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DOI: 10.1055/a-2178-0197
Medication Reconciliation during Transitions of Care Across Institutions: A Quantitative Analysis of Challenges and Opportunities
Funding This work was supported by National Institutes of Health/National Center for Advancing Translational Sciences grant number UL1 TR003167, Blue Cross Blue Shield Association, the Reynolds and Reynolds Foundation and the Cullen Trust for Healthcare.
Abstract
Objective Medication discrepancies between clinical systems may pose a patient safety hazard. In this paper, we identify challenges and quantify medication discrepancies across transitions of care.
Methods We used structured clinical data and free-text hospital discharge summaries to compare active medications' lists at four time points: preadmission (outpatient), at-admission (inpatient), at-discharge (inpatient), and postdischarge (outpatient). Medication lists were normalized to RxNorm. RxNorm identifiers were further processed using the RxNav API to identify the ingredient. The specific drugs and ingredients from inpatient and outpatient medication lists were compared.
Results Using RxNorm drugs, the median percentage intersection when comparing active medication lists within the same electronic health record system ranged between 94.1 and 100% indicating substantial overlap. Similarly, when using RxNorm ingredients the median percentage intersection was 94.1 to 100%. In contrast, the median percentage intersection when comparing active medication lists across EHR systems was significantly lower (RxNorm drugs: 6.1–7.1%; RxNorm ingredients: 29.4–35.0%) indicating that the active medication lists were significantly less similar (p < 0.05).
Medication lists in the same EHR system are more similar to each other (fewer discrepancies) than medication lists in different EHR systems when comparing specific RxNorm drug and the more general RxNorm ingredients at transitions of care. Transitions of care that require interoperability between two EHR systems are associated with more discrepancies than transitions where medication changes are expected (e.g., at-admission vs. at-discharge). Challenges included lack of access to structured, standardized medication data across systems, and difficulty distinguishing medications from orderable supplies such as lancets and diabetic test strips.
Conclusion Despite the challenges to medication normalization, there are opportunities to identify and assist with medication reconciliation across transitions of care between institutions.
Authors' Contributions
All authors participated in the problem formulation and experimental design. A.A. and E.V.B. wrote the initial manuscript. A.A. performed the data analysis. A.A., L.R.T., G.M.F., L.D.H., K.O.H., H.M.H., and E.V.B. revised the manuscript. E.V.B. provided the data. All authors reviewed and approved the manuscript prior to submission.
Human Subjects Protection
This study has been approved by the Committee for the Protection of Human Subjects (the UTHSC-H IRB) under protocol HSC-SBMI-13-0549.
Data Availability
The data underlying this article cannot be shared publicly due to the fact that these data are individually identifiable and represent real-world patients.
Publication History
Received: 07 May 2023
Accepted: 06 August 2023
Accepted Manuscript online:
19 September 2023
Article published online:
22 November 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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