Medication reconciliation remains a high priority for many clinicians, but due to the fragmented nature of our healthcare ecosystem, care providers often lack access to a complete and accurate list of their patients’ medications. To tackle these challenges, Michigan Health Information Network Shared Services (MiHIN) is developing the Med Rx Hub platform, which aims to serve as a “single source of truth” for medication information statewide.
As Isabell Pacheco, MiHIN’s chief administrative officer, explained in a recent interview with Healthcare Innovation, medication histories are often incomplete because information is scattered across multiple providers, pharmacies, and health systems that do not consistently share data. Sources of information about patient medication use exist in many places, including e-prescribing systems, clinic, and hospital EHRs, physician office records, and pharmacies. Studies show that 94% of patients have at least one medication history error, and 16% of hospital readmissions within 30 days of discharge are medication-related—40% of which are preventable.
“When a patient is seeing a primary care physician and several specialists and maybe ends up at the hospital, medication reconciliation is really tough mostly because the information is siloed at each of those organizations,” Pacheco said. “Being able to connect all of those providers to the medication list is something that is not happening in Michigan, and we knew it was a problem that we wanted to address. We wanted to help reduce medication errors, make data more interoperable, and try to get a better sense of all of the medication history for a patient.”
Pacheco said MiHIN is strategically positioned to facilitate statewide medication reconciliation by leveraging its existing technical and legal infrastructure. Med Rx Hub will serve as a centralized data-sharing solution, integrating both prescribed and dispensed medication data from multiple sources, including e-prescribing systems, pharmacies, and health information exchanges (HIEs).
MiHIN held a three-part workshop series in early 2024 to hear from healthcare execs and clinicians about medication reconciliation. Stakeholders confirmed that medication reconciliation is currently not as efficient, comprehensive, or effective as it could be at preventing errors due to many obstacles. There is no single source of truth for medication use information. Rather, information about a patient’s medication use is fragmented and scattered across multiple locations.
The workshops also highlighted that providers and pharmacists are not financially incentivized to prioritize this process. In other cases, providers are unaware of the billing codes that could be used to compensate them for the time spent on this process.
Med Rx Hub is being designed to provide real-time access to a more accurate and comprehensive medication history, enabling providers to make informed decisions at every stage of care. The Hub’s goals are to:
• Aggregate medication data from multiple sources into a single, standardized record.
• Enhance interoperability by ensuring medication data is accessible within provider workflows.
• Enhance patient safety by minimizing errors and ensuring that providers have a comprehensive understanding of a patient’s medication use.
The new solution should increase MiHIN’s interactions with pharmacists, Pacheco said. “Today, the the only way pharmacists interact with MiHIN at all is through immunization submissions. But this will be a whole new ball game for pharmacists to have access to this kind of data.”
MiHIN is developing Med Rx Hub through partnerships with technology vendors, ensuring that the platform integrates seamlessly into existing healthcare IT systems while maintaining scalability and security.
This project also requires MiHIN to gather data it hadn’t previously. “It’s data that we did not have. It’s a brand new data set for us,” Pacheco explained. “Previously, we did have medication lists, which aren’t always updated and they’re not always accurate. Instead, we’re going to get the electronic prescriptions that go to pharmacies. We’re going to get a copy of those from the providers themselves.”
The National Council for Prescription Drug Programs has a file format that is used for pharmacies to share data with HIEs. MiHIN is using that file format to have the pharmacies send it the filled prescription data.
Pilot to start with 3 FQHCs
MiHIN will pilot the Med Rx Hub with three Federally Qualified Health Centers (FQHCs) starting in September 2025.
The pilot will focus on:
• Testing interoperability across different EHR and pharmacy systems.
• Validating the accuracy and completeness of medication data within provider workflows.
• Gathering feedback to refine Med Rx Hub before statewide rollout.
By starting with FQHCs, MiHIN can ensure the solution meets the needs of both primary care and community health providers before expanding more broadly.
MiHIN’s plans a phased statewide expansion over five years, starting with the FQHC pilot and scaling to additional provider types, including:
• Hospitals and health systems
• Specialty providers (e.g., cardiology, endocrinology)
• Specialty pharmacies and long-term care facilities
• Emergency departments and urgent care centers
The expansion strategy will focus on:
• Proving value during the pilot phase by demonstrating improved medication reconciliation outcomes.
• Building stakeholder buy-in by engaging providers, payers, and policymakers.
Possible EHR integration to reduce workflow disruptions for clinicians.
Pacheco stressed that Med Rx Hub will adhere to HIPAA, 42 CFR Part 2, and Michigan-specific data-sharing regulations. It will employ:
• Role-based access controls ensure that only authorized providers can access patient data.
• Encryption and secure data exchanges to prevent unauthorized access.
• Strict auditing and monitoring to track and prevent misuse of medication data.
MiHIN is also learning from other HIEs, such as Nebraska’s prescription drug monitoring program, which securely collects all dispensed medication data from pharmacies statewide and makes it available to authorized providers.
Measuring the impact
By analyzing pre- and post-implementation data, MiHIN will seek to quantify the improvements in patient safety, care quality, and cost efficiency that Med Rx Hub brings to Michigan’s healthcare system. Key performance indicators include:
• Reduction in medication history errors (baseline studies show 94% of patients have at least one error).
• Decrease in medication-related hospital readmissions (currently, 16% of readmissions are medication-related).
• Time savings for providers, reducing manual medication reconciliation efforts.
• Improved medication adherence and patient outcomes.
“We are in talks with the University of Michigan on creating an evaluation project for this work,” Pacheco said. “Their School of Pharmacy is very interested to see what the outcomes of this solution will be. We’re working on developing evaluation criteria with them.”
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