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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 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 36-40

Posted on September 27, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I hope you’re enjoying the series.

40. Do NOT let the finance department drive the EMR choice or deployment
I’m far too much of a physician advocate to even imagine a finance department driving the EMR choice and deployment plan. Ok, I understand that it happens, but it’s a travesty when it does. Considering the finance department will almost never use the system, it should make sense to everyone to have the users of the system help drive the EMR choice and deployment. After all, they will have to use the system once deployed.

Let’s not confuse what I’m saying. I’m not saying that finance shouldn’t be involved in the EMR choice. I’m not saying that finance can’t provide some great insights and an outside perspective. I also am not saying that users of the EMR should hold the hospital hostage with crazy demands that could never be met. It’s definitely a balance, but focus on the users of the EMR will lead to happy results.

39. Ensure work flow can be hard coded when necessary, and not hard coded when necessary
Related to this EHR tip is understanding when the EHR company has chosen to hard code certain fields or work flows. You’ll be surprised how many EHR have hard coded work flows with no way to change them. In some cases, that’s fine and even beneficial. However, in many other cases, it could really cause you pain in dealing with their hard coded work flows.

Realize which parts of the EHR can be changed/modified and which ones you’re stuck with (at least until the next release..or the next release….or the next release…).

38. You can move to population based medicine
You’re brave to do population based medicine on paper. Computers are great at crunching and displaying the data for this.

37. Safety is created by design
Just because you use an EHR doesn’t mean you don’t need great procedures that ensure safety. Sure, EHRs have some things built in to help with safety, but more often than not it’s a mixture of EHR functionality and design that results in safety. Don’t throw out all your principles of safety when you implement your EHR.

36. Medication Reconciliation should be a simple process
I’m not sure we’ve hit the holy grail of medication reconciliation in an EHR yet, but we’re getting closer. It’s worth the time to make this happen and will likely be required in the future.

If you want to see my analysis of the other 101 EMR and EHR tips, I’ll be updating this page with my 101 EMR and EHR tips analysis. So, click on that link to see the other EMR tips.