Home Healthcare, Hospice, and Information Technology Innovations Conference

Innovations in Home Healthcare, Hospice, and Information Technology

A forum towards achieving evidence-based diffusion and implementation of innovations

H3IT: Home Healthcare, Hospice, and Information Technology Conference Nashville, TN, 2015

Evaluation of an Electronic Module for Reconciling

Medications in Home Health Plans of Care

Bryan Gibson, DPT, PhD

1, 2

, Heidi Kramer, PhD

1

, Yarden Livnat, PhD

3

, Iona Thraen ASCW, PhD

1, 4

, Abraham Brody,

RN, PhD, GNP-BC

5, 6

, Randall Rupper, MD, MPH

7, 8

C

urrently home health referrals involve the exchange of paper documents between referring providers and home

health agencies. In these exchanges medication lists are often manually annotated to address discrepancies

between records. This manual process is error prone and inefficient, leading to ambiguities in the patient

record and placing patients’ safety at risk. In this project we developed an electronic medication reconciliation

module that was integrated into a simulated EHR and intended for use by VA providers when managing plans of care

returned by home health. We evaluated the effects of this module on the accuracy and efficiency of addressing medication

discrepancies.

Methods: Nineteen physicians who had experience in managing home health referrals were recruited to participate in a

within-subjects experiment. Participants completed two blocks of three clinical cases each. In each block of cases the first

case was an orientation case, this was followed by two cases for which the data was used for analysis. The first block of

cases (mixed paper/electronic) simulated current practice: reconcile medication discrepancies between a paper plan of care

(CMS 485) returned form home health and a simulated electronic health record. For the second block of cases (medication

reconciliation module) participants used the electronic only medication reconciliation module that was integrated into the

simulated electronic health record. The order of the cases was randomized for each participant within these blocks Repeated

measures ANOVA was used to test our hypotheses that the medication reconciliation module would improve accuracy of

reconciliation, and decrease time to complete cases. Provider satisfaction was evaluated using a composite scale derived from

a post experiment questionnaire. Participants also provided qualitative feedback regarding the design and functionality of

the electronic tool.

Results: Participants left more discrepancies unaddressed in the mixed paper/electronic than when using the electronic

only medication reconciliation module (1.5 vs. 0.45, F=21.9, p<0.0001), supporting our hypothesis that the electronic

tool would improve reconciliation accuracy. However, individuals took the same amount of time to complete cases in each

condition (258.7 vs. 260.4 seconds, F=0.01, P=0.92),this was contrary to our hypothesis that the electronic system would

decrease time to complete cases. Based on participants’ verbal feedback, we hypothesize that by providing assistance with

the mechanics of reconciliation, the electronic only medication reconciliation module afforded participants ‘found time’ to

forage in the record for information related to the appropriateness of medications. This post-hoc hypothesis was supported

by examining the number of times participants switched between tabs in the mixed paper/electronic vs. electronic only

medication reconciliation module conditions in the simulated EHR (7.2 vs. 15.3, F=12.4, P<0.0001). Finally the hypothesis

that the medication reconciliation module would increase provider’s satisfaction was supported by a mean score of 6.4/7

on the composite satisfaction scale and by the fact that 17/19 participants expressed a preference for the electronic only

medication reconciliation module over the current mixed paper/electronic process.

Conclusion:We present an evaluation of an electronic medication reconciliation module integrated into the EHR. The system

improved the accuracy and providers’ satisfaction with medication reconciliation in home health plans of care. Further work,

particularly in addressing our unexpected finding of increased searching of the EHR when using the medication reconciliation

module, will b e discussed.

1

IDEAS 2.0 Center George E Whalen VA Medical Center, Salt Lake City, UT

2

Division of Epidemiology, University of Utah, Salt lake City, UT

3

Scientific Computing Institute, University of Utah

4

College of Social Work, University of Utah

5

James J Peters Bronx VA Medical Center GRECC, Bronx, NY

6

Hartford Institute for Geriatric Nursing at the NYU College of Nursing, New York, NY

7

Salt Lake VA Geriatrics Research Education and Clinical Center

8

Department of Medicine, University of Utah

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