Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge

Abstract

Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30 days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.

Figure 1

Screenshot of the postdischarge-medication reconciliation tool. The preadmission electronic medical record (EMR) medication list is on the left, the discharge medication regimen on the right. Selecting ‘Add’ or ‘Modify’ buttons between the two lists updates the ambulatory EMR medication list. The trash-can icon can be used to delete medications from the EMR list. EMR medications can also be verified. Once the user is done, the buttons at the bottom reconcile the EMR medication list in part or in full. Note at the top the links to the most recent discharge summary and ‘Quick Look,’ a read-only view of the EMR.