Medication Reconciliation Agent

The work it takes off your plate

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.

How it works

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. Step 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

   Result: A complete multi-source medication inventory is available for comparison.

2. Step 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

   Result: Clinically meaningful med discrepancies are ranked for review.

3. Step 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

   Result: A draft reconciled medication list is ready for clinician sign-off.

4. Step 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

   Result: A verified medication list is documented and shared across the care continuum.

Why use it

• Safer Transitions. Reduces adverse drug events driven by incomplete med histories.
• Multi-Source BPMH. Combines EHR, pharmacy, claims, and patient-reported data.
• Pharmacist Efficiency. Surfaces only true discrepancies for expert review.
• Audit-Ready Attribution. Tracks source of every medication line.
• Continuity of Care. Keeps reconciled lists synchronized through discharge.