The Importance of Electronic Health Record Access For Accurately Completing Drug Regimen Reviews

OBJECTIVE: To challenge the standard of practice by evaluating the identification of medication discrepancies found depending on type of access to an electronic health record (EHR). In other words, is there a difference in the number of discrepancies between a pharmacist with only access to the postacute long-term care (PALTC) EHR (ie, single-access pharmacist [SAP]) compared with a pharmacist with access to both the PALTC and hospital EHRs (ie, dual-access pharmacist DAP) In October 2018, the Improving Medicare PostAcute Care Transformation (IMPACT) Act mandated admission drug review (DRR) upon admission to a postacute, long-term care (PALTC) facility.
SUMMARY:This was a prospective study investigating the occurrence of medication therapy problems (MTP) identified by two different DRR processes; SAP versus DAP. Data were collected in a community hospital and a stand-alone PALTC facility. It was found that the DAP identified more safety-related medication needs and medication omissions than an SAP. There was a significant association between the type of access and whether a MTP (ie, yes or no) was discovered, the type of medication-related need, and MTP category.
CONCLUSION: These results strongly suggest that current standard of practice should change to require access to both hospital and PALTC EHR systems for a pharmacist completing the medication reconciliation. Until the gap in EHR interoperability is closed, the potential breakdown in communication associated with SAP places patients transitioning from hospital to PALTC facilities at increased risk for medication problems and accompanying adverse medication events.