Medication Reconciliation

1. Medication Reconciliation University of Minnesota N5115 Spring 2009 Group 2 Jolene Dickerman, Denise Frederick, Tom Lewison, Chris Pensinger, Sue Strohschein, Andrea Szkarlat University of Minnesota NURS 5115 April 17th, 2009

2. Group Two Use Case: Medication Reconciliation Questions Addressed • Questions 1 & 3 Denise Frederick • Question 2 Susan Strohschein • Questions 4 & 10 Andrea Szkarlat • Questions 5 & 11 Jolene Dickerman • Questions 6 & 7 Chris Pensinger • Questions 8 & 9 Thomas Lewison University of Minnesota NURS 5115 April 17th, 2009

3. Group Two Use Case: Medication Reconciliation Group Two Use Case: Medication Reconciliation 1. Minnesota eHealth Initiative and 2015 Mandates • “ By January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health records system within their hospital system or clinical practice setting. “ • Synchronizing patient data • E-prescribing • Lab result management • Timely clinical decision support University of Minnesota NURS 5115 April 17th, 2009

4. Group Two Use Case: Medication Reconciliation 2. Medication Reconciliation: an Identified Gap in Care Preferred Pharmacy Start Pharmacy Processes Dschg Ordered Floor RN Charge RN Reviews HUC Prints Med List Printed from EHR Patient End University of Minnesota NURS 5115 April 17th, 2009

5. Group Two Use Case: Medication Reconciliation Medication Reconciliation Reality Preferred Pharmacy Start Pharmacy Processes Dschg Ordered Floor RN Charge RN Reviews Charge RN Writes the Final Med List onto the Discharge Note HUC Prints Med List Printed from EHR Patient End University of Minnesota NURS 5115 April 17th, 2009

6. Group Two Use Case: Medication Reconciliation 3.Proposed Use Case and Objectives • The use case we chose is Medication Reconciliation at the point of discharge from an inpatient facility to self-care at home. • Current process involves many steps and people • Due to number of steps, increased chance of error • Time consuming, which equals more resources and this means more cost • Medication list is a paper copy, no electronic version available University of Minnesota NURS 5115 April 17th, 2009

7. Use Case Objectives cont. • Promote accurate medication reconciliation at time of discharge through an EHR • Improve patient safety • Increase patient knowledge and understanding of prescribed medications • Create interoperability • Maintain focus on the needs of the patient regarding medication reconciliation

8. Group Two Use Case: Medication Reconciliation 4. Relationship of Use Case to eHealth Initiative • Improve patient safety Reduction of medication errors • Increase quality and efficiency Fewer paper copies “Flags” to notify providers • Interoperability Continuity of care “Smart card” proposal • Potential to aid in transition to e-prescribing University of Minnesota NURS 5115 April 17th, 2009

9. Group Two Use Case: Medication Reconciliation 5.Benefits of Use Case to Specific Stakeholders • Patient and Family • Providers (Hospital and Primary Care) • Nursing • Pharmacy • Community Care Agencies • Clinics/Hospitals • Insurance Companies • State and National Regulatory Agencies University of Minnesota NURS 5115 April 17th, 2009

10. Group Two Use Case: Medication Reconciliation 6. Expectedimprovements in medication reconciliation workflow: • Decrease in lost paper records • Reduction in errors • Improved efficiency • Expedites the discharge process • Clinical decision support assistance • Increased productivity • Electronic medication list for patients University of Minnesota NURS 5115 April 17th, 2009

11. Group Two Use Case: Medication Reconciliation 7. Necessary communication links: University of Minnesota NURS 5115 April 17th, 2009

12. Group Two Use Case: Medication Reconciliation 8. Functional Requirements Needed • Administration (demographics and financial) • Clinical Documentation • Data Export • Data Import • ePrescribing • Orders Management • Privacy Protection and Security University of Minnesota NURS 5115 April 17th, 2009

13. Group Two Use Case: Medication Reconciliation 9. Relevant Data, Vocabulary, and Technical Standards • SNOMED-CT has 311,000 active concepts • SNOMED-CT is a registered standard with HL7 • Most comprehensive clinical vocabulary available. • Can cross-map to other international standards • Already used in more than fifty countries • See following vocabulary example: University of Minnesota NURS 5115 April 17th, 2009

14. Group Two Use Case: Medication Reconciliation Demographic Data Elements University of Minnesota NURS 5115 April 17th, 2009

15. Group Two Use Case: Medication Reconciliation Medication Data Elements University of Minnesota NURS 5115 April 17th, 2009

16. Group Two Use Case: Medication Reconciliation Discharge Data Elements University of Minnesota NURS 5115 April 17th, 2009

17. Group Two Use Case: Medication Reconciliation 10. Proposed System Life Cycle • Initiation/Concept Development • Identified a need for improving medication reconciliation • Design • Using EHR exclusively to manage discharge meds • Smart card • Development • Research vendors to support needs (ie. Eclipsys) • Implementation • Maintenance Maryland Department of Information Technology (2008) University of Minnesota NURS 5115 April 17th, 2009

18. Group Two Use Case: Medication Reconciliation 11. Proposal’s Desirability, Usability, and Feasibility • Desirability • Increased Provider efficiency and Patient safety • Usability • Patient and Provider friendly system • Feasibility • Collaboration between multiple health systems • Timeframe to achieve interoperability • Financial and Regulatory requirements University of Minnesota NURS 5115 April 17th, 2009

19. Group Two Use Case: Medication Reconciliation References A Prescription for Meeting Minnesota’s 2015 Interoperable Electronic Health Record Mandate. A Statewide Implementation Plan. (June 2008) Retrieved April 10, 2009 from: http://www.health.state.mn.us/ehealth/ehrplan2008.pdf Barnsteiner J. Chapter 38: Medication reconciliation in Hughes RG (ed.) Patient safety and quality: An evidence-based handbook for nurses. Volume 2 (Prepared with support from the Robert Wood Johnson Foundation.) AHRQ Publication No. 08-0043. Rockville, MD: Agency for Healthcare Research and Quality; April 2008; p 2-459 International Health Terminology Standards Development Organization. (2009). About SNOMED-CT. Retrieved April 12, 2009 from: http://www.ihtsdo.org/snomed-ct/snomed-ct0/ http://www.health.state.mn.us/e-health Maryland Department of Information Technology: System Development Life Cycle (SDLC), Volume 1. (2008). Retrieved April 14, 2009 from: http://doit.maryland.gov/policies/Documents/sdlc/sdlcvol1.pdf NYEHealth Collaborative. (2008). The Statewide Collaboration Project. EHR Functional Requirements. Retrieved April 12, 2009 from: http://www.nyehealth.org/files/File_Repository16/pdf/EHR_Reqs_20081103.pdf University of Minnesota NURS 5115 April 17th, 2009