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Transitions of care, the movement of patients through different settings, are prone to miscommunications, loss of information and preventable adverse events. One possible strategy to address these challenges is the medication reconciliation process.
In this article, we discuss:
- What is medication reconciliation?
- Why is medication reconciliation important?
- Challenges of medication reconciliation
- How can health plans use artificial intelligence to improve the medication reconciliation process?
- The need for a more efficient medication reconciliation process
What is Medication Reconciliation?
According to the Institute of Healthcare Improvement, medication reconciliation is the process of establishing the most accurate list of medications the patient currently takes, comparing that list to the current list in use, and documenting and resolving any discrepancies between the two lists. The goal of the process is to prevent medication errors like omissions, duplication, incorrect doses, or drug interactions.
According to the Joint Commission, medication reconciliation should be done throughout the continuum of care. More specifically, health organizations such as hospitals, ambulatory care centers and assisting living facilities, should reconcile medications at the beginning of each episode of care. Medication reconciliation may also be done in:
● Behavioral health service centers
● Home care
● Nursing care center
● Outpatient surgery centers.
However, medication reconciliation is often difficult to complete throughout the care pathway given the resources required, as well as the challenges of accessing and analyzing the necessary data. Artificial intelligence offers potential solutions to these ongoing obstacles.
This article will discuss why medication reconciliation is an important process for health plans and how artificial intelligence can remove challenges in conducting medication reconciliations.
Why is medication reconciliation important?
Medication reconciliation has long been identified as a strategy to increase patient safety and has been part of the Joint Commission National Patient Safety Goals since 2005. A review published in Drug Safety Journal estimated that about half of adult patients discharged from the hospital experienced medication errors or unintentional medication discrepancies. Because of these errors, patients may experience adverse drug reactions and adverse drug events such as preventable readmissions.
Medication reconciliation can reduce readmissions
Research has shown that medication reconciliation reduces hospital readmissions. In a study published in the Journal of American Pharmacist, patients who received post-discharge medication reconciliation were significantly less likely to go back to the hospital after 14 days. The lower readmission rate saved the health organization $35,000 per 100 patients, which translated to over $1,500,000 of annual savings.
In a different study looking at inappropriate prescribing, the authors found that healthcare providers who were required to complete discharge medication reconciliation were less likely to prescribe potentially inappropriate medications. As a result, patients who received medication reconciliation were less likely to experience drug-related readmission within 90 days.
Medication reconciliation can improve adherence
In addition to decreasing hospital readmissions, medication reconciliation also enables clinicians to discuss medication adherence with their patients and remove barriers when needed. For instance, a pharmacist reviewing a patient medication list can determine when the patient last refilled their medication, if they fully understand how to take it, and address any medication adherence problem.
Medication reconciliation affects quality ratings
Besides potentially reducing healthcare costs through lower readmission rates and better medication adherence, medication reconciliation is also crucial for health plans because it’s linked to the Healthcare Effectiveness Data and Information Set (HEDIS) and the Center for Medicare and Medicaid Services (CMS) Star rating systems.
Medication reconciliation post-discharge (MRP), which is the percentage of discharged plan members whose medications are reconciled within 30-days of an inpatient setting (or hospital) discharge , is part of the transition of care HEDIS measure. CMS also requires health plans to report this measure and use it for their Medicare Part C star rating program.
Challenges of medication reconciliation
The concept of medication reconciliation seems like a simple one, documenting the patient’s current medications and comparing them to the medication prescribed in the hospital or at the skilled nursing facility. Yet, healthcare organizations encounter multiple challenges in implementing the process.
Conducting medication reconciliations can be extremely labor-intensive and require time, in some cases taking over half an hour to complete per patient. It requires a high level of collaboration between a team of diverse trained clinical staff, including nurses, physicians, and pharmacists from different settings. It can be especially challenging when reconciling medication lists for people with multiple comorbidities, who see multiple specialists and have polypharmacy.
