The Personal Medication Record - Summary

Although this is the fourth and final AlignMap entry focusing on the Personal Medication Record¹ (PMR) as an important method of decreasing unintentional medication noncompliance (i.e., errors in taking medication),² it summarizes the previous entries and can be read as a stand-alone manual on the practical steps to create and use a PMR.

The The No-Nonsense Summary that follows is a condensed version of the lengthier discussion that begins with the heading Creating The Optimal Personal Medication Record.

Finally, the continuation of “How To Create and Use A Personal Medication Record”³ will be a description of some of the practical issues I found in creating my own PMR and will illustrate many of the points raised in this discussion.

1. A PMR decreases the risk of medication errors and can provide information that could save your life. Everybody should have one. If you don’t have a PMR, stop what you’re doing, go to the heading, “IA. If you do not have a PMR, make a temporary one - now” (a couple of paragraphs below the collage of PMR forms) and follow those instructions to create a temporary Personal Medication Record.

2. Decide which format suits your permanent, optimal PMR:

A. A pencil and paper form that is simple to use and has fewer privacy risks but is more prone to error and requires more work to update and distribute.

B. A computerized version of the paper and pencil PMR that is not stored on-online so it is easier to revise and less prone to error and has less risk to privacy than internet PMRs but lacks the 24 hours day availability wherever Internet access exists.

C. An on-line PMR that is easy to update, less prone to error, always available, and easy for others to access with your permission, but has inherent privacy risks.

Note: If you cannot add information (e.g., over the counter medications) to a medication list generated by your pharmacy, insurer, healthcare provider, etc., that medication list is not a useful PMR.

3. On-line PMRs offered by employers and insurers carry sufficient risks to privacy and potential problems with portability and access that privately administered PMRs, even if they charge a fee, are, in my judgment, a better choice.

4. Decide which data to enter into your Personal Medication Record based on its utility to you and your healthcare providers, not on the slots and prompts of a form. The core of the PMR is the list of every medicine you take, including prescribed medications, over the counter drugs, herbal remedies, diet supplements, drugs taken “as needed” as well as those taken routinely, and those administered by a nurse or at a clinic (such as I.V. chemotherapy given at the oncologist’s office), with the dose of each, when it is taken, the reason it is taken.

5. Revise your Personal Medication Record immediately if there is any change in the medications you take, regardless of why the change took place. An outdated PMR may not only be inaccurate but also dangerous. Distribute updated PMRs immediately to your personal physician, your pharmacy, and your emergency contact.

6. Use your Personal Medication Record routinely to review your medications before a doctor’s appointment, to order refills, to stock your pillbox, to discuss treatment with your clinicians, …

A Personal Medication Record decreases the risk that you will make a mistake in taking your medication or that healthcare professionals will make a medication error that will result in treatment failure or even harm to you. It can provide essential information in emergencies, especially if you cannot provide that data yourself. Your PMR can also prevent bureaucratic hassles, increase the efficiency of the communication between you and your treatment team, and lessen tensions during doctor visits. That’s why …

IA. If you do not have a PMR, make a temporary one - now
(If you do have a PMR already, go to Step IB)

The Personal Medication Record is such an important healthcare tool that creating a basic, operational version takes precedence over deciding on and completing your optimal PMR.

On an ordinary sheet of paper, write “Medication List” at the top. Then, write the following headings down the left side of the page, followed by the pertinent information:

• Name: your name
• Birth Date: your birth date
• Date: today’s date
• Physician: your primary physician’s name and phone number
• Emergency Contact: your emergency contact’s name, relationship to you, and number
• Medications: each medicine (including prescribed medications, over the counter drugs, herbal remedies, diet supplements, drugs taken as needed as well as those taken routinely, those administered by a nurse or at a clinic, such as I.V. chemotherapy given at the oncologist’s office, etc; if no medications are currently taken, write “I am currently taking no prescribed or over the counter medications, herbal remedies, or dietary supplements.”); the dose of each medicine; when it is taken; the reason it is taken
• Drug Allergies or Reactions: your drug allergies and any bad reactions to drugs you’ve had - if you have no allergies or history of bad reactions, write “None”

Once the list is complete, make at least four copies of the original.

