Improving Lab Follow-up by Delivering an Enhanced Medication List to Outpatient Physician Practices

The goal of this project was to design, develop, and evaluate a method of providing medication data from the Indiana Network for Patient Care (INPC) to ambulatory primary care practices in order to enhance health care quality and safety. The project team at Indiana University and the Regenstrief Institute developed the Enhanced Medication History (EMH), a medication history based on pharmacy dispensing records from three sources: RxHub commercial pharmacy benefit managers, Medicaid, and the Wishard County health services outpatient pharmacy. The EMH is supplemented by laboratory data from INPC and includes clinical decision support reminders specifically related to the patient on drug-drug interactions, drug-lab interactions, and drugs to be avoided in the elderly. The main objectives of the project were to:

• Aggregate medication histories from multiple sources into a single document.
• Add decision support rules to medication history documents in selected areas, such as inadequate lab monitoring, drugs with abnormal labs, or drugs to avoid in the elderly.
• Deliver enhanced medication history documents to clinics.
• Examine instances of decision support rule use.
• Examine quality and safety improvements.

The project team evaluated the EMH in a randomized controlled trial, examining its impact on patient quality and safety indicators compared to usual care, as well as provider satisfaction with the EMH. Over a 46 week time period, the EMHs were successfully delivered to health care providers at two sites of a community health organization for 4,449 patients. Although analysis did not detect any significant difference between intervention and control patients on the safety and quality measures, providers found the medication histories useful, especially when the provider did not know what the patient was taking. Nine physicians were surveyed and reported the usefulness of medication histories; however, there was less agreement on the completeness of the histories. Physicians strongly agreed that medication histories helped discover drugs which were previously unknown and helped identify overuse of controlled substances. The entire process, triggered automatically by registering a patient, required less than 2 minutes from the initial arrival of the patient to the final delivery of the printed report. The printed documents were easily integrated into the paper-based process of assembling a clinic chart.