national e-health transition authority 1 electronic medication management (emm) dr stephen chu...

National E-Health Transition Authoritywww.nehta.gov.au

1

Electronic Medication Management (eMM)

Dr Stephen Chu

Concepts and Definitions

2 National E-Health Transition Authoritywww.nehta.gov.au

Medication List• A record of prescribed and dispensed medications for an individual• Can be unreconciled or reconciled

• Unreconciled Medication List A list of prescribed and dispensed medications for an individual

that is automatically generated A raw list that has not undergone [human] clinical review,

validation and reconciliation processing

• Reconciled Medication List A list of all medications that an individual known to be taking The list is the outcome of comprehensive and authoritative

clinical review, validation and reconciliation Omissions, inconsistencies, e.g. duplicates, are identified and

rectified

eMM Key Concepts and Definitions


Medication List• A record of prescribed and dispensed medications for an

individual• Can be unreconciled or reconciled • Medication History List

A record of previously prescribed and dispensed medications (may include over-the-counter medications) for an individual

It is retrospective in nature Can be automatically [system] generated by queries performed

against databases of ePrescription and eDispense records

• Current Medication List A list of all medications (prescribed and over-the-counter) that an

individual should be/known to be currently taking as identified at the time of review



Medication List• A record of prescribed and dispensed medications for an

individual• Can be unreconciled or reconciled • Medication History List• Current Medication List

A list of all medications (prescribed and over-the-counter) that an individual should be/known to be currently taking as identified at the time of review

• The concepts of “Current or Past Medication List” is temporal and contextual in nature. They present significant challenges in information

management and pose serious clinical safety risks especially when merging data from such lists automatically into clinical information system or EHR/EMR repositories]




Medication Profile• Comprehensive list of medications taken by a patient

with information on indications, actions, use patterns, and may include precautions, side effects, contraindications, and known allergy,

intolerance histories where applicable Managed contraindications Failed therapy Patient preferences

• May include diagnosis and pre-existing conditions to allow contra-indication (may include supporting clinical evidences such as diagnostic results) checks

• (may include genetic profile in future)



Medication Management Plan A structured, formally defined scheme of patient medication

management strategies and actions, including: Patient’s demographics, problems/diagnoses and pre-existing

conditions (including allergies and intolerances) List of medications Indications, actions, contraindications, precautions and

managed contraindications where applicable Patient preferences; failed therapy Medication [supply and administration] schedules where

applicable/necessary Ongoing medication management strategies/recommendations Next review due

May be stand alone or part of comprehensive care plan Shared with other authorised health care providers



Medication Review• A process of systematic evaluation of a person’s

complete medication regimen and management of the medications*1

• Includes a comprehensive, accurate medication history of the patient careful examination of the purposes and actual use of

individual medications issues identified (including indications, actions, uses, effects

and side effects), and medication management recommendations



Medication Review Record• Comprehensive and authoritative reviewed list of all

medications (prescribe and over-the-counter) that a patient is current taking

• Includes recommendations regarding proposed changes and ongoing medication management where applicable/required



Medication Documentation• An IHE pharmacy white paper• Identify the information requirements and structure from the

various information sources on known prescription, dispenses and administration

• Identify a standardised reference structure and semantics for harmonized medication data documentation to support procuring, representing and viewing medication data from

various sources Clinical consultation and patient medication management Medication review and reconciliation Secondary uses: clinical effectiveness and cost effectiveness

analysis; epidemiological and bio-surveillance analysis; management and executive decision analysis


Medication Reconciliation• Medication reconciliation is a formal process of obtaining and

verifying a complete and accurate list of each patient’s current medicines. Matching the medicines the patient should be prescribed to those they are actually prescribed. Where there are discrepancies, these are discussed with the prescriber and reasons for changes to therapy are documented. When care is transferred (e.g. between wards, hospitals or home), a current and accurate list of medicines, including reasons for change is provided to the person taking over the patient’s care. Points of

transition that require special attention are*2 Admission to hospital Transfers within hospital (e.g. ED to ward; ICU to ward, etc) From the hospital to home, residential aged care facilities or to

another hospital



Medication Reconciliation• The process of comparing various medications lists to

avoid errors such as transcription, omission, duplication of therapy, drug-drug and drug-disease interactions *3 Based on this definition, the medication reconciliation processes

include comparing and rectifying discrepancies as well as review of medication management therapy

• It refers to the process of reviewing the patient’s complete medication regimen on admission, at transfer and discharge, comparing it with the regimen being considered for the new care setting. The process aims at avoiding inadvertent inconsistencies in medication regimen across transition in care *4


national e-health transition authority 1 electronic medication management (emm) dr stephen chu...

Documents

unreconciled medication

past medication list

list of prescribed

accurate medication

therapy medication supply

raw list

dispensed medications

definitions slide