Using a Health Information Exchange to Improve Medication Reconciliation

摘要

This project focused on utilizing new healthcare technology to address the problems associated with medication reconciliation during transitions in care. A health information exchange (HIE) was used to document and share medication lists for a subset of patients in the Camden Coalition of Healthcare Providers’ (CCHP) Care Transitions Program. The project utilized the quality improvement science of Plan-Do-Study-Act (PDSA), which involves small tests of change to a process in order to improve outcomes. Data sources included hospital discharge summaries, a medication reconciliation form, and the Camden Health Information Exchange. Eleven (11) patients enrolled in CCHP’s Care Transitions Program were followed over a four-month period beginning with hospital discharge. Two PDSA cycles were conducted to improve the medication reconciliation process, and medication lists and discrepancies were collected at each phase for analysis. The project team documented 135 medications across 8 discharge summaries, 207 medications in the homes of 11 patients, and 184 medications for these 11 patients are currently maintained in the Camden HIE. The variation in medication lists across care transitions depended on factors such as type/severity of illness, literacy level and mental status. Use of the HIE to narrow down the list across healthcare providers resulted in a clean, accurate and timely list of medications for these high-risk patients. Although the study did not get as far as needed to study the effect of using a HIE to share medication data across settings, it provided a good argument for the HIE’s value in documenting and tracking medications across the patient’s continuum of care. The project also highlighted the need for improved discharge documentation by hospitals, as well as better care coordination after hospital discharge.