How Electronic Medical Records Create Dangerous Gaps in Medication Accuracy
Electronic medical records were supposed to solve a simple problem: Keep important clinical information accurate, current, and accessible.
And in many ways, they succeeded.
But when it comes to one of the most critical data sets in medicine, the medication list, the system breaks down. Even though medical professionals try to maintain it and patients voice their concerns, the workflow itself makes accuracy nearly impossible to sustain.
Here’s a behind-the-scenes explanation of why something so essential is so often wrong.
Medications are entered into the EMR by medical professionals when ordered in a hospital or when sent to an outpatient pharmacy. They are also entered into the EMR to update the med list, including over-the-counter meds and supplements.
The patient’s electronic chart is updated during in-person visits, telemedicine sessions, and often after important phone calls or other correspondence… yep, the fax machine is still alive and well in the medical world.
The other way the med list is updated is when an external consult note is received or a hospitalization has occurred outside of the usual system.
When a physician or other medical professional does pre-charting (starts their electronic note template before the patient arrives) the med list is pulled into their note. When the patient arrives and is roomed, the medical assistant or nurse reviews and “updates” the med list, but it isn’t pulled into the electronic note for that visit because the note was already started.
Dumb, I know.
The patient painstakingly itemizes their meds ahead of time by completing portal forms (a waste of time, since nobody reads them), by going over them verbally with the medical assistant, and by mentioning them to their physician. But at the conclusion of the visit, the visit note usually still has the outdated, incorrect med list.
If this note is forwarded to others, the med list errors are perpetuated.
Rinse and repeat at the next visit.
Add in the outside medical center wild card (same city, different city, or even out of state), and the “reconciled” medications pulled into the current med list can even include meds that were discontinued years ago.
Not to mention frequent errors due to pharmacy swaps, formulary substitutions, and med changes due to cost or patient preference that only further add to med list inaccuracies.
When the most accurate medication list lives on a piece of paper in a patient’s wallet, the system, not the patient, has failed.
And, until accuracy is rewarded as much as documentation, the medication list will remain a suggestion, not a source of truth.
: : :
Her book, The Menopause Menu, is an all-in-one giftbook, medical guide and recipe book for navigating menopause.
Join her talk show, Voices With Vigor, which is free, live & virtual. Topics are health-adjacent, and three fantastic guests are profiled each month.