Electronic tools to support medication reconciliation: a systematic review by Sophie Marien, Bruno Drug and Anne Spinewine

I agree with all statements #1-4 . The method used to identify the studies and tools was a systematic review of the academic and grey literature. They also searched for patents. The authors located in Europe stated difficulties with certain key words that did not capture the relevant literature from Embase. So alternate key words were used. The authors discussed difficulties they experienced when doing the search and I too wondered whether it was adequate to capture all tools that have been developed.

How are Canadian vendors making their findings known? Where are these findings being documented ?

Interesting Post. I would however caution your comments towards the lack luster outcome or your belief that this article/study has included all vendors in Canada. My comments:

1.) Not all Canadian based solutions were included in this study.
2.) No complete review of implemented MedRec solutions was done or review of usage follow up, after 1 year.
3.) Some of the solutions such as the McGill project were only "Pilot" or "Test" projects and may not have been in full production throughout the institutions.
4.) This paper is unclear on follow up or mechanisms to review the quality of the data used or reasons for missing data. Seems to be pointing to small implementations.

Of particular interest: n=14 and the year of 2013. I would suggest much has been completed since 2013.

"Participants from the online survey conducted in 2013, who indicated they had implemented eMedRec to some
extent, were invited to participate in a subsequent phone interview to collect more detailed data about their
experiences. Fourteen (n = 14) participants, each representing different organizations in Canada, were interviewed."

From my experience, hospitals or regional entities that concentrated "real" effort in accomplishing the benefits of MedRec with full interoperability between community pharmacies and Hospitals and other sources of information were quite successful in showing "real" benefits in the aging population groups.

I would caution that this article is only one of many that everyone should consider. But I thank you for making us aware that this one does exist, as it will add to the debate; Pro or Con.

Kind regards,

from Paper to Electronic MedRec Implementation Toolkit, 2nd Edition

This article is a systematic review of electronic tools used to support the Medication Reconciliation (MedRec) process. After a thorough searching strategy, the authors identified 18 papers and 11 tools. The papers consisted of 8 Quality Control Studies, 5 Observational Studies, 1 Randomized Control Trial (RCT), 2 RCT protocols and 2 patents. All studies and tools were American apart from one Canadian study and tool.

MedRec is now an accreditation requirement in most countries as it has been shown to decrease medication discrepancies during transitions of care thereby increasing the quality and safety of the care provided. But, it is costly and labour intensive. As such, academic facilities have attempted to develop e-tools that are efficient and effective to decrease the cognitive and economic burdens associated with the process.

According to this review, no study nor tool has been able to demonstrate improvements in quality and safety with tangible measurables such as a decrease in medication discrepancies, or death or ADR. Instead, the authors compiled a summary of recommendations for the successful development and implementation of eMedRec tools as described in Box 1.