1079 — Availability and Impact of Non-VA Medication Information in a Regional Health Information Exchange Tool

Boockvar KS, James J Peters VAMC, Bronx, NY; Ho W, James J Peters VAMC, Bronx, NY; Hung WW, James J Peters VAMC, Bronx, NY; Nebeker J, VA Salt Lake City Health Care System;

Objectives:
VA providers' access to non-VA information through electronic health information exchange (HIE) is increasing. The objective of this study was to describe non-VA medication information available in a regional HIE and estimate its potential impact on veteran care.

Methods:
Veterans admitted to 4 units at JJP VAMC who had an identity match in the Bronx Regional Health Information Organization (RHIO), indicating use of non-VA system care, were assigned by unit to pharmacist medication reconciliation with RHIO access (intervention) or without (control). Medication discrepancies between inpatient and pre-admission medications were counted and categorized by type, potential to cause harm, intentionality, and whether they could have been detected without RHIO access.

Results:
188 intervention and 193 control patients were enrolled. Of intervention patients, 19.8% and 24.2% had non-VA inpatient and outpatient medication data, respectively, available in the RHIO. This frequency increased to 29.4% during a time when a pharmacy benefits company (Surescripts) participated in the RHIO. There were 1.25 and 1.13 discrepancies recorded per intervention and control patient, respectively (p = .44). 31% of discrepancies had potential to harm (no group difference). More discrepancies with potential to harm were unintentional in intervention than control patients (65% vs. 50%; p = .06). 13% of discrepancies in intervention patients were rated as detectable solely as a result of RHIO access during Surescripts participation, as opposed 2% at other times (p = 0.007). Overall, there were 13 discrepancies detected solely as a result of RHIO access in the intervention group, of which 7 had potential to harm, extrapolating to 6.9 preventable discrepancies and 3.7 opportunities to prevent harm per 100 patients.

Implications:
A minority of VA admissions with known non-VA service use had non-VA medication information in a regional HIE. Although the number of discrepancies recorded was not different between medication reconciliation with HIE (intervention) and control, some discrepancies with potential to harm were preventable only because of HIE access.

Impacts:
HIE has the potential to improve medication reconciliation for veterans who receive VA and non-VA care and to prevent adverse drug events. However, complete non-VA medication information may not be present in HIEs. VA providers should still consult multiple sources of medication information and take a thorough non-VA medication history from all patients.