• Keep the original with you at all times (typically, folks carry this in their purses or wallets).
• The first copy goes to your doctor and your medical record at his office. Contact your doctor’s office, tell the office you have just updated and revised your Medications List and would like it placed in your medical record to make sure your doctor has your current and accurate medication information. Ask how to best forward it to them, preferably by fax or email, but otherwise by USPS.
• One copy goes to your emergency contact. Inform your emergency contact that you are sending your Medications List and the importance of keeping it immediately accessible.
• One copy goes to your spouse, parent, adult child, or other close relative or friend.
• Another copy is kept as a back-up in an easy to remember and accessible location. (Mine is in an envelope taped to an inconspicuous spot inside my car.)

Once this is accomplished, go to Step II: Choose a format for your optimal Personal Medication Record.

IB. If you do have a PMR, check that it is up to date, contains at least the essential data, and has been distributed properly

The most basic PMR should contain at least the information listed in Step IA and should be distributed as described there. If your PMR lacks any data or needs to be sent to others, please proceed with that before going on to Step II: Familiarize yourself with the formats available for your optimal Personal Medication Record.

II. Familiarize yourself with the formats available for your optimal Personal Medication Record⁴

There is no standardized PMR today. Any Personal Medication Record, including a list scribbled on the back of an envelope crammed into a wallet, is better than no Personal Medication Record. Because form and content are both important factors, I suggest that you first look at a few of the forms available but not commit to one or another until you have read the next section, II. Enter the data categories you’ve selected, which addresses the content your Personal Medication Record should contain.

Your Personal Medication Record should not only be easy for you to access and use but it should also be easy for your clinicians to access and use. This principle is so fundamental that if your doctor or your healthcare organization offers or actively promotes a particular Personal Medication Record or expresses a preference in response to your query, I suggest you make that PMR your presumptive choice.⁵

Take care, however. Some providers offer access to data that covers only the care they or their clinic perform for the patient and do not allow the patient to enter additional data. If the patient cannot add medications such as those prescribed by others, over the counter medications, herbal remedies, etc and other data such as emergency contact or if there is a problem in making the record accessible to others, the document is inadequate as a Personal Medication Record.⁶

The most important distinctions between Personal Medication Records can be assessed by dividing the formats into four categories: (1) Paper & Pencil PMRs, (2) Healthcare Professional-driven PMRs, (3) Software-driven PMRs that are not stored on-line, and (4) On-line PMRs.

1. Paper & Pencil PMRs
These formats are available from many sources and have the advantage of simplicity. They also carry the greatest risk of errors such as misspellings and illegibility which can lead to serious misunderstandings and are most labor-intensive (thus discouraging updating), and lack a built-in link to information resources. Anyone who has tried to maintain a paper and pencil telephone listing of friends for more than a year or two will understand the logistic problems. Paper & Pencil PMRs should be chosen only when using a computer is, for any reason, impossible or the medications listed are so few in number and so unlikely to change that automating the process would be counterproductive.

2. Healthcare Professional-assisted PMRs
Pharmacies and, less frequently, clinical offices may offer printouts of a patent’s medication list. While this method has the advantages of being automatic and enlisting the efforts of a healthcare professional, the key point is whether the medication list generated includes not only drugs purchased at that pharmacy or prescribed by that doctor but also other, patient-entered information such as those drugs obtained from or prescribed by other sources, non-prescription drugs and herbal remedies, diet supplements, etc. and can be easily updated and redistributed whenever a dose changes or a patient begins taking Vitamin X on the advice of a friend. Myk informal inquiries have indicated that adding data of this sort is, at best, a cumbersome process. Unless you can conveniently add information about mediations prescribed by or obtained from other facilities, I can only recommend this strategy as a last resort for those who might otherwise be unable to organize such a listing.

