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Medication Reconciliation: What Role Will I.T. Play?


By Howard J. Anderson, Executive Editor July 2007
Medication reconciliation, the difficult process of keeping track of all prescribed and over-the-counter medications a patient takes before, during and after hospitalization, can have a profound impact on patient outcomes.

"If we fail to give patients the proper list of medications for use after discharge, we can't guarantee they will be taking the right medications at home, and they could easily wind up back in the hospital," says Pam Mattio, a registered nurse at East Jefferson General Hospital in Metairie, La. The hospital has automated many of the steps involved in the reconciliation process.

The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Ill., requires that hospitals "accurately and completely reconcile medications across the continuum of care," according to its current National Patient Safety Goals. So hospitals are scrambling to build processes to track medications every step of the way.

However, there's still a lot of work to be done. Only about 13% of U.S. hospitals have computerized systems in place to support the medication reconciliation process from admission to discharge, according to a 2006 study by the Institute for Safe Medicine Practices, a Huntington Valley, Pa.-based think tank. About half the 1,400 respondents used paper forms to reconcile medications. The remainder rely mostly on paper forms, but some have automated portions of the reconciliation process, says Stuart Levine, an informatics specialist at the institute.

"We do consults all over the country, and we haven't yet found a hospital that has really been able to do a complete job from end to end," he says. "Everyone is waiting for a magic bullet-software that can easily fix the process."

JCAHO executives acknowledge that medication reconciliation is extremely challenging. "Of the patient safety goals we have established, this is one of the more complicated ones," says Peter Angood, M.D., JCAHO's vice president and chief patient safety officer. "It's fair to say most hospitals still have a long way to go."

Many technologies, including electronic health records and computerized physician order entry systems, can play important roles in medication reconciliation, Angood says. "We encourage institutions to standardize their processes, keeping them as simple as possible so as to make them a matter of routine. That way, all clinicians are aware of the processes and they become a regular part of the practice of medicine."

Many Different Paths

Hospitals that are beginning to use information technology to streamline the medication reconciliation process are using a variety of strategies. Some are building their own applications as add-ons to a clinical information system. Others are serving as test sites for new, specialized software. And some are leveraging their CPOE systems to help get the job done.

Faced with inefficient, paper-based medication reconciliation processes that were far from standard, East Jefferson General Hospital formed a committee to tackle standardizing and automating as many steps of the process as possible.

"It's so important to get an accurate list of medications from patients as they come into the hospital," says Roland Bourgeois, M.D., the physician champion for the project. "It helps us avoid medical errors and avoid continuing the wrong medications that could do harm."

The organization built its own reconciliation application as a module for its clinical information system from Cerner Corp., Kansas City, Mo.

Upon admission to the hospital, a nurse now enters the patient's home medications into an electronic record, along with any newly ordered medications for the hospital stay. This information is then printed out on a form attached to the paper charts that doctors use. If a patient is transferred to another unit, the reconciliation information is updated electronically, printed and passed along to appropriate caregivers.

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