Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial

Abstract

Objective: To determine the effects of a personal health record (PHR)-linked medications module on medication accuracy and safety.

Design: From September 2005 to March 2007, we conducted an on-treatment sub-study within a cluster-randomized trial involving 11 primary care practices that used the same PHR. Intervention practices received access to a medications module prompting patients to review their documented medications and identify discrepancies, generating 'eJournals' that enabled rapid updating of medication lists during subsequent clinical visits.

Measurements: A sample of 267 patients who submitted medications eJournals was contacted by phone 3 weeks after an eligible visit and compared with a matched sample of 274 patients in control practices that received a different PHR-linked intervention. Two blinded physician adjudicators determined unexplained discrepancies between documented and patient-reported medication regimens. The primary outcome was proportion of medications per patient with unexplained discrepancies.

Results: Among 121,046 patients in eligible practices, 3979 participated in the main trial and 541 participated in the sub-study. The proportion of medications per patient with unexplained discrepancies was 42% in the intervention arm and 51% in the control arm (adjusted OR 0.71, 95% CI 0.54 to 0.94, p=0.01). The number of unexplained discrepancies per patient with potential for severe harm was 0.03 in the intervention arm and 0.08 in the control arm (adjusted RR 0.31, 95% CI 0.10 to 0.92, p=0.04).

Conclusions: When used, concordance between documented and patient-reported medication regimens and reduction in potentially harmful medication discrepancies can be improved with a PHR medication review tool linked to the provider's medical record.

Trial registration number: This study was registered at ClinicalTrials.gov (NCT00251875).

Figure 1

Study flow diagram. *‘No match’ indicates patients in the active control arm who did not match any patient in the intervention arm of the sub-study by practice and by date and type of visit. †‘Opted out’ includes those patients who opted out by email after receiving the invitation to participate in the medications sub-study and those who declined participation once contacted by phone. ‡‘Never called’ indicates those patients in the active control arm who did not need to be called because a sufficient number of eligible patients had already been enrolled. PCP, primary care provider.