A special case of Healthcare Professional-assisted PMRs is the model offered by Medicare. Medicare beneficiaries may be eligible Medication Therapy Management, which specifically includes a Personal Medication Record prepared from Medicare Part D services. Eligibility for these services is explained in Helping Medicare Patients With Part D :
Under Medicare Part D, PDPs are required to have an MTM program for “targeted beneficiaries” who have multiple chronic diseases, multiple medications, and are likely to incur costs above a certain level ($4,000 for 2006). MTM can be offered to all beneficiaries. Non-targeted beneficiaries must pay for MTM out-of-pocket. MTM may include a variety of services (education, special packaging, collaborative drug therapy management, etc.). The best resource to learn more about MTM is http:www.aphanet.org/medicare

While these Personal Medication Records may be handled differently by various pharmacies, the description of the service offered by the National Community Pharmacists Association, directed toward participating pharmacists, is instructive:

CCRx’s Part D MTM program gives you all the tools you need for creating and delivering a state-of-the-art PMR to the patients you serve. Here are a few helpful points for creating an accurate and useful PMR using the Community MTM
(CMTM) platform:

• Information you enter in the “Medications” section of the CMTM application automatically populates the PMR. This includes the “Purpose” field, the “Patient Directions” field, and any additional medications you add to the list.
• Always enter information in the “Patient Directions” field in English, NOT Latin abbreviations. (If you type “TID,” this will appear exactly that way on the patient’s PMR and they won’t understand it).
• As you go through the patient’s medications in the “Medications” field, ask, “Are you still taking this?” If the patient answers no, simply mark “No Longer Taking” and the PMR will automatically update as you go along.
• The PMR also prints a sheet of blank lines for keeping the PMR up-to-date with hand-written entries after the service. New meds get written in and discontinued meds get a line drawn through them with a “no longer taking” note. You can educate the patient how to do this or even offer to do it for them as a value-added service when they come to your pharmacy with their next prescriptions.

After you complete your MTM service and documentation, click the “Documents” icon on the CMTM application. This will allow you view the PMR you’ve created. Review it for accuracy then simply hit the print button and give it to the patient. Remember, the PMR is the centerpiece of the CCRx MTM service.

3. Software-driven PMRs that are not stored on-line
These so-called desktop solutions should have links to medication databases both to access any need information needed and to facilitate data entry by suggesting the medication names and doses. A spell-checker and means of securing data retained on the computer are also important. Many have added features such as automated reminders and alerts when refills are due. In most cases, the software-driven medication records will be part of a larger, more comprehensive Personal Heath Record (PHR), and many software programs will offer the option of on-line storage. Few, if any, software-driven PMRs and PHRs are free; most cost $30-$100. Some software solutions may be offered by a health insurer or an employer free to clients or employees, respectively. If this is the case, users should inquire as to whom has access to the records and what privacy protections are in place. Software-driven PMRs that are not stored on-line are the appropriate choice for those who are (1) able to use computers and (2) wish to protect their healthcare data to the extent possible.

4. On-line PMRs
On-line PMRs have an inherent problem - there is no guarantee that private healthcare data stored on-line can be protected from every possible threat. That said, there is no guarantee that private data of any sort, such as fiscal records, legal information, or romantic emails can be protected from every possible threat - whether that information is transmitted and stored as electronic pulses on-line, sent as a check via snail mail, or handed to a waitress in the form of a credit card. The decision is, then, whether the potential benefits outweigh the risks. And, there are benefits: On-line PMRs are, theoretically, available 24 hours a day, 365 days a year. The well-designed examples are can be easily and readily adapted, revised, corrected, and shared with others by email or fax. Many have links to medication databases, provide graphics of the pill or capsule being taken, and offer refill and medication administration reminders. And, as a final bonus, they tend to be less expensive than software for ones computer and some are offered without charge.

For any on-line PMR offered at by an employer, insurance company, or clinical organization, you should ask (1) if the Personal Medication Record can be continued if you change or drop your insurance with that insurance company, leave that employer, or change healthcare providers, (2) if you can grant others, such as your physician, easy access to records, and (3) if your employer or health insurer can access your healthcare information and use it administratively (e.g., could your employer obtain information about your newly diagnosed serious medical problem and terminate you to avoid future healthcare costs).

