Medication Reconciliation

MU Requirements

Meaningful Use Measures:

Perform medication reconciliation for at least 80% of relevant encounters and transitions of care.

Certification Criteria for EHR:

Electronically complete medication reconciliation of two or more medication lists (compare and merge) into a single medication list that can be electronically displayed in real-time.

Requirements Detailed

The business function for this is pretty straight forward. Physicians need to be able to see past medications and prescriptions, review them with the patient and easily log that they have done so, and report on it when requested.

In semi formal requirements language:

1. Meaningful Use Measures: The system shall allow the provider to Perrform medication reconciliation for at least 80% of relevant encounters and transitions of care.
2. Certification Criteria for EHR: The system shall allow the provider to Electronically complete medication reconciliation of two or more medication lists (compare and merge) into a single medication list that can be electronically displayed in real-time. ** THIS MAY NOT be needed as we only have one medication list *** I'll add this to the issues list for tonights MU Project meeting
3. Use Case:
   1. Provide or authorized staff retrieves a list of the current patients medications displayed on screen from form all the places that Medications and Prescriptions can be entered.
   2. Provider reviews each medication that has NOT been canceled (special case)
   3. Provider logs the current state of the medication, system logs date and time reviewed in the correct table and the log table with an appropriate status
   4. Reporting: The provider or authorized staff shall have the ability to report reviews including percentages as indicated in #1. Contents of the report may need to be de-identified per HIPAA requirements (add this issue)

Propsed Solution

1. Ensure information about Reconciliation can be seen from the Patients records

2. Add 2 columns: Status and Reconciled Date to the editing table columns:

3. For each record, add a new status: current, canceled, discontinued. The active field is not sufficient for addressing the need here. We cannot delete a medication record. So we need a "canceled" status for any input mistake, e.g. wrong name or a duplicate. Discontinued is used when the patient is no longer taking the medication.

4. Disallow editing of medication record, especially prescription. Legally, this is not allowed.

Effected Code, Tables, etc

Table: add 3 new fields to prescriptions table:

• type - To identity type of medication, e.g. prescriptions, OTC, supplements
• status – To record the status of the medication record
• date – To record the date medication reconciliation has been made

  -- 
  -- Table structure for table `lists`
  -- 

  DROP TABLE IF EXISTS `lists`;
  CREATE TABLE `lists` (
 `id` bigint(20) NOT NULL auto_increment,
 `date` datetime default NULL,
 `type` varchar(255) default NULL,
