Electronic Medication Management ( eMM )

1. Electronic Medication Management (eMM) Concepts and Definitions Dr Stephen Chu

2. eMM Key Concepts and Definitions • 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

3. 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 previouslyprescribed and dispensed medications (may include over-the-counter medications) for an individual • Retrospective in nature, but can contain continuing/future meds • 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 currentlytaking as identified atthe time of review

4. 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 • Current Medication List • A list of all medications (prescribed and over-the-counter) that an individual should be/known to be currentlytaking as identified atthe 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]

5. eMM Key Concepts and Definitions • Medication Statement (HL7 Concept) • Used to assert that a patient is "on" a medication independent of the knowledge of specific events such as prescriptions, administrations and dispenses • used: • When we have knowledge that a patient is taking a particular med and don't have knowledge of the underlying events (or those events aren't relevant) • When we have knowledge that a patient is taking a particular med and we *do* know the details about the underlying events, but from a workflow perspective it would be inappropriate or unnecessary to capture the details, but it's still important to capture the patient/drug

6. eMM Key Concepts and Definitions • Medication Profile • Comprehensive list of medications taken by a patient with information on indications, actions, use patterns, and may include • precautions, side effects, contraindications, max cumulated dose, 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)

7. eMM Key Concepts and Definitions • 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, max cumulated dose 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

8. eMM Key Concepts and Definitions • 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, max cumulated dose, contraindications), and • medication management recommendations

9. eMM Key Concepts and Definitions • Medication Review Record • Comprehensive and authoritative reviewed list of all medications (prescribe and over-the-counter) that a patient is current taking • And outcome of the review • Includes recommendations regarding proposed changes and ongoing medication management where applicable/required

10. eMM Key Concepts and Definitions • 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

11. eMM Key Concepts and Definitions • 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

12. eMM Key Concepts and Definitions • 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

13. IHE Pharmacy documents • From: ihe-pharmacy@googlegroups.com [mailto:ihe-pharmacy@googlegroups.com] On Behalf Of Marco DemarmelsSent: Wednesday, 20 June 2012 3:13 AMTo: ihe-pharmacy@googlegroups.com; pharmacy@lists.hl7.orgSubject: [IHE-Pharmacy:] Stephen Chu's "eMM Key Concepts and Definitions" in the Pharmacy glossary • Dear pharmacites • I have incorporated Stephen's definitions into the IHE/HL7 Pharmacy glossary spreadsheet: • https://docs.google.com/spreadsheet/ccc?key=0AmpTn7l3l1lfdFFQNFhzd0FqRUxaTUNneUZhTkk2YlE • I deliberately left out the concept "Medication Documentation" from the glossary because it doesn't represent • a term to be harmonized between HL7 and IHE, but rather explains the goals of the IHE Pharmacy whitepaper with that title. • Stephen Chu's "eMM Key Concepts and Definitions" presentation was sent around as an attachment. • In addition to that I made it available as a Google Doc: • https://docs.google.com/file/d/0B2pTn7l3l1lfTWpNUVpSU3dfZGc/edit • I would like to thank Stephen again for this valuable contribution and the presentation today in the IHE Pharmacy telco. • Cheers Marco

14. IHE Pharmacy documents