title: Primary care provider perceptions and use of a novel medication reconciliation technology.
abstract: BACKGROUND
  Although medication reconciliation (MR) can reduce medication discrepancies, it is challenging to operationalise. Consequently, we developed a health information technology (HIT) to collect a patient medication history and make it available to the primary care (PC)  provider. We deployed a self-service kiosk in a PC clinic that permits patients to indicate a medication adherence history. Patient responses are immediately viewable in the legacy electronic health record. This paper describes a survey developed to assess PC provider perceptions of our HIT  and HIT implementation effectiveness.
  
  
  METHODS
  We developed and administered a survey to all PC providers to assess technology implementation effectiveness. The survey included scales measuring (1) user attitudes towards MR, (2) perceptions of our HIT and (3) the local organisational  climate for implementation. We also assessed the consistency and quality of tool use.
  
  
  RESULTS
  Nearly 90% of PC providers responded to the survey and 58% indicated that they were familiar with the technology and had seen the tool output. Most providers believed that MR represented  an important safety intervention, although 43% did not believe that they had the necessary resources to manage discrepancies. Composite scale scores for the 58% of respondents familiar with the HIT indicate that the majority favoured our tool over usual care. However, composite scale scores  suggest that the climate for implementation at our facility was suboptimal. Overall, the quality and consistency of tool use among providers was very heterogeneous.
  
  
  CONCLUSIONS
  A patient self-service kiosk offers an efficient mechanism to collect a medication adherence history;  provider survey responses indicate that they appreciated and used the MR kiosk output. Nonetheless, opportunities exist to improve data displays and embed decision support to facilitate discrepancy management.
authors.affiliation: Portland Informatics Center and Hospital and Specialty Medicine Division, Portland Oregon Veterans Affairs Medical Center, Portland, OR 97239, USA. blake.lesslroth@va.gov
authors.forename: Blake J
authors.initials: BJ
authors.lastname: Lesselroth
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Holahan
authors.forename: Kathleen
authors.initials: K
authors.lastname: Adams
authors.forename: Zhen Z
authors.initials: ZZ
authors.lastname: Sullivan
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Church
authors.forename: Susan
authors.initials: S
authors.lastname: Woods
authors.forename: Robert
authors.initials: R
authors.lastname: Felder
authors.forename: Shawn
authors.initials: S
authors.lastname: Adams
authors.forename: David A
authors.initials: DA
authors.lastname: Dorr
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007256:Information Systems / Q000458:organization & administration*; D008297:Male; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D009922:Oregon; D010349:Patient Compliance; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D014584:User-Computer Interface