When every patient requires medication reconciliation at hospital admission and discharge, and it’s been a quality measure of The Joint Commission for nearly 20 years, why is the medication history in your electronic health record (EHR) still full of so many holes? And why is med rec still a “med wreck?”

Some key factors contribute to this broken process. The first is incomplete data. I recall the early days of EHRs, when there was no interoperability of data outside the four walls of my organization. I was in my residency when clinicians gained access to the “external Rx history,” which was a watershed moment in digital care that finally provided some data around the patients’ prescription fills.

Unfortunately, I soon learned that this data is never complete. The standard external data feed pulls prescription information into the EHR from payers’ pharmacy benefit managers (PBMs), financial transactions, and pharmacies. Today, there are still pharmacies or PBMs that aren’t connected to the standard feed. On top of that, financial transaction data for prescriptions almost always lacks instructions, also known as “sigs,” on how the patient is supposed to take the medication. This means the data feed is missing entire prescriptions and often lacks visibility into how the medication was intended to be used.

The second factor is incoming data that uses terminology that’s different from the nomenclature your EHR uses. This causes information to arrive in a free-text block rather than structured in discrete fields, which prevents its immediate use for tasks such as triggering critical safety alerts like potential drug interactions. Read more >