The Handoff Gap: What Falls Through When Pharmacies Aren’t Connected

The patient is discharged on Tuesday afternoon. By Wednesday morning, the patient is at the pharmacy, but the pharmacist has very few details about what happened in the hospital. The patient will see their pharmacist more than any other clinician this year, yet the pharmacist is often out of the loop with the rest of the care team.

That’s the handoff gap. And it’s a data exchange problem.

A Pitfall in Transitions of Care

Often, the assumption is that there’s a healthcare professional on the other side of a transition in care who gets the patient’s discharge summary and is informed about any changes to their medication regimen. Ben Bluml, R.Ph., who leads research and innovation at the American Pharmacists Association (APhA) Foundation, challenges that assumption when a patient is discharged home.

“There’s usually not a good handoff between the discharge planner and the pharmacist in the community, where the patient spends 99.9% of their lives,” says Bluml, who makes a case for the connected pharmacist. He explains that pharmacists don’t have access to the patient’s clinical history, physical exam results, lab values or diagnostic results.

Bluml offers a scenario that shows how easily a medication change can fall through the handoff gap.

What Happened in the Hospital

The hypothetical patient came in on a medication with a single-active ingredient for high blood pressure. The hospital switched him to a medication with a two-active ingredient combination on its formulary—standard practice—and the discharge prescription is sent out.

But the reconciled record never reaches the community pharmacy.

The patient still has the original prescription at home. No one has told him to stop taking it. So, he takes both. Now he’s on three medications, rather than two, and his blood pressure drops. The patient falls and breaks his hip.

“This is a common event happening every day in this country,” Bluml says, “because we don’t have good coordination of care.”

Great Access, No Context

Nearly nine in 10 Americans live within five miles of a pharmacy. Not much else in healthcare is that close to that many people, but proximity doesn’t mean connection and data exchange.

“We have this great access,” Bluml says, “but the paradox is that people often think of the pharmacy as only a place where they receive a product, instead of products plus the services that provide important education and safety information about the medications we put into our bodies. That’s where the real gap is.”

Just 27% of pharmacists say it’s even somewhat easy to share patient information securely and confidently with other care providers, and only 36% feel their position allows them to offer patients all the care they need.

It doesn’t have to work this way, and in some settings it doesn’t. Inside an integrated delivery system, Bluml says, the pharmacist has read-write access to the patient’s entire electronic medical record. The information runs in both directions, and all of it, in Bluml’s words, is “right there at their fingertips.” The pharmacist sees the diagnosis, condition, history and physical, and contributes to the record.

The Infrastructure for Connection Already Exists

TEFCA™—the Trusted Exchange Framework and Common Agreement™—sets common rules for nationwide health information exchange. Organizations connect to it through a Qualified Health Information Network® (QHIN™). A QHIN is a network designated to exchange health information under TEFCA’s common rules. Joining one—like Surescripts Health Information Network®—links them to every other participant under the same agreement. No more negotiating connections one health system at a time.

Given basic details about QHINs and their benefits, 71% of pharmacists said joining one should be a high or essential priority in the next several years.

“TEFCA gives us a better path forward,” Bluml says. “It lets practitioners—whether a primary care physician, a primary care pharmacist, a nurse, someone in a health system, or someone working with population-level data at a health information exchange—move that data around and look at it in a secure, productive way. I think that’s going to help us all invent the preferred future we’re seeking.”

And the industry is organizing around it.

The Sequoia Project launched its Pharmacy Interoperability Work Group in 2025 under the Interoperability Matters program, sponsored by Surescripts, the APhA Foundation, the National Association of Chain Drug Stores and the NCPA Foundation.

Closing the Handoff Gap 

Data exchange is the multiplier on care that pharmacists are already delivering.

Back to Wednesday: The patient is at the pharmacy counter, and this time the pharmacist knows what changed on Tuesday after discharge—not because they had to make an extra phone call, but because the discharge summary made it through.

A discharge summary is not the whole medical record at the pharmacist’s fingertips, but it’s an example of where to start, and the infrastructure to get there is already built.