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Medication discrepancies in integrated electronic health records
1Section of General Internal Medicine, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130, USA. amy.linsky@va.gov
BMJ Quality & Safety
|October 27, 2012
Summary
Medication discrepancies are common in electronic health records (EHRs) despite pharmacy integration. Patients with more medications face higher risks of commission and duplication errors, highlighting the need for thorough patient medication reviews.
Area of Science:
- Health Informatics
- Patient Safety
- Clinical Pharmacy
Background:
- Medication discrepancies are linked to adverse drug events.
- Electronic health records (EHRs) and pharmacy dispensing integration may reduce these discrepancies.
- Prevalence and factors of medication discrepancies require characterization.
Purpose of the Study:
- Determine the prevalence of medication discrepancies in a national healthcare system with EHR-pharmacy linkage.
- Characterize the specific types of medications involved in discrepancies.
- Identify factors associated with medication discrepancies.
Main Methods:
- Retrospective cohort study of ambulatory care patients (April 2010-July 2011).
- Primary outcome: presence of any medication discrepancy (commission, omission, duplication, alteration).
- Utilized Veterans Affairs Boston Healthcare System data with EHR-pharmacy linkage.
Main Results:
- 60% of patients had at least one medication discrepancy.
- Prevalence: commissions (36%), omissions (27%), duplications (11%), alterations (19%).
- Increasing medication count associated with more commissions/duplications and fewer omissions.
Conclusions:
- Medication discrepancies remain prevalent (60%) in ambulatory patients despite EHR-pharmacy linkage.
- Higher medication counts increase risks for commission and duplication errors.
- EHRs alone are insufficient; thorough patient medication reviews are crucial for accuracy.
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