My personal recommendation is to opt for a PMR maintained by a for-profit consumer-oriented business or even one subsidized by advertising rather than volunteer data for an insurer’s or employer’s program. The risk of data abuse, however remote, is simply unnecessary. Consequently, On-line PMRs are the first choice for (1) those able to use internet tools and (2) willing to accept the risk to privacy in return for the benefits of on-line processes.

II. Select the data for your PMR and enter that information

The data you choose to enter in your PMR is - and should be - an especially personal choice, a notion reflected in my primary recommendation:

The data fall into two broad groups:

1. Essential Data: The first goal is to assure that most important medication information is included in your PMR and is up to date.⁷

• Name & Birth Date
• Date PMR was last revised
• Primary Physician’s name and phone number
• Emergency Contact’s name, number, and relationship to you
• All medications’ names, dosages, times of doses, and reasons for taking the medication⁸
• Medication allergies and bad reactions

2. Optional Data: Beyond the fundamentals is a seemingly infinite amount of medical information that could, in some circumstances, be helpful. Typically, that help is in the form of familiarizing a clinician with your general health and medication regimen in situations ranging from a routine yearly check-up to a life or death emergency in which you are unconscious or otherwise unable to provide medical information to those treating you. The goal is to provide as much of that information as possible without compromising your privacy beyond those limits you set and without demanding so much ongoing data entry that completing and revising your PMR becomes a burdensome task that is deferred or avoided altogether.

To assist your decision-making, I’ve divided the Optional Data into two subgroups:⁹

Non-essential Information With High Potential Utility and Risk Of Abuse

• Medication issues and precautions (e.g., “Take with food” “Avoid sunlight”)
• Start date of currently used medications
• Stop date of discontinued medications
• Non-medication healthcare supplies (e.g., blood glucose test strips for diabetics, CPAP settings)
• Pharmacist’s name and contact information
• Prescriber name(s) and contact information (in addition to Primary Physician)
• List of all current health problems, whether taking medication for them or not
• Specific notation whether generic or brand name of the medicine is taken
• Date of most recent vaccinations

Optional Information That Incurs Privacy Risks

• Social security number
• Insurance Information (e.g., Company, Group Number, Policy Number)
• Location where medications can be found in home
• Address
• Home phone number
• Cell number
• Date of birth

III. Make and distribute hard copies

Paper copies of your PMR are necessary even if it is available online or in a USB drive or CD you carry.

1. Create and maintain a separate Personal Medication Record for each individual.
2. Carry a current copy of your Personal Medication Record with you at all times
3. Bring extra copies to any healthcare appointment, including pharmacy visits
4. Keep another copy of your PMR in a safe, easy to find place (e.g., in an envelope taped under the dash or seat of your car)
5. Send a copy to your emergency contact. Replace all copies if the medications you take change.

In addition, if your Personal Medication Record is on-line:

1. Arrange for your physician to receive instructions to access your on-line PMR. Check that your physician’s office received them and has actually completed the procedure to assure they can access your PMR
2. Change your password no less often than every three months

IV. When changes occur, update and redistribute your PMR

If there is any change in the medications you take, regardless of why the change took place, immediately revise your Personal Medication Record and change the “Last Revised” date. It is also essential to send an updated copy of your PMR to your primary physician and your pharmacist. Finally, destroy all copies of any previous, now outdated PMRs.

V. Use your Personal Medication Record

Review your PMR before every visit to the clinic. If your understanding of your medication regimen is not identical to the information in your PMR, ask your physician or pharmacist for clarification; prompting questions and facilitating enlightenment is an excellent use of PMRs.

Keep track of and order new refills with your PMR.

If you transfer your medications from the pharmacy’s bottles to a pillbox, use your PMR to fill that container.

