Adverse drug events (ADE) are the most common of all healthcare-associated adverse events1 and commonly occur after hospitalization when multiple changes to medication regimens take place in the context of poor patient education, inadequate information transfer and delayed continuity of care. Medication reconciliation - i.e., any intentional process to resolve discrepancies between what medications the patient is taking and what medications the health care team thinks the patient is taking - has been designated a "National Patient Safety Goal" since 2005.2-6 Recent studies examining inpatient computerized medication reconciliation tools and pharmacist-facilitated medication reconciliation programs at hospital discharge have shown promising results. However, little is known about successful medication reconciliation strategies following discharge, representing an untapped point of leverage to improve medication safety.
With recently awarded seed funding, and in collaboration with the Department of Veterans' Affairs (VA) nationwide Medication Reconciliation Initiative, we are developing an informatics-based tool for medication reconciliation following hospital discharge by secure, e-mail-like communication: the Secure Messaging for Medication Reconciliation Tool (SMMRT). In this proposed study, we plan to pilot the SMMRT prototype through My HealtheVet (MHV), the VA's secure personal health record and web portal, among 50 Veterans at VA Boston, with the following two Specific Aims:
Specific Aim 1: Refine the existing SMMRT prototype and integrate it into MHV's secure messaging web-interface, with authentication of secure two-way communication between patient and primary healthcare team. We will use a participatory and patient-centered process involving the primary care clinicians, pharmacists, nurses, other staff members and Veterans working collaboratively with the research team to establish the usability and acceptability of the prototype SMMRT.
Specific Aim 2: Pilot the SMMRT prototype, refined through Specific Aim 1, among 50 Veterans with primary care relationships and hospitalized at our facility. Veterans will be recruited prior to hospital discharge, enrolled in MHV if necessary, and trained in the use of secure messaging and specifically the SMMRT tool.
This study will benefit from a recently funded preliminary study (Veterans' Engineering Resource Center seed funding, $25,000), in enabling us to analyze the primary care environment's receptivity to SMMRT-based post-discharge medication reconciliation, focusing on staff activation and education, workflow optimization to incorporate staff and clinicians managing SMMRT's incoming and outgoing messages, and coordination with MHV staff to ensure continued successful software integration.
This proposed CIMIT-funded study will lead to a refined and strengthened intervention to enhance the preliminary use of SMMRT, as well as qualitative results that will constitute the foundation of an investigator-initiated research proposal alongside a full-scale implementation of SMMRT into MHV for Veterans nationwide.
