Journal of the American Pharmacists Association
ResearchIdentifying discrepancies in electronic medical records through pharmacist medication reconciliation
Section snippets
Objectives
The current study sought to describe the types of and reasons for discrepancies between patient-reported medications and medications listed in EMRs as identified by pharmacist medication reconciliation in an ambulatory care setting. The secondary objective was to identify patient characteristics associated with the presence of discrepancies between patient-reported medications and medications listed in EMRs.
Methods
Following approval from the Duquesne University Institutional Review Board, patients from a primary care center (Catholic Charities Free Health Care Center) serving an indigent, uninsured population were recruited for participation in the study. The center, which is located in an urban setting, provides free medical and dental services to uninsured adults with household incomes less than 200% of the Federal Poverty Level. Patients eligible for care at the center cannot have private or
Results
A total of 219 patients who received a medication reconciliation intervention by a pharmacist or student pharmacist were included in the analysis. Patient interviews occurred during 2009–10 during a 13-month time frame. Baseline demographic characteristics are shown in Table 1.
Discussion
Discrepancies and inaccuracies in EMRs among outpatients occurred at an alarming rate in the current work—a finding that is similar to results from previous studies examining traditional documentation systems. These results indicate that despite the potential for improvements with use of EMRs, discrepancies continue to exist, suggesting that the method of documentation alone is not sufficient to have a considerable effect on the rate and types of discrepancies. Assuming that “usual care,” prior
Limitations
One limitation of the current work was that the clinical importance of the discrepancies identified was not described beyond the discrepancy reason. This limits our ability to accurately predict the discrepancies' effect on patient outcomes, including relative risk of harm to the patient. Another limitation was the use of convenience sampling, as this population (indigent adults aged 18–65 years) may not be representative of patients in all primary care centers and may differ as a result of
Conclusion
Medication reconciliation remains an important initiative for ensuring patient medication safety and is of concern in both outpatient and inpatient settings. Inaccuracies in charted medications remained a common occurrence in this setting, despite the use of an EMR system, and often are related to the use of OTC therapies and lack of communication and documentation during physician office visits. Patient-related factors such as number of medications and degree of medication-related knowledge
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Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.
Acknowledgments: To Hildegarde J. Berdine, PharmD, BCPS, CDE, for general support.
Previous presentations: American College of Clinical Pharmacy (ACCP) Annual Meeting, Anaheim, CA, October 18–21, 2009, and ACCP Annual Meeting, Charlotte, NC, April 23–27, 2010.