One of the most bedeviling arenas for improvement in hospital care is called "medication reconciliation." As I have noted below, part of this standard means that we are supposed to discuss with all patients the medications they are taking before entering the hospital, and review their medications again upon discharge.
Here's part of problem. Many people do not know or do not remember what medicines that are taking, so a doctor who asks these questions while doing the patient's medical history will not get accurate information.
One way to work through this problem would be if we could get access to the records of pharmacies and get the list of medicines that have been prescribed and dispensed to patients.
The good news here in Massachusetts is that we are the #1 user of e-prescribing. Under this system, when you need a medication, the doctor sends the order electronically to your pharmacy of choice, and you pick it up there. No more scripts, no more handwriting.
The program involved lots of folks, with support from Blue Cross Blue Shield of MA, Harvard Pilgrim Health Care, and Tufts Health Plan, and is done in cooperation with Surescripts, an organization founded by the pharmacy industry in 2001.
BIDMC is one of the first hospitals in the country to use this advanced technology. We've been live with Surescripts routing on our web-based online medical record system since last year. Now, the plan is to use the capability in reverse -- to be able to query the Surescripts system and other stakeholders with pharmacy databases (e.g., Rxhub, which connects mail order pharmacies). So, when you showed up for surgery or another visit, we would be able to download a list of your current medications from the database of pharmacies. Even if you lived in Nevada and showed up at our emergency room in Boston, we would have access to this national database and make sure we were not giving you a medication that interacted badly with one you are taking.
We are hoping to go live with this by September 15 and, of course, will share our experience with all others in the region and beyond.
This approach does not solve all the issues around medication reconciliation, but it is an example of where the creative use of information technology can help enhance patient safety.
