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Claims Data May Be Helpful in Compiling Medication History

Cheryl A. Thompson

As hospitals seek an efficient way to reconcile the medications of newly admitted patients, the usefulness of prescription claims data in constructing medication histories must be viewed in the proper perspective, according to persons familiar with the shortcut.

The data, said physician Steven B. Miller, chief medical officer for Barnes-Jewish Hospital at Washington University Medical Center in St. Louis, "is not a substitute for the medication history."

For one thing, prescription claims data—which include the drug's name and strength, quantity dispensed, and number of days covered by the prescription—may not be based on new instructions the physician gave a patient about a medication in the days immediately before hospitalization, he said, particularly if the person's medical status was changing and a supply of the drug had already been obtained.

Miller, who spoke Friday in San Francisco at MedInfo, a triennial international meeting for the medical informatics community, has been examining the prescription claims data sent to the hospital since mid-January by RxHub LLC.

Three-year-old RxHub electronically routes prescription-related information between health care providers and the firm's founders, the prescription benefit management companies (PBMs) now known as Caremark Rx Inc., Express Scripts Inc., and Medco Health Solutions Inc. Originally implemented in the outpatient setting, where prescribers need to know about their patients' drug benefit, including formulary, when writing a prescription, RxHub is being eyed as an easy way of helping hospitals determine the medications that patients took before admission.

Interest in having an accurate medication history for every new patient gained momentum in July when the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released its National Patient Safety Goals for 2005.

JCAHO added the following new goal for accredited organizations: "Accurately and completely reconcile patients' medications across the continuum of care." During the coming year, according to JCAHO, hospitals and other health care organizations must develop a process for obtaining and documenting a complete list of each patient's current medications when the person is admitted for care.

So far, Miller said, coworkers' anecdotal reports about the usefulness of prescription claims data "have been compelling." But he expects a lot of problems to result from hospital personnel overestimating the accuracy of the prescription claims data.

Although RxHub's Robert B. Elson, vice president of medical affairs and a physician, said a "claims history can provide a low-cost surrogate" for a medication history, he noted that prescription claims histories lack data on nonprescription drugs, dietary supplements, and anything else a patient buys outside their pharmacy benefit plan.

Ken Majikowski, also with RxHub, reported that 73 percent of the patients whose data were requested by Barnes-Jewish had at least one claim for a prescription drug.

He explained that this result does not necessarily mean the other patients were not using any medications when admitted to the hospital. Those patients, he said, might have had their prescription claims settled by a company other than Caremark, Express Scripts, or Medco.

Miller, Elson, and Majikowski spoke during a panel discussion on the pros and cons of constructing medication histories from prescription claims.