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Electronic health records and adverse drug events after patient transfer
  1. K S Boockvar1,2,3,
  2. E E Livote1,
  3. N Goldstein1,2,
  4. J R Nebeker4,
  5. A Siu1,2,
  6. T Fried5,6
  1. 1 Geriatric Research, Education, and Clinical Center, James J Peters Veterans Affairs Medical Center, Bronx, New York, USA
  2. 2Departments of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York, USA
  3. 3The Jewish Home Lifecare, New York, New York, USA
  4. 4VA Geriatrics Research, Education, and Clinical Center, Salt Lake City, Utah, USA
  5. 5Yale University School of Medicine, New Haven, Connecticut, USA
  6. 6Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
  1. Correspondence to Kenneth S Boockvar, James J Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA; kenneth.boockvar{at}


Background Our objective was to examine the frequencies of medication error and adverse drug events (ADEs) at the time of patient transfer in a system with an electronic health record (EHR) as compared with a system without an EHR. It was hypothesised that the frequencies of these events would be lower in the EHR system because of better information exchange across sites of care.

Methods 469 patients transferred between seven nursing homes and three hospitals in New York and Connecticut between 1999 and 2005 were followed retrospectively. Two groups of patients were compared: US Veterans Affairs (VA) patients, with an EHR, and non-VA patients, without an EHR, on the following measures: (1) medication prescribing discrepancies at nursing home/hospital transfer, (2) high-risk medication discrepancies and (3) ADEs caused by medication discrepancies according to structured medical record review by pairs of physician and pharmacist raters.

Results The overall incidence of ADE caused by medication discrepancies was 0.20 per hospitalisation episode. After controlling for demographic and clinical covariates, there were no significant differences between VA and non-VA groups in medication discrepancies (mean difference 0.02; 95% CI −0.81 to 0.85), high-risk medication discrepancies (−0.18; 95%CI −0.22 to 0.58) or occurrence of an ADE caused by a medication discrepancy (OR 0.96; 95% CI 0.18 to 5.01).

Conclusions There was no difference, with and without an EHR, in the occurrence of medication discrepancies or ADEs caused by medication discrepancies at the time of transfer between sites of care. Reducing such problems may require specialised computer tools to facilitate medication review.

  • Medical records systems-computerised
  • medication error
  • medication systems
  • nursing homes
  • hospitals
  • information technology
  • medication safety
  • hand-off

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  • Funding Financial support was provided by the VA Health Services Research and Development Service, the New York State Department of Health and the Mount Sinai Practice Improvement Cluster. Dr. Goldstein was supported by 5K23AG025933-04 from NIH.

  • Competing interests The authors have no competing interests to report. The sponsors had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or in the preparation, review or approval of the manuscript. Dr Boockvar had full access to study data and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Ethics approval This study was conducted with the approval of the Mount Sinai School of Medicine, James J Peters VA Medical Center, VA Connecticut Healthcare System and Jewish Home Lifecare.

  • Provenance and peer review Not commissioned; externally peer reviewed.