medication reconciliation
DESCRIPTION
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 17 th , 2009. Group Two Use Case: Medication Reconciliation. - PowerPoint PPT PresentationTRANSCRIPT
Medication ReconciliationUniversity of Minnesota
N5115Spring 2009
Group 2
Jolene Dickerman, Denise Frederick, Tom Lewison, Chris Pensinger, Sue Strohschein,
Andrea Szkarlat
University of Minnesota NURS 5115 April 17th, 2009
Questions Addressed
Questions 1 & 3 Denise FrederickQuestion 2 Susan Strohschein
Questions 4 & 10 Andrea SzkarlatQuestions 5 & 11 Jolene DickermanQuestions 6 & 7 Chris PensingerQuestions 8 & 9 Thomas Lewison
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
1. Minnesota eHealth Initiative and 2015 Mandates
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation Group Two Use Case: Medication Reconciliation
“ 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 dataE-prescribingLab result managementTimely clinical decision support
2. Medication Reconciliation: an Identified Gap in Care
Start
Dschg Ordered
HUC Prints Med List Printed from
EHR
Charge RN Reviews
Pharmacy Processes
Floor RN
Patient
Preferred Pharmacy
End
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
Medication Reconciliation Reality
Start
Dschg Ordered
HUC Prints Med List Printed from
EHR
Charge RN Reviews
Pharmacy Processes
Floor RN
Patient
Preferred Pharmacy
End
Charge RN Writes the Final Med List onto the Discharge Note
University of Minnesota NURS 5115 April 17th, 2009
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 peopleDue to number of steps, increased chance of errorTime consuming, which equals more resources
and this means more costMedication list is a paper copy, no electronic
version available
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
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
4. Relationship of Use Case to eHealth Initiative
Improve patient safetyReduction of medication errors
Increase quality and efficiencyFewer paper copies“Flags” to notify providers
InteroperabilityContinuity of care“Smart card” proposal
Potential to aid in transition to e-prescribing
University of Minnesota NURS 5115 April 17th, 2009
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
Group Two Use Case: Medication Reconciliation
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
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
6. Expected improvements in medicationreconciliation workflow:
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
7. Necessary communication links:
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
Group Two Use Case: Medication Reconciliation
9. Relevant Data, Vocabulary, and Technical Standards
SNOMED-CT has 311,000 active conceptsSNOMED-CT is a registered standard with HL7Most comprehensive clinical vocabulary
available.Can cross-map to other international
standards Already used in more than fifty countriesSee following vocabulary example:
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
Demographic Data ElementsLocal Term From Use
CaseDefinition Content Vocabulary Term Code Standardized Vocabulary
Unique Patient Identifier Code specific to patient identification
Medical Record Number 39822500 SNOMED-CT
Last Name Legal Name Patient Identification 184096005 SNOMED-CT
First Name Legal Name Patient Identification 408677003 SNOMED-CT
Middle Initial Legal Name Patient Identification 397742009 SNOMED-CT
Street Address Physical Address Environment 397635003 SNOMED-CT
City City which patient resides Environment 284560003 SNOMED-CT
State State which patient resides
Environment 398070004 SNOMED-CT
Zip code Zip code of patient’s residence
Environment SNOMED-CT
10 Digit Phone Number Contact number Phone number 398198004 SNOMED-CT
Date of birth MM-DD-YYYY Birth date 184099003 SNOMED-CT
Primary Care Provider Health Care Professional Medical Practitioner 158965000 SNOMED-CT
Preferred Pharmacy Pharmacy of Choice Pharmacy Facility 264372000 SNOMED-CT
Primary Clinic Clinic of health care Health Care Related Organization
257585005 SNOMED-CT
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
Medication Data ElementsLocal Term From Use
CaseDefinition Content Vocabulary Term Code Standardized Vocabulary
Unique Patient Identifier Code specific to patient identification
Medical Record Number 39822500 SNOMED-CT
Allergies Patient’s drug allergies Hypersensitivity 106190000 SNOMED-CT
Medication Name Prescribed medication on discharge
Pharmaceutical Preparations
373873005 SNOMED-CT
Medication Dose Amount of medication Quantitative Concept 408102007 SNOMED-CT
Medication Route PO, SQ, IV, IM, topical Drug Administration Routes
263513008 SNOMED-CT
Medication Frequency Times to take medications
Frequencies (time pattern)
272123002 SNOMED-CT
Start Date When to begin medication
Date 118575009 SNOMED-CT
End Date When to stop medication Date 118575009 SNOMED-CT
Final Discharge Medication List
Therapeutic or Preventive Procedure
Medication Reconciliation
C2317067 SNOMED-CT
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
Discharge Data ElementsLocal Term From Use
CaseDefinition Content Vocabulary Term Code Standardized
Vocabulary
Final discharge medication list
List generated from final reconciliation process
Discharge Planning (procedure)
A3398333/SNOMED Clinical Terms/FN/371754007
SNOMED CT
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
DevelopmentResearch vendors to support needs (ie. Eclipsys)
Implementation Maintenance
Maryland Department of Information Technology (2008)
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
11. Proposal’s Desirability, Usability, and Feasibility
DesirabilityIncreased Provider efficiency and Patient safety
UsabilityPatient and Provider friendly system
FeasibilityCollaboration between multiple health systemsTimeframe to achieve interoperabilityFinancial and Regulatory requirements
University of Minnesota NURS 5115 April 17th, 2009
Group Two Use Case: Medication Reconciliation
ReferencesA 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-healthMaryland 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
Group Two Use Case: Medication Reconciliation