Engaging patients in medication reconciliation via a patient portal following hospital discharge

Abstract

Few ambulatory medication reconciliation tools exist. Transitions between inpatient and outpatient care can result in medication discrepancies. An interdisciplinary team designed a new 'Secure Messaging for Medication Reconciliation Tool' (SMMRT) within a patient web portal and piloted it among 60 patients at a Veterans Affairs hospital, an integrated system with a shared electronic health record. Recently discharged patients used SMMRT to view their medications in a secure email message and replied using SMMRT's interactive form, verifying their medication regimens and clarifying any inaccuracies. In total, 108 medication discrepancies and 23 potential adverse drug events (ADEs) were seen. Nearly 50% of the potential ADEs were classified as serious. Overall, participants were enthusiastic about SMMRT; 90% said they would use SMMRT again. Enabling patients to conduct medication reconciliation through a web portal is feasible in the transition from inpatient to outpatient care and may improve medication safety.

Keywords: Adverse Drug Events; Health Information Technology; Medication Reconciliation; Patient Web Portal; Patient-Centered Care; Transitions in Care.

Figure 1

Example of an initial outbound Secure Messaging for Medication Reconciliation Tool (SMMRT), pasted into the body of a secure message. All secure messages were addressed to the patient by name and specified the patient's date of birth, discharge date and diagnosis as well as allergies. Medications were grouped as ‘Current’, ‘Non-VA, Herbal, Over-the-counter’, ‘Stopped’, ‘Expired’ and ‘Other’ to emulate the display of the medication list provided by the inpatient team at discharge. EHR, electronic health record

Figure 2

Overview of the Secure Messaging for Medication Reconciliation Tool (SMMRT) pilot study. SMMRT was initiated within 72 h of discharge, establishing two-way communication with the patient. At home, the patient completed the interactive SMMRT and sent it back to the clinical pharmacist. Updated medication lists were posted to the electronic health record (EHR) to be viewed by providers.

Figure 3

Responses of 10 pilot participants to domains of experience following the Secure Messaging for Medication Reconciliation Tool (SMMRT) pilot. We conducted 10 in-depth interviews among participants who completed the pilot to evaluate their experience and seek feedback on SMMRT.