Design and Implementation of an Application and Associated Services to Support Interdisciplinary Medication Reconciliation Efforts at an Integrated Healthcare Delivery Network

TLDR

Confusion about patients' medication regimens during admission and discharge causes many preventable medication errors, prompting organizations to redesign clinical processes to improve patient safety. This manuscript presents a novel application that aggregates medication data from EMR and CPOE systems to allow clinicians to efficiently create accurate pre‑admission medication lists. The application, implemented within Partners HealthCare’s integrated network, pulls data from multiple outpatient EMR and inpatient CPOE systems and supports clinicians in generating pre‑admission lists, writing orders, performing assessments, and reconciling inpatient orders. Early pilot testing indicates that the new reconciliation process is well accepted by clinicians and has strong potential to reduce medication errors during care transitions.

Abstract

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.