title: Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting.
abstract: BACKGROUND
  Discrepancies in medication documentation most often occur at handoffs or transition points in care. A process improvement team at the Portland Department of Veterans Affairs developed a standardized medication reconciliation process for the Portland chemotherapy administration unit, a physically self-contained clinic with a standard intake process and a uniform patient traffic pattern.
  
  
  METHODS
  The team developed the automated patient history intake device (APHID), a reconciliation software program accessed by the patient using a computer terminal kiosk in the clinic lobby. The program simultaneously checks in patients for an appointment and gathers a medication-adherence history by retrieving medication lists from all Veterans Affairs facilities and pairing each medication with a pill picture. Installation of the APHID kiosk included an initial two-week roll-in period beginning in February 2008.
  
  
  RESULTS
  During the roll-in period, 91 (82.0%) of 111 patients completed check-in and performed medication reconciliation using the kiosk. Medication lists gathered at the kiosk were compared with existing health record documentation and clinician interviews. For each patient encounter, the process demonstrated an average of 4.59 discrepancies and an average of 1.61 clinically significant or potentially lethal discrepancies. The new process saved approximately 0.24 full-time equivalents of nursing time in the chemotherapy clinic-a nearly 50% reduction in nursing time dedicated to reconciliation activities without an apparent loss in data accuracy.
  
  
  CONCLUSIONS
  A patient-centered reconciliation model using consumer-based kiosk technology helped providers efficiently retrieve a comprehensive list of medications across a geographically diverse area and improve patient medication recall using visual cues including medication pictures.
authors.affiliation: Clinical Applications/Medicine Service, Portland Department of Veterans Affairs, Portland, OR, USA. Blake.Lesselroth@va.gov
authors.forename: Blake
authors.initials: B
authors.lastname: Lesselroth
authors.forename: Shawn
authors.initials: S
authors.lastname: Adams
authors.forename: Robert
authors.initials: R
authors.lastname: Felder
authors.forename: David A
authors.initials: DA
authors.lastname: Dorr
authors.forename: Phillip
authors.initials: P
authors.lastname: Cauthers
authors.forename: Victoria
authors.initials: V
authors.lastname: Church
authors.forename: David
authors.initials: D
authors.lastname: Douglas
mesh_terms: D003625:Data Collection; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D004059:Diffusion of Innovation; D004344:Drug Incompatibility; D006784:Hospitals, Teaching; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control*; D008511:Medicine; D009922:Oregon; D019982:Organizational Case Studies; D010358:Patient Participation; D017751:Safety Management / Q000379:methods*; D013038:Specialization; D014584:User-Computer Interface