Commentary on Medication Management During Transitions of Care.
Electronic health records and health information exchanges are providing a multitude of new data sources to share patient information. However, similar to other sources of data such as printed papers, facsimiles and of course, the patients themselves, the accuracy of this information still relies on the quality of human documentation and other human factors. As pharmacists, we often deal with this in medication management during transitions of care.
Reviewing all sources of information during medication reconciliation and transitions of care can often be a laborious process. Although electronic sources make data more available, it can create challenges in translating the data into usable and accurate information. This can be further complicated when dealing with multiple electronic health records and both private and government-based health information exchanges. All these sources of data often result in multiple and non-uniform entries for the same medication at different doses, and for numerous entries of different medications from the same therapeutic area. This frequently results in questions such as “Was the dose of amlodipine for this elderly patient increased to 10 mg from 2.5 or 5 mg?” and “Is this patient on amlodpine or nifedipine?” Additionally, there may be a four, five, or even more different data sources to check for the patient’s medication list.
Other issues can arise from the timing of information exchange and retrieval. Clinical information summaries and records are often sent to and shared with other facilities prior to the patient’s discharge. Oftentimes, these summaries and records are static snapshots in time, and the final medications and their dosages may change. These details can be missed depending on when and if updated information is sent with the patient. This results in pharmacists checking that the correct medications and dosages were communicated to receiving facilities.
Quite a few of the pharmacists we have interacted with have experienced these challenges. Currently, many of the pharmacists, students, and technicians at our institutions are spending lots of time and effort sorting through the many sources of data. Although this issue is commonly dealt with during medication reconciliation and management, it occurs with many other aspects of transitions of care. We would be interested in hearing how your institution is working to address them. Additionally, we wonder how software and technology can be leveraged to create usable and accurate information from many data sources.
Clem is a Pharmacy Informatics Specialist at Anne Arundel Medical Center in Annapolis, MD.
Catherine is the Directory of Pharmacy at Cornell Scott-Hill Health in New Haven, CT.
From the Transitions of Care Workgroup of the Clinical Applications Section Advisory Group
Thong Dang, Pharm.D. Pharmacy Systems Manager; PGY2 Pharmacy Informatics Residency Director. Kaiser Permanente, Downey, CA.
Ben Iredell, Pharm.D. PGY1/PGY2 Medication Systems and Operations Resident. The Johns Hopkins Hospital, Baltimore, MD.
Jason Lebowitz, Pharm.D. Senior Consultant, MedMined. BD Digital Health, Santa Monica, CA.
Clement Ng, Pharm.D., CAHIMS. Pharmacy Informatics Specialist. Anne Arundel Medical Center, Annapolis, MD.
Andrea Parker, Pharm.D., BCPS. Clinical Pharmacy Manager. Novant Health, Charlotte, NC.
Catherine Sharafanowich, B.S.Pharm. Director of Pharmacy. Cornell Scott-Hill Health, New Haven, CT.