Allergies and Workflow

I was recently asked about the best way to record allergies in healthcare environments.

Specifically:

At what point should allergy verification be occurring for a planned hospital admission? Should it be prior to admission or at the time of admission?

Is there any data yet to support decreased adverse drug reactions when the patient is asked to complete their own history initially through a patient portal?

Should data entry of allergies into smaller best of breed procedural area systems be permitted or should allergies only have one official “source of truth” location and be entered there?

Here's the answers I received from our workflow experts.

For outpatients:

For existing patients, allergies are printed on the patient's medication list which is given to him/her at the time of check in to support the medication reconciliation process. The patient can update both their medications and allergies at that time. This is given to the clinician or practice assistant to enter in the system at the time of their visit.

If medication lists are not distributed to patients prior to their appointment (such as for new patients), clinicians will enter allergies during the course of their visit with the patient.

For inpatients:

Whether entered in a PHR prior to admission or entered by clinicians at the time of admission, as long as it is done accurately, the timing does not matter. Certainly there is evidence that accurate recording of allergies (a meaningful use criterion) reduces errors, but I am unaware of specific evidence that recording them in a PHR verses an EHR makes a significant difference.

Whenever possible, one source of truth for allergies is the way to go. Otherwise the medical record will contain silos of conflicting information.

At BIDMC we have a single unified inpatient and outpatient record. Medications and allergies are shared between all inpatient (CPOE) and outpatient (EHR) systems. Medication reconciliation, e-prescribing, and transitions of care between inpatient and outpatient visits are integrated rather than interfaced. The last bit of implementation we need to do is bedside medication verification with an electronic medication administration record.