Medication reconciliation
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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.

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Medication Reconciliation

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Medication reconciliation

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


Questions addressed

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


1 minnesota ehealth initiative and 2015 mandates

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


2 medication reconciliation an identified gap in care

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


Medication reconciliation reality

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


3 proposed use case and objectives

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


Use case objectives cont

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

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


5 benefits of use case to specific stakeholders

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


Medication reconciliation

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


Medication reconciliation

Group Two Use Case: Medication Reconciliation

7. Necessary communication links:

University of Minnesota NURS 5115 April 17th, 2009


8 functional requirements needed

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


9 relevant data vocabulary and technical standards

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


Demographic data elements

Group Two Use Case: Medication Reconciliation

Demographic Data Elements

University of Minnesota NURS 5115 April 17th, 2009


Medication data elements

Group Two Use Case: Medication Reconciliation

Medication Data Elements

University of Minnesota NURS 5115 April 17th, 2009


Discharge data elements

Group Two Use Case: Medication Reconciliation

Discharge Data Elements

University of Minnesota NURS 5115 April 17th, 2009


10 proposed system life cycle

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


11 proposal s desirability usability and feasibility

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


References

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


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