Highly Recommended

Of the 20+ specimens from the paper and pencil category I examined,¹⁰ my favorite was My Personal Medication Record, which is AARP-affiliated but can be used by individuals regardless of age. It’s well organized, has prompts for all the essential data and most of the “probably useful” information. At the My Personal Medication Record site, you can (1) download the form in English or Spanish as as a PDF file to complete by hand, (2) download the file as a Microsoft Word document which can be either printed to be filled out by hand or, if you have the Microsoft Word software, completed on your computer, or (3) order the same forms as paper documents by phone at 1-888-OUR-AARP (1-888-687-2277). There is no charge for any of these formats. The AARP deserves accolades for providing, alone of all the Personal Medication Records I checked, a sample of their PMR with a couple of examples filled in and instructions for gleaning the necessary information from the prescription medication labels, which can be found at Sample PMR & Prescription Drug Label Made Easy. Also on the AARP web site is Over-the-Counter Drug Fact Labels, an article which provides analogous instructions for over the counter drug labels.

Information from the American Health Information Management Association about Personal Health Records, most of which include a medication list, can be found at My Personal Health Record. At PHR Search, one can search for programs based on cost (purchase Vs free) and format (Internet service, Software program, Paper-based).

My Medication Schedle is included in the “highly recommended” category primarily because it is a free on-line service (the site also sells medication-related supplies) that generates a usable medication list and has a few bells and whistles (e.g., refill reminders) but is not designed as an online medication list to be accessed by others, such as personal physicians. Because on-line PMR’s offered by providers (e.g., Kaiser-Permanente), insurers, and employers are available only to individuals affiliated with those organizations, those who wish to get a feel for how the on-line process takes place can do so here at no cost.

Other Reources
Other paper and pencil format examples include the Athens Regional Medical Center Personal Medication Record from the Athens Regional Medical Center, Athens, Georgia, My Medicine List developed by the American Society of Health-System Pharmacists, the Universal Medication Form, from the University of Louisville Hospital, the Seniorr Navigator Personal Medication Record from Virginia’s Resource for Health and Aging, and the Park Nicollet Personal Medication Record.

Examples of companies selling encrypted USB keys for storing medical data include CapMed’s HealthKey and MedInfoChip.

WebMD Health Manager is an online service that organizes ones health information for a monthly fee.

Followme.com offers, for a yearly fee, both online and paper-based ways to manage medical records.

Footnotes

1. ”Personal Medication Record” is the quasi-official name for a document with the important information about the medicines you take. Instead of “How To Create and Use A Personal Medication Record,” the title could have been “How To Create and Use A List Of Your Drugs,” “How To Make A Medication List,” “How To Make A List Of Medicines,” etc. [back]
2. The previous posts in this series follow:
   1. Everyone Needs A Personal Medication Record
   2. Choosing The Right Personal Medication Record
   3. Compiling The Personal Medication Record

   [back]

3. The continuation should be published in the next 2-3 days [back]
4. See Choosing The Right Personal Medication Record for a more complete discussion [back]
5. By “presumptive choice,” I mean the referenced PMR should be your choice unless you find a distinct disadvantage with the clinician-preferred program or another offering is clearly superior. [back]
6. See also 2. Healthcare Professional-assisted PMR below. [back]
7. More complete instructions for entering this information is available under the heading “IA. If you do not have a PMR, make a temporary one - now” [back]
8. Take care to spell medication names exactly as they are listed on their labels (many different medications have similar names) and and list their dosages and the frequency with which they taken accurately. If you cannot do so or if you are unsure, bring all your medications, including over the counter drugs, herbs, and vitamins with you to the doctor or pharmacist to receive help in completing the list. [back]
9. This is a simplified adaptation of my original groupings listed in Compiling The Personal Medication Record [back]
10. The Paper & Pencil PMR examples were chosen as de facto representatives based on their high ranking on Google [back]

• Another Reason The Personal Medication Record Is Essential
• Test-Driving The Personal Medication Record
• How To Create and Use A Personal Medication Record
• Once More, Everyone - Not Just The Elderly - Needs A Personal Medication Record
• Everyone Needs A Personal Medication Record