When patients review Rx in EHR, accuracy & engagement improve

A pilot program that allowed patients to provide feedback on medications listed in their EHR found 89 percent of respondents requested changes. These patients were also more than twice as likely to use the health system outpatient portal compared to average patients, researchers found.

In chronic conditions, such as heart failure and hypertension, a complex pharmacopeia requires patients, physicians and pharmacists to work together to keep medications balanced and avoid negative interactions. With more than 55.1 million Americans living with hypertension and more than 22.5 million with heart disease, enabling patient involvement in healthcare is vital to reducing errors and improving communication and efficiency.

Patients who were more involved in updating medications also sought more frequent clinician contact through secure electronic messaging via the same outpatient portal, found lead author Prashila Dullabh, MD, of the National Opinion Research Center at the University of Chicago, and colleagues. Electronic communication between patients and providers among active portal users who updated medication lists occurred 1.35 times more frequently than patients who declined the pilot.

Geisinger Health Systems unrolled the medication feedback pilot in 2011 as an approach to improve patient engagement with its EHR. The pilot encompassed patients from two primary care clinic sites out of the 10 in-network.

As part of the pilot, patients were invited to review and update the list of current medications in their EHR. Medications may have included prescriptions, both current and prior, and over-the-counter medications and vitamins. Patients were also asked if frequency and dosage had changed. Eligible patients had chronic diseases such as hypertension, heart failure, chronic obstructive pulmonary disorder, asthma or diabetes and had previously used the MyGeisinger outpatient portal for appointment scheduling, prescription ordering, secure clinician messaging and lab result checks.

Utilizing a mixed method approach, Dullabh et al reviewed the outcomes of the Geisinger pilot to determine qualitatively and quantitatively how record accuracy, efficiency and patient engagement improved.

Physicians, pharmacists and patients alike responded well, the research team wrote. When pharmacists were able to contact patients, 68 percent of changes were accepted. Even when pharmacists were unable to contact patients, 51 percent of changes were accepted. Patients found they were able to reduce some office visit frequency, as related to updating medications. Physicians found the electronic medication form process improved office efficiency, allowing them to tackle patient health issues directly rather than spending office visits discussing medications.

Requests were made for further opportunities for patient input into the EHR, including updates on allergies, immunizations, condition-specific tools and problem lists. Several of these requests were in process at the time of publication and Geisinger expanded the pilot to include all 10 sites.

Dullabh et al noted that useful data could arise from future study utilizing a control arm methods, allowing comparison of accuracy and impact on efficiency of communication between patient and provider.

These findings were published online in October in eGEMs (Generating Evidence & Methods to improve patient outcomes).