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Laying the Best Foundation for Medication Reconciliation

Posted on September 6, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Brian Levy, MD, Senior Vice President and Chief Medical Officer for Health Language.
Levy Low Res
Effective medication reconciliation across the continuum of care is a critical element to eliminating medication errors and adverse drug events (ADEs). It is a focal point of such national initiatives as Meaningful Use (MU) and the Joint Commission’s National Patient Safety Goals and will also be crucial to ensuring performance metrics are met under Value-Based Purchasing and the Hospital Readmissions Reduction Program.

Simply put, one of the primary end-goals of current industry movements is to eliminate the revolving door effect in healthcare where patients are readmitted soon after discharge due to ADEs or lack of good information across the continuum. A growing body of research points to enhanced medication reconciliation as an effective way for hospitals to reduce readmission rates to meet this objective.

A 2012 study published in the Joint Commission Journal on Quality and Patient Safety found that accurate preadmission medication lists—acquired as part of medication reconciliation strategies— reduced ADEs both in the hospital and following discharge. Another paper published in the November 2012 edition of Pharmacotherapy also points to the critical role ADEs play in readmission rates and how ineffective care transitions, especially as they relate to medication management, exacerbate the situation.

The logistics of medication reconciliation has historically been an uphill battle for many clinicians. Without an electronic method for capturing information, the scene usually comes down to a Q&A session where physicians, nurses or other clinicians rely on patients to give them an accurate medication list. When a patient is unaware of the name of a medication, it usually results in a protracted delay in patient care while phone calls are made and consults conducted to accurately identify medications and avoid the potential for error.

EHRs provide the first step to correcting this inefficient way of gathering information. And while these systems are great repositories of patient information, the difficulty for medication reconciliation has been a lack of standards—specifically the lack of a standardized medical vocabulary. A number of proprietary medical terminologies exist within the industry, and without a standard for information exchange, the risk is that one drug could be identified by a number of different terminology codes depending on the proprietary system used.

Clinicians need an effective method for exchanging patient medication information between disparate systems in a standardized format that can be translated accurately by various healthcare organizations, providers and departments involved in patient care. MU is addressing this issue on one level through the introduction of RxNorm, a normalized naming system produced by the National Library of Medicine for generic and branded drugs and a tool that supports semantic interoperability between drug terminologies and pharmacy knowledge base systems.

RxNorm is a critical first step to ensuring the feasibility of building and accessing an accurate medication summary, thus minimizing the possibility of duplicate therapies, drug allergies and drug interactions. By adopting this standard, healthcare organizations and providers will begin receiving RxNorm codes in important CCD summary of care documents and HL7 messages. This standard will complement the use of the Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT®), a widely-used clinical terminology set also required under MU for the creation of problem lists.

While RxNorm provides efficient and accurate capture of medication information from external systems, healthcare organizations and providers will still require a method of converting codes from RxNorm to internal systems and visa-versa. This step ensures that internal medicine systems and drug information and interactions databases like Medi-Span, First Databank, Micromedex and Multum can also reconcile important patient medication information.

To address the full picture of data normalization, healthcare providers can leverage a healthcare terminology management solution to ensure automated mapping of patient medication data received from disparate sources to standardized terminologies. This process de-duplicates data, creating a normalized code across all clinical systems used internally, minimizing the potential for error.

This approach also provides an effective way for leveraging a comprehensive, longitudinal patient record, which is a primary goal of the health IT movement to enhance patient care. A foundation of standardized codes enables healthcare organizations to more fully develop advanced clinical decision support functions, where alerts can be received immediately for clinical activity impacting individual patients or within populations of patients.

As the healthcare’s industry move toward higher-quality care and more efficient care delivery continues to mature, the use of standardized medical terminologies will be paramount to effective clinical information exchange. While some initiatives like RxNorm and SNOMED CT are addressing this need for standardization, healthcare organizations can further advance data normalization strategies by leveraging the efficiencies and advantages of healthcare terminology management solutions.

Patient Accountability and Responsibility

Posted on February 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I think you can add this post to my series of posts on the Physician Revolt that I talked about earlier. The following message is from a doctor who emailed me. Obviously, they didn’t realize it would be published, so ignore some of the grammar errors, but the message is a good one that we should be discussing.

The doctors are going to be graded on the health outcomes but yet patients are going to do whatever. Nowhere in the law it states that patient is responsible for anything.

So while the ACOs are going to offer coverage…… there is going to be no immediate access due to shortage of MDs and the current MDs whose slots are overfilled are going to be dinged with penalties for not taking care of their patients completely (ie. all time coverage for all patients all the time). which means the MD has to refund the already reduced reimbursements back to the government because patients will complain about this.

Of course, the patients themselves will not tighten their belt and become personally responsible for their health so that they take up less appointment slots……..

So the significant question is Where are the patients held accountable in all these free health care reforms?

This is an important question as we shift to an ACO model. I think the above narrative places a little too much blame on the patient for the higher healthcare costs. Certainly there are things that doctors and our health system can do to lower costs that are outside of the patient. A simple example is 2 doctors ordering duplicate tests. If they just transferred the data, they’d provide the same care for a much lower cost. Plus, I think there are ways that a doctor together with a clinical care team can improve the overall quality of care of a patient population regardless of the patient’s choices. Another example of this is the hospital to PCP hand off. Doing this right can lower healthcare costs by reducing hospital readmissions.

While much can be done by doctors and the healthcare system as a whole, the doctor does raise a good question about patient responsibility. In what ways could we incentivize patients to take some accountability and responsibility for their healthcare as well?

The first thing that popped in my head was the way car insurance companies are doing it. One of the insurance companies is tapping into your car’s computer to monitor safe driving and then they provide discounts to you for being a safe driver. Are we going to have the same models in healthcare? In some ways we do, since if you’re a non-smoker your health insurance costs a lot less. Will health insurance companies start lowering a patient’s health insurance costs based on data from a wearable device that monitors your activity?

I’m honestly not sure how it’s all going to play out, but I am sure that healthcare IT is going to play a role in the process. We’ll never totally solve the issue of patient responsibility and accountability. That’s a feature of life, but I think that technology can help to hold us all more accountable for our health choices. What technologies do you see helping this?