability to notify the practice if the medications listed there are inaccurate. Goel pointed out that either he or another clinician needs to review any medications before they're removed from a patient's medication list to ensure that it's appropriate for them to stop taking those medications.

About 900 miles due east, Newton, Mass.-based health system Atrius Health has also tackled the issue of medication reconciliation within the EHR. Richard Lopez, an internal medicine doctor who treats many geriatric patients, said that it starts once the medical assistant sits down at the computer with the patient in the exam room.

After checking a patient's blood pressure and respiratory rate and determining whether they need to schedule a mammogram or a colonoscopy, the medical assistant will review and update their medication list within the EHR. Atrius Health's EHR provides the same capability as Goel's, which allows clinicians to see medications prescribed to patients, even if those medications were prescribed outside of the Atrius Health network.

Since many of the patients he treats are elderly, it's particularly helpful for patients to bring in printed copies of the medications they're taking - or to come with a family member who knows the medications the patient is taking. That information is shared during the patient visit and then updated within the EHR.

Specialists at Atrius Health are responsible for updating their patients' medication lists, if they change their medications. For example, if a patient who's taking a beta blocker has their medication changed, their cardiologist will update it within the EHR, said Lopez.