Arar NH et al. 2005 "Communicating about medications during primary care outpatient visits: the role of electronic medical records."

Arar NH, Wen L, McGrath J, et al. Communicating about medications during primary care outpatient visits: the role of electronic medical records. Inform Prim Care 2005;13(1):13-21.
"OBJECTIVES: To assess the role of electronic medical records (EMR) in facilitating the content and process of patient-provider exchanges about medications during outpatient primary care visits. METHODS: Fifty encounters with six physicians using the EMR were videotaped, transcribed and content-analyzed by applying conversation analysis and ethnomethodology techniques. The analysis focused on three aspects of medication communication: (1) process of care: practices by patients and physicians to implement medication decisions; (2) themes: medication topics that consistently emerge; and (3) names: ways patients and physicians refer to medications. In-depth analysis of 20 encounters examined the extent to which either or both parties initiated, expanded and concluded medication discussions. RESULTS: On average 21.2 (range: 8-35; SD=7.4) distinct exchanges per encounter were observed. Of those, 33% were related to medication. Of the 350 medication-related exchanges throughout the encounters, 56% were categorised as routine medication discussion such as ordering and/or refilling medications. Mailing issues were the next most common medication-related exchanges (10.6%), followed by partial adherence (8.9%), self-regulation (7.4%), alternative therapy/over-the-counter medication (6.6%), side effects (6%) and formulary issues (4.6%). Patients and providers used three ways to name medications: generic/scientific name (42%); physical description (39.7%) and brand name (18.3%). Forty-one percent of exchanges included initiation by one or both parties but no further discussion of the issue; 42% included initiation and expansion by both parties but not conclusion; only 17% of exchanges contained complete medication exchanges (initiation, expansion and conclusion) by both parties. CONCLUSIONS: EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, fewer than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens."
To describe the effect of prescription data availability via an EMR on the content of patient-physician communication regarding medications.
Tools Used
Type Clinic
Primary care
Type Specific
Internal medicine
Other Information
The study was conducted at Audie L Murphy Memorial Veterans Hospital in San Antonio, Texas.
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
The EMR, "[p]ulls data from scheduling, laboratory, radiology, consults and clinic notes into a single integrated patient record...The pharmacy package allows the provider to enter new prescriptions, refill existing prescriptions, and check on the frequency and timing of patient refill requests; it also prompts when a patient has a potential drug allergy and for potential drug-drug interactions." "The medications screen of [the EMR] shows the patient's active, discontinued, suspended and expired medications within the [Veterans Administration] VA system. It also includes information on dosage, prescribing physician, date prescribed, date of last refill, refill expiration date and number of remaining refills for each medication."
Workflow-Related Findings
"The EMR improves the continuity of care by enhancing coordination between primary care physicians and specialists. It provides a method of communication between different providers by compiling comprehensive lists of medications, labs and consults. In Example 2, the primary care physician was easily able to access reports from the patient's allergist and provide necessary refills."
"In Example 3, another physician had prescribed an immune suppressant medication, but the patient did not bring the medication to the encounter and could not remember its name. The EMR enabled the physician to quickly verify the correct medication, dosage and prescribing physician."
"The majority of patients (44, 88%) did not have their medications with them and used general descriptions of their medication. In such cases physicians used the patient's EMR to obtain accurate information."
"In Example 7, the physician detects a potential problem with medication adherence. The physician notices that, according to the EMR, the patient has not been refilling medications although the patient claims he/she is receiving medications through the mail. By having easy access to refill information (number of remaining refills and date of last refill), physicians can check medication adherence."
"The patient's response to the question about benadryl led to a medication renewal and a discussion of another medication, baclofen. In this case, the EMR allowed for immediate renewal of a prescription and access to information regarding other active medications."
"Using the EMR, the doctor was able to prescribe the necessary medications to ensure they were available when the patient needed them. While the physician was entering prescriptions into the EMR, the patient asked about pharmacy procedures. In most cases, pharmacy procedures were discussed in conjunction with entering prescriptions."
"In this example the doctor is able to use the computer to identify the mailing problem without the patient or doctor needing to directly contact the pharmacy."
"Despite the increased number of questions and responses [with EMR usage], our study found that neither patients nor providers presented any clear conclusions regarding plans for improving adherence"
"EMR use was significantly associated with polypharmacy: the amount of time spent interacting with the EMR increased with the number of medications prescribed (r=0.534; P=0.000)."
In one example, a patient's caregiver "had a tendency to forget which medications the patient was to take. The doctor was able to assist by providing the care-giver with a printed medication list retrieved from the EMR. This list included medications prescribed by this doctor as well as other doctors within the VA system."
"Direct observations and content analysis of the videotaped encounters showed that EMR use facilitated patient-physician communication regarding medication process of care by allowing physicians easy access to checking active and inactive prescriptions and entering patients' new prescriptions and refills."
Study Design
Only postintervention (no control group)
Study Participants
Fifty patients were videotaped during their encounters with six staff physicians.