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Appl Clin Inform 2024; 15(02): 230-233
DOI: 10.1055/a-2181-1847
Invited Editorial

From MedWreck to MedRec: A Call to Action to Improve Medication Reconciliation

Nitu Kashyap
1   Internal Medicine, Emory Healthcare, Emory University school of Medicine, Atlanta, Georgia, United States
,
Sean Jeffery
2   University of Connecticut School of Pharmacy, Storrs, Connecticut, United States
,
Thomas Agresta
3   Family Medicine, Center for Quantitative Medicine, University of Connecticut School of Medicine, Storrs, Connecticut, United States
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In moments that matter, clinicians frequently make treatment decisions based upon incomplete, inaccurate, and outdated medication histories.[1] [2] Poorly reconciled medications often lead to a series of unfortunate events, MedWreck. Medication Reconciliation (MedRec) is a three-step process of (1) verification, (2) clarification, and (3) reconciliation.[3] Performing MedRec is generally a manual, time-consuming collection, and review of medication lists across prescribers, patients, and systems. Supply chain challenges e.g., recent drug shortages and resultant unanticipated drug substitutions have worsened this situation. There are, however, far more opportunities for reconciling medications in routine ambulatory care between primary care, specialists, ambulatory procedures, and retail pharmacies. Primary care physicians have been tasked as default custodians of a patient's medication list but with increasing complexity and specialization of medication regimens, there is a need to expand reconciling medications at every contact with a clinician.

There is evidence showing the clinical and financial value of effective MedRec.[4] [5] While the reconciliation process requires clinical expertise and often shared decision-making with the patient, technology has the potential to facilitate the verification and clarification steps. However, several critical gaps perpetuate an inefficient, expensive, and often ineffective MedRec such as siloed electronic health records (EHRs), unintegrated prescription dispense data from retail pharmacies, and failure to adopt universal prescription data standards. There is a need for a national, coordinated, strategic effort to widen important ongoing initiatives to improve MedRec.[6] [7]

Concerned about increasing medication use and health care costs, the Connecticut State Legislature formed a Medication Reconciliation and Polypharmacy workgroup. This was a diverse group of 22 experts to evaluate MedRec with a systems-based approach.[8] [Fig. 1] illustrates a diagrammatic view of a MedRec system. The year-long effort resulted in 11 recommendations to improve MedRec consisting of policy changes, promoting interoperability, and adoption of existing standards such as CancelRx.[9] [10] These recommendations were further developed by the subsequent Medication Reconciliation and Polypharmacy Committee into 22 business and 88 functional requirements needed for implementing an electronic Best Possible Medication History (eBPMH) in a real-world setting. This foundational work has led to the development of Connecticut State Health Information Exchange (HIE) eBPMH, which was launched recently.[11] T.A., N.K., and S.J. were involved in leading this process through its lifecycle. Insights gained from this process enhanced our understanding of the substantial challenges in optimizing MedRec.

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Fig. 1 Achieving MedRec requires a holistic approach across the various component systems and interactions between them. Prescribing and dispensing systems provide data inputs, which is processed by an aggregating engine and output includes user facing systems such as electronic health record modules or patient applications. (Reproduced with permission from Agresta et al[9].)

We call upon stakeholders across public and private sectors to collaborate on a national strategic initiative, across 10 key areas to solve MedWreck. Key stakeholders not only include clinicians, pharmacists, nurses, and patients, but also standards bodies, policy makers, EHR and other health IT vendors, pharmaceutical manufacturers, Office of National Coordinator, Interoperability experts, to name a few.



Publication History

Received: 16 May 2023

Accepted: 24 September 2023

Accepted Manuscript online:
25 September 2023

Article published online:
27 March 2024

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