Secure Messaging for Medication Reconciliation Tool (SMMRT): A “smart” approach to post-discharge medication reviews

Objectives:  Medications frequently change during a hospital stay and are a key component of discharge plans. At home, patients may be nonadherent, confused about medicines, or experience drug-related problems. Adverse drug events (ADE) are among the most common healthcare-associated adverse events and often occur following a hospitalization. Additionally, lag time prior to primary care follow-up leaves patients vulnerable after discharge. The objective of this study is to design and pilot pharmacist-facilitated medication reconciliation via secure messaging in the post-hospital discharge period.

Methods: Following revision and refinement of a Secure Messaging for Medication Reconciliation Tool (SMMRT) prototype, a pilot study will enroll 50 patients hospitalized at VA Boston. Patients will be recruited prior to hospital discharge, enrolled in the VA’s secure personal health record and web portal, and trained in the use of SMMRT. A pharmacist will contact patients via secure message within 48 hours of discharge. Message content will include the discharge medication list and photos (e.g., tablets, inhalers) to promote interactive, two-way communication to review and reconcile the medication list. Pharmacists will address medication problems and discrepancies and will communicate directly with primary care providers. 

Results:  Primary outcomes include qualitative assessments describing demographics of SMMRT users, details of their medical history and medication regimen (i.e., number of discharge medications, medication changes), and patient perceptions of the tool. Secondary outcomes include a comprehensive understanding of medication discrepancies, patient reported adherence, and drug-related problems (e.g., drug interactions, adverse drug events).  

Conclusion: Pharmacist-facilitated medication reconciliation by secure messaging is a novel approach to improving medication safety among post-discharge patients. We anticipate this pilot study will highlight the implementation challenges of electronic medication reconciliation in preparation for large-scale SMMRT trial. Clinical pharmacists can triage, address or relay medication issues, which may reduce ADEs and healthcare utilization.