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 17 th, 2009

2. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

3. 1. Minnesota eHealth Initiative and 2015 Mandates University of Minnesota NURS 5115 April 17 th, 2009 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 data  E-prescribing  Lab result management  Timely clinical decision support

4. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

5. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

6. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

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. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

9. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

10. University of Minnesota NURS 5115 April 17 th, 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 medication reconciliation workflow :

11. University of Minnesota NURS 5115 April 17 th, 2009 Group Two Use Case: Medication Reconciliation NursingPhysiciansPharmacy Information Technology Patients Ancillary services Outpatient clinics 7. Necessary communication links:

12. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

13. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

14. University of Minnesota NURS 5115 April 17 th, 2009 Group Two Use Case: Medication Reconciliation Demographic Data Elements Local Term From Use Case Definition ContentVocabulary TermCodeStandardized Vocabulary Unique Patient IdentifierCode specific to patient identification Medical Record Number39822500SNOMED-CT Last NameLegal NamePatient Identification184096005SNOMED-CT First NameLegal NamePatient Identification408677003SNOMED-CT Middle InitialLegal NamePatient Identification397742009SNOMED-CT Street AddressPhysical AddressEnvironment397635003SNOMED-CT CityCity which patient residesEnvironment284560003SNOMED-CT StateState which patient resides Environment398070004SNOMED-CT Zip codeZip code of patient’s residence EnvironmentSNOMED-CT 10 Digit Phone NumberContact numberPhone number398198004SNOMED-CT Date of birthMM-DD-YYYYBirth date184099003SNOMED-CT Primary Care ProviderHealth Care ProfessionalMedical Practitioner158965000SNOMED-CT Preferred PharmacyPharmacy of ChoicePharmacy Facility264372000SNOMED-CT Primary ClinicClinic of health careHealth Care Related Organization 257585005SNOMED-CT

15. University of Minnesota NURS 5115 April 17 th, 2009 Group Two Use Case: Medication Reconciliation Medication Data Elements Local Term From Use Case Definition ContentVocabulary TermCodeStandardized Vocabulary Unique Patient IdentifierCode specific to patient identification Medical Record Number39822500SNOMED-CT AllergiesPatient’s drug allergiesHypersensitivity106190000SNOMED-CT Medication NamePrescribed medication on discharge Pharmaceutical Preparations 373873005SNOMED-CT Medication DoseAmount of medicationQuantitative Concept408102007SNOMED-CT Medication RoutePO, SQ, IV, IM, topicalDrug Administration Routes 263513008SNOMED-CT Medication FrequencyTimes to take medications Frequencies (time pattern) 272123002SNOMED-CT Start DateWhen to begin medication Date118575009SNOMED-CT End DateWhen to stop medicationDate118575009SNOMED-CT Final Discharge Medication List Therapeutic or Preventive Procedure Medication Reconciliation C2317067SNOMED-CT

16. University of Minnesota NURS 5115 April 17 th, 2009 Group Two Use Case: Medication Reconciliation Discharge Data Elements Local Term From Use Case Definition ContentVocabulary TermCodeStandardized Vocabulary Final discharge medication list List generated from final reconciliation process Discharge Planning (procedure) A3398333/SNOMED Clinical Terms/FN/371754007 SNOMED CT

17. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

18. 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 17 th, 2009 Group Two Use Case: Medication Reconciliation

19. 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 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.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 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 http://www.nyehealth.org/files/File_Repository16/pdf/EHR_Reqs_20081103.pdf University of Minnesota NURS 5115 April 17 th, 2009 Group Two Use Case: Medication Reconciliation