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Medication Reconciliation Agent

PharmacyMedication Reconciliation

Builds a best possible medication history across EHR, pharmacy, and patient sources at transitions of care.

4
Process steps
5
Integrations
4
Data inputs

Medication discrepancies at admission, transfer, and discharge are a leading cause of adverse drug events

Clinicians must manually stitch together EHR med lists, retail pharmacy fill histories, patient-reported regimens, and discharge summaries—often under time pressure

Incomplete histories lead to omitted, duplicated, or conflicting orders

The Medication Reconciliation Agent assembles a best possible medication history (BPMH) from multiple sources, highlights discrepancies, and supports pharmacist and clinician review at every transition of care

At transitions of care, the agent consolidates medication data from the EHR, external pharmacy networks, claims, and patient interviews. It normalizes drug identities, detects conflicts, proposes a reconciled list, and routes unresolved discrepancies for pharmacist verification before the list is finalized in the chart.

1

Aggregate Multi-Source Medication Data

  • Retrieve active meds from EHR, Surescripts/PBM fills, and prior discharge lists
  • Capture patient- or caregiver-reported medications and OTCs
  • Normalize NDC, RxNorm, dose, route, and frequency
Outcome: A complete multi-source medication inventory is available for comparison.
2

Detect Discrepancies

  • Identify omissions, duplications, dose conflicts, and discontinued agents still listed as active
  • Flag high-alert medications and narrow therapeutic index drugs
  • Score discrepancy severity for pharmacist prioritization
Outcome: Clinically meaningful med discrepancies are ranked for review.
3

Propose Best Possible Medication History

  • Generate recommended BPMH with source attribution for each line
  • Suggest continuation, hold, or discontinue decisions for admission orders
  • Attach evidence links from fill history and prior notes
Outcome: A draft reconciled medication list is ready for clinician sign-off.
4

Finalize and Propagate Across Transitions

  • Capture pharmacist and provider verification
  • Update admission, transfer, and discharge medication lists
  • Hand off unresolved issues to discharge counseling workflows
Outcome: A verified medication list is documented and shared across the care continuum.
Epic Willow
Cerner PharmNet
Surescripts
RxNorm
First Databank