Here is an issue that I would love
to get some technological assistance with: medication reconciliation.
to get some technological assistance with: medication reconciliation.
Has anyone discovered a good tool
for medication reconciliation, that works for the outpatient setting?
for medication reconciliation, that works for the outpatient setting?
As an outpatient geriatrician, I
spend a lot of time reviewing medications, and it’s not uncommon for my
patients to be taking 10-15 medications. This is clinically VERY important; medications are a top cause of delirium, falls, and other adverse effects in non-hospitalized elders.
spend a lot of time reviewing medications, and it’s not uncommon for my
patients to be taking 10-15 medications. This is clinically VERY important; medications are a top cause of delirium, falls, and other adverse effects in non-hospitalized elders.
The problem: even if I have an
accurate list of what has been prescribed by myself and the other involved
doctors (a big if — more on that soon), matching this up with what the patient is
taking tends to take a while. Here’s what I used to do at my previous clinic
job, which had a medication list in the e-prescribing system, and also in the
paper chart:
accurate list of what has been prescribed by myself and the other involved
doctors (a big if — more on that soon), matching this up with what the patient is
taking tends to take a while. Here’s what I used to do at my previous clinic
job, which had a medication list in the e-prescribing system, and also in the
paper chart:
- Get the patient to bring in all bottles. (Usually involves multiple reminders and some coaxing; it’s hard to get patients to not juts bring in their outdated list from 6 months ago.)
- As I look at a bottle, check it off against the
existing list. (Oh wait, if I want an existing list I can scribble on, I
need to copy the list we have, or print from e-prescribing; doing either task will set me further behind.) - Forget about checking it off. I decide to just write
down all the meds, and then compare it against the list I have, using my
eyeballs and brain to stop the discrepancies. - Hm. These two lists are long, and the meds are in
different orders. Maybe I should start by counting the two lists and
seeing if I have the same number of meds on each one. - Aha! The original list says metoprolol 50mg bid, but
the patient has brought in a bottle that says metoprolol 100mg bid.
Discrepancy identified! - As I start to inquire about this discrepancy, the
patient brings up three other problems of greater concern to her, and I
never finish spotting the other discrepancies during the visit.
Yes I admit it, I often found it
very difficult to get through comprehensive medication reconciliation at an
outpatient visit.
very difficult to get through comprehensive medication reconciliation at an
outpatient visit.
But this is part because this is one
of the many tasks that providers are often left to do with eyeballs and brain,
even though of course computerized technology can do this faster and better.
of the many tasks that providers are often left to do with eyeballs and brain,
even though of course computerized technology can do this faster and better.
Here’s a hypothetical technological set-up to do medication reconciliation faster:
- Patient’s med list is kept in some kind of program,
perhaps web-based. Ideally this should be accessible for viewing by the
patient as well as the provider. - Meds at the visit get input into the program. Ideal
would be for the entry to bypass human eyes and finger, like barcode
scanning. Heck, maybe you could even snap pictures of QR codes on the bottle, as these are now all
the rage. (Why don’t prescription med bottles come with barcodes that can be read in clinic??) - The computer doesn’t care that the meds were entered in
a different order. It can rearrange them and identify the discrepancies in
a snap. - One second later, provider has a list of the
discrepancies, and can start investigating.
So, does this exist?? My preliminary
Google search reveals that:
Google search reveals that:
- Microsoft HealthVault
can download medication info from some big pharmacy chains like CVS and
Walgreen’s. I suppose you’d have to enter your own meds post
hospitalization. And it’s unclear from their promotional materials how
HealthVault helps patients, families, and providers spot discrepancies. - A company called PatientKeeper
claims to have recently rolled out the “First Physician-Friendly Med
Rec Software Application”. Unclear how you enter meds at a visit, or how usable
it is in outpatient setting.
In general, when I look into technology for medication reconciliation, I overwhelmingly find tools like this one, which are:
- designed for med rec in hospital, not outpatient setting
- focus on reconciling what has been prescribed, rather than what the patient actually has on hand.
Obviously it’s very important to achieve medication reconciliation during hospital admission and discharge.
But as everyone agrees that it’s important to provide good outpatient care, in order to avert hospitalizations and maintain wellness, we really need better med rec tools for the practicing primary care clinician.
How are the rest of you managing outpatient medication reconciliation for elders? Have you come across any tool or technology that can make this med rec process more doable in the usual outpatient clinic setting?