Although electronic health records (EHR) have allowed health organizations to have more access to the patient medication history, they sometimes only show part of the big picture. Most of the time, supplements, over-the-counter medications or medications that the patients may have obtained directly from his provider’s office don’t appear in EHRs.
Some EHR systems can’t retrieve prescription claim information when patients have a hyphenated name or more than one last name. Most EHRs systems are not interoperable between different facilities, which means data can’t crossover and clinicians only have access to data in the current care setting.
Medication reconciliation processes are error-prone
To complement EHRs that may not give the complete medication history, healthcare organizations rely on patients' and caregivers' memories to conduct admission medication reconciliation. Unfortunately, this can lead to additional mistakes.
Transitions of care, like patient admissions or discharges, are usually times when patients may feel overwhelmed and not in a state to recall all their medications. Ideally, they may have their current medications boxes with them or carry an updated medication list; but it’s not always the case.
Plus, when one medication reconciliation contains mistakes, those mistakes are likely to follow the patient in their following healthcare encounters.
Finally, because there’s no standard on how to do medication reconciliation, different people may obtain different medication information from patients, which can also result in incomplete or incorrect medication reconciliation.
How can health plans use artificial intelligence to improve the medication reconciliation process?
Use predictive analytics to identify patients most likely to benefit from a medication reconciliation
Instead of manually going through patient data to identify patients recently discharged from a hospital, health plans can utilize artificial intelligence to generate appropriate reports.
They can then use predictive analytics to identify patients more at risk for readmission, like elderly patients, or patients taking certain high-risk medications.
A powerful example of the impact of AI-driven medication reconciliation is Joe, an elderly male who had a recent history of multiple hospital visits for heart failure, chronic obstructive pulmonary disease, and chest pain. Joe had significant mobility barriers and couldn’t see his primary care physician nor pick up his medications regularly. Using Arine’s predictive analytics, Joe’s health plan identified him at risk of disease progression and implemented a timely intervention that included a detailed medication reconciliation. As a result, his heart failure medications were optimized, his prescriptions were transferred to a pharmacy offering free delivery and Joe was connected to a transportation service to facilitate his doctor’s appointments. Subsequently, Joe didn’t experience any readmissions post-intervention and was able to save over $4000 in 3 months.
Use automation to integrate data from different sources
Health organizations can use artificial intelligence to pull relevant medication histories from different sources, such as hospitalization medical records and prescription claims, and then translate them into accurate and complete medication lists.
AI can then automate the transfer of this information into EHRs and consequently lower the amount of time spent on each medication reconciliation as well as reduce the number of incomplete or wrong medication histories.
Use machine learning to quickly implement meaningful interventions
During medication reconciliation, machine learning can help clinicians by automatically identifying medication-related problems, including duplication, omissions, inappropriate drug prescribing, or medication non-adherence.
An AI-powered platform can also provide clinical decision support and assist clinicians in resolving these medication-related problems. For instance, Arine’s medication intelligence not only generates prioritized recommendations for each patient based on their unique profile, but it can also prompt personalized questions based on patients’ diagnoses and medication histories to assist pharmacists in helping identify gaps in care, resolve associated issues and remove barriers for patients.
The need for a more efficient process
Medication reconciliation is an important but labor-intensive tool to improve patient safety. Many challenges are associated with the execution of this process, from how to effectively incorporate it in the workflow to the possibility of mistakes.
By leveraging artificial intelligence platforms, health plans can more easily integrate medical reconciliation throughout the care journey at key care transition points (e.g. at discharge or beginning of each new care episode), ensure that broad sets of data are integrated to provide a more comprehensive view of a patient’s medication regimen, and ensure that accurate information is clearly communicated to care team members and patients.
By integrating artificial intelligence in their medication reconciliation processes, health plans can improve the effectiveness and efficiency of the process while potentially reducing its cost.