Health systems turn to inventive methods to document OTCs in the EHR

Abstract

What was once a relatively small selection of OTCs has expanded into more than 80 classes of OTC medications at any given pharmacy. However, this convenience is not without its drawbacks. Discrepancies in hospital OTC documentation can pose a substantial risk to patient safety, such as drug–drug interactions, accidental drug duplication, and unforeseen drug–disease complications. These risks are compounded when hospital providers are not aware of a patient's OTC usage, causing harm that often propagates throughout a patient's hospitalization, even after discharge. In recognition of this growing concern, the National Association of Chain Drug Stores Foundation convened a summit in October 2016 of several industry stakeholders to establish basic guidelines for the advancement of OTC integration into hospital electronic health records (EHRs) through the creation of an OTC medication tracking system—similar to the process utilized for prescription medication tracking through insurance metadata. However, the guidance that resulted from this summit is vague and unconstructive—a far cry from the Joint Commission's National Patient Safety Goals, for instance. It begs the question if progress has been made on any of these goals. In general, there is a common feeling among hospital pharmacists that limited progress has been made on the integration of OTC medications into EHRs, and even less on creating a universal OTC metadata registry. “Electronic health records oftentimes do not even include options for providers to add OTC medications,” said Edgar Peñaloza, PharmD, a clinical pharmacy specialist at Ascension Sacred Heart Bay Medical Center in Panama City, FL. “Since they are not commonly administered during inpatient stays, OTCs may not be entered into an EHR simply because the EHR program itself will not allow the medications to be entered in as a discrete identifier within the system.” Peñaloza went on to explain that if an OTC medication is added to a patient's medication administration record, the system does not recognize it. Oftentimes, it necessitates adding the medication through the EHRs “non-formulary” process. But profiling the medication this way bypasses the EHRs ability to run the medication through interaction programs that can help ensure patient safety. Peñaloza listed examples such as Kratom and cannabidiol-containing agents, which may consist of varying ingredients affecting a patient's response to drug therapy. The ability to have EHRs automatically integrate a patient's OTC history is a complex, multifaceted obstacle, with virtually no obvious solutions. While broadscale industry leadership may have failed to make meaningful progress on tracking OTC medication use within EHR systems, some national health systems, such as the Ascension hospital system, have been attempting to tackle the issue on their own. Ascension, one of the largest private health care systems in the United States has recently piloted a telehealth medication history program within its Texas hospital network to facilitate the accurate recording of all newly admitted patient's medications, whether prescriptions, OTCs, nutraceuticals, or herbal supplements. A review of this pilot program was published by McGinnis and colleagues in the Journal of the American Pharmacists Association in 2019. By using videoconferencing equipment installed on mobile computer carts stationed in the ED, Ascension employed highly trained, pharmacy technicians. These technicians interviewed patients about all of the medications they were taking in order to minimize as many discrepancies as possible when transferring them over to the EHR. According to McGinnis and colleagues, “The motivation for this program was the inconsistent and ineffective use of [hospital] resources to reliably conduct accurate medication histories, demonstrated by the sharp decline in medication history completion rates after removal of the site-based ED technicians and institution of a nurse-driven program.” After Ascension's pilot program was initiated, medication history completion rates continued to improve significantly. An exploratory analysis of this pilot program demonstrated pharmacy technicians were both more accurate and efficient when performing medication histories. Hopefully, as telehealth continues to permeate deeper into the clinical sphere, novel approaches to solving the safety issues of a dubious inpatient OTC medication history will continue to manifest themselves. It may have not been the exact solution hoped for, but it is certainly a step in the right direction.