Evaluation of an Electronic Module for Reconciling Medications in Home Health Plans of CareThe research reported here was supported by Pilot Study Grant N19-FY14Q1-S2-P01023 by the United States (U.S.) Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health. Dr. Randall Rupper is the Associate Director, Clinical, Geriatric Research Education and Clinical Center at the George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
16 November 2015
accepted: 04 March 2016
16 December 2017 (online)
Transitions in patient care pose an increased risk to patient safety. One way to reduce this risk is to ensure accurate medication reconciliation during the transition. Here we present an evaluation of an electronic medication reconciliation module we developed to reduce the transition risk in patients referred for home healthcare.
Nineteen physicians with experience in managing home health referrals were recruited to participate in this within-subjects experiment. Participants completed medication reconciliation for three clinical cases in each of two conditions. The first condition (paper-based) simulated current practice – reconciling medication discrepancies between a paper plan of care (CMS 485) and a simulated Electronic Health Record (EHR). For the second condition (electronic) participants used our medication reconciliation module, which we integrated into the simulated EHR.
To evaluate the effectiveness of our medication reconciliation module, we employed repeated measures ANOVA to test the hypotheses that the module will: 1) Improve accuracy by reducing the number of unaddressed medication discrepancies, 2) Improve efficiency by reducing the reconciliation time, 3) have good perceived usability.
The improved accuracy hypothesis is supported. Participants left more discrepancies unaddressed in the paper-based condition than the electronic condition, F (1,1) = 22.3, p < 0.0001 (Paper Mean = 1.55, SD = 1.20; Electronic Mean = 0.45, SD = 0.65). However, contrary to our efficiency hypothesis, participants took the same amount of time to complete cases in the two conditions, F (1, 1) =0.007, p = 0.93 (Paper Mean = 258.7 seconds, SD = 124.4; Electronic Mean = 260.4 seconds, SD = 158.9). The usability hypothesis is supported by a composite mean ability and confidence score of 6.41 on a 7-point scale, 17 of 19 participants preferring the electronic system and an SUS rating of 86.5.
We present the evaluation of an electronic medication reconciliation module that increases detection and resolution of medication discrepancies compared to a paper-based process. Further work to integrate medication reconciliation within an electronic medical record is warranted.
- 1 Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. The New England journal of medicine 2009; 360 (14) 1418-1428 Epub 2009/04/03. doi: 10.1056/NEJMsa0803563. PubMed PMID: 19339721.
- 2 Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health affairs (Project Hope) 2010; 29 (01) 57-64 Epub 2010/01/06. doi: 10.1377/hlthaff.2009.0629. PubMed PMID: 20048361; PubMed Central PMCID: PMCPMC2826971.
- 3 Stitt DM, Elliott DP, Thompson SN. Medication discrepancies identified at time of hospital discharge in a geriatric population. The American journal of geriatric pharmacotherapy 2011; 09 (04) 234-240 Epub 2011/07/19. doi: 10.1016/j.amjopharm.2011.06.002. PubMed PMID: 21763215.
- 4 Unroe KT, Pfeiffenberger T, Riegelhaupt S, Jastrzembski J, Lokhnygina Y, Colon-Emeric C. Inpatient medication reconciliation at admission and discharge: A retrospective cohort study of age and other risk factors for medication discrepancies. The American journal of geriatric pharmacotherapy 2010; 08 (02) 115-126 Epub 2010/05/05. doi: 10.1016/j.amjopharm.2010.04.002. PubMed PMID: 20439061; PubMed Central PMCID: PMCPMC3740385.
- 5 The Joint Commission. Using medication reconciliation to prevent errors Sentinel Event Alert Issue 35. Epub January 25, 2006
- 6 Varkey P, Cunningham J, O’Meara J, Bonacci R, Desai N, Sheeler R. Multidisciplinary approach to inpatient medication reconciliation in an academic setting. American Journal of Health-System Pharmacy 2007; 64 (08) 850-854 doi: 10.2146/ajhp060314.
- 7 Mueller SK, Sponsler K, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: A systematic review. Archives of Internal Medicine 2012; 172 (14) 1057-1069 doi: 10.1001/archinternmed.2012.2246.
- 8 Plaisant C, Wu J, Hettinger AZ, Powsner S, Shneiderman B. Novel user interface design for medication reconciliation: an evaluation of Twinlist. 2015 2015–02–07 00:00:00.
- 9 Cadwallader J, Spry K, Morea J, Russ AL, Duke J, Weiner M. Design of a medication reconciliation application: facilitating clinician-focused decision making with data from multiple sources. Applied clinical informatics 2013; 04 (01) 110-125 Epub 2013/05/08. doi: 10.4338/aci-2012–12-ra-0057. PubMed PMID: 23650492; PubMed Central PMCID: PMCPMC3644819.
- 10 Holtzblatt K, Wendell JB, Wood S. Rapid contextual design:A how-to guide to key techniques for user-centered design. San Francisco, CA: Morgan Kaufmann; 2005: 313.
- 11 Nielsen J. Usability Engineering: AP Professional; 1994
- 12 Brooke J. SUS-A quick and dirty usability scale. Usability evaluation in industry 1996; 189 (194) 4-7.
- 13 Team RC. R: A language and environment for statistical computing. 3.1.2. ed. Vienna, Austria: R Foundation for Statistical Computing; 2014
- 14 Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Studies 2009; 04 (03) 114-123.
- 15 Monkman H, Borycki EM, Kushniruk AW, Kuo M-H. Exploring the Contextual and Human Factors of Electronic Medication Reconciliation Research: A Scoping Review. In: Context Sensitive Health Informatics: Human and Sociotechnical Approaches. Studies in Health Technologies and Informatics; 166-172.
- 16 Tresner-Kirsch D, Keybl M, Henderson J, Clark C, Aberdeen J, Turchin A, Palchuk M. Automated Detection of Discrepancies in Pharmaceutical Order-Entry Data. MITRE Corporation. 2015
- 17 Del Fiol G, Workman T, Gorman PN. Clinical questions raised by clinicians at the point of care: A systematic review. JAMA Internal Medicine 2014; 174 (05) 710-718 doi: 10.1001/jamainternmed.2014.368.
- 18 Gleason KM, McDaniel MR, Feinglass J, Baker DW, Lindquist L, Liss D, Noskin GA. Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. Journal of general internal medicine 2010; 25 (05) 441-447 Epub 2010/02/25. doi: 10.1007/s11606–010–1256–6. PubMed PMID: 20180158; PubMed Central PMCID: PMCPmc2855002.
- 19 Press MJ, Gerber LM, Peng TR, Pesko MF, Feldman PH, Ouchida K, Sridharan S, Bao Y, Barron Y, Casalino LP. Postdischarge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes. Journal of the American Geriatrics Society 2015; 63 (07) 1299-1305 doi: 10.1111/jgs.13491.