J Am Med Inform Assoc 18:309-313 doi:10.1136/amiajnl-2010-000040
  • Brief communication

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge

  1. David W Bates2,3,9
  1. 1Brigham and Women's Hospital Hospitalist Service, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Geriatric Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, USA
  7. 7Partners Information Systems Clinical Informatics Research and Development, Wellesley, Massachusetts, USA
  8. 8Division of Endocrinology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  9. 9Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Jeffrey L Schnipper, Division of General Medicine, Brigham and Women's Hospital, 1620 Tremont Street, BC3-2Y, Boston, MA 02120-1613, USA; jschnipper{at}
  • Received 22 October 2010
  • Accepted 20 February 2011


Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30 days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.


  • Funding This study was supported by a grant from the Agency for Healthcare Research and Quality (1 U18 HS016970-01). JLS was supported by a mentored career development award from the National Heart Lung and Blood Institute (1 K08 HL072806-01).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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