Errors associated with medication documentation account for a substantial fraction of preventable medical errors. Hence, the Joint Commission has called for the adoption of reconciliation strategies at all United States healthcare institutions. Although studies suggest that reconciliation tools can reduce errors, it remains unclear how best to implement systems and processes that are reliable and sensitive to clinical workflow. The authors designed a primary care process that supported reconciliation without compromising clinic efficiency. This manuscript describes the design and implementation of Automated Patient History Intake Device (APHID): ambulatory check-in kiosks that allow patients to review the names, dosage, frequency, and pictures of their medications before their appointment. Medication lists are retrieved from the electronic health record and patient updates are captured and reviewed by providers during the clinic session. Results from the roll-in phase indicate the device is easy for patients to use and integrates well with clinic workflow.

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Medication-prescribing errors generated at interfaces-in-care are the most common cause of preventable health care errors and contribute substantially to adverse patient outcomes. For this reason, standardized medication reconciliation (MR) processes need to be inserted at these interfaces. However, MR is an inherently complex task, and little data exist to inform system-based operationalization. The Portland Informatics Center addressed this challenge by creating an electronic patient-directed multimedia survey to automate the medication history collection. This article describes a research protocol designed to compare the software's medication discrepancy detection rate with traditional history collection strategies. For this randomized, controlled, single-blind trial, participants are randomly allocated into one of two groups: the control group reviews a paper list printed from the electronic record, whereas the intervention group uses a computer-assisted reconciliation survey that includes display of visual data (i.e., medication pictures). C 2011 Wiley Periodicals, Inc.

Gaps in information about patient medication adherence may contribute to preventable adverse drug events and patient harm. Hence, health-quality advocacy groups, including the Joint Commission, have called for the implementation of standardized processes to collect and compare patient medication lists. This manuscript describes the implementation of a self-service patient kiosk intended to check in patients for a clinic appointment and collect a medication adherence history, which is then available through the electronic health record. We used business process engineering and simulation modeling to analyze existing workflow, evaluate technology impact on clinic throughput, and predict future infrastructure needs. Our empiric data indicated that a multi-function healthcare kiosk offers a feasible platform to collect medical history data. Furthermore, our simulation model showed a non-linear association between patient arrival rate, kiosk number, and estimated patient wait times. This study provides important data to help administrators and healthcare executives predict infrastructure needs when considering the use of self-service kiosks.