title: Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge.
abstract: Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30&emsp14;days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.
authors.affiliation: Brigham and Women's Hospital Hospitalist Service, Brigham and Women's Hospital, Boston, Massachusetts, USA. jschnipper@partners.org
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Liang
authors.forename: Claus
authors.initials: C
authors.lastname: Hamann
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Karson
authors.forename: Matvey B
authors.initials: MB
authors.lastname: Palchuk
authors.forename: Patricia C
authors.initials: PC
authors.lastname: McCarthy
authors.forename: Melanie
authors.initials: M
authors.lastname: Sherlock
authors.forename: Alexander
authors.initials: A
authors.lastname: Turchin
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000555:Ambulatory Care Information Systems; D003266:Continuity of Patient Care; D057286:Electronic Health Records; D006284:Health Plan Implementation; D006801:Humans; D059065:Medication Reconciliation; D010351:Patient Discharge; D014481:United States; D014584:User-Computer Interface