Link between prescriptions and the electronic health record

Scott D. Nelson, Taylor Woodroof, Christoph U. Lehmann, Wing Liu

Research output: Contribution to journalArticle

Abstract

Purpose. The extent to which medication prescriptions had a reason for the medication use documented in form of a potential indication within the electronic health record (EHR) problem lists using a MEDication Indication (MEDI) resource was evaluated. Methods. Prescriptions from January 1 to June 30, 2015, comparing them to patients’ problem lists using MEDI and the MEDI High Precision Subset (MEDI-HPS) were analyzed. RxNorm generic ingredient name codes in MEDI were used to map prescriptions to problems using codes from the International Classification of Diseases, 9th edition. A reference standard was established to evaluate the MEDI precision and recall by having 2 pharmacists independently manually review prescriptions and problem lists from 30 randomly selected patients. Results. For 62,191 patients, 61% of prescriptions matched a potential indication on the patient’s problem list using MEDI, whereas only 38% had a match using MEDI-HPS. The precision of MEDI compared to the reference standard was 47% with a recall of 57%, whereas MEDI-HPS had a precision of 79% and recall of 96%. Secondary analysis excluding medication prescribed with a supply of ≤14 days gave slightly better, yet not significant, results. Conclusion. Analysis of patient records found most patients did not have an indication listed in the EHR problem list that would match a specific medication, suggesting that the problem lists may be incomplete. When using MEDI, 61% of prescriptions matched to the problem list, compared with only 38% using MEDI-HPS. Likewise, 37% of problems matched to prescriptions when using MEDI, compared with only 21% using MEDI-HPS.

Original languageEnglish (US)
Pages (from-to)S29-S34
JournalAmerican Journal of Health-System Pharmacy
Volume75
Issue number11
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Keywords

  • Clinical decision support
  • Electronic health records
  • Medical records
  • Medication reconciliation
  • Problem oriented

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

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