Summary
Objectives
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Medication reconciliation - medical transition care - electronic medical records -
patient safety - home health agency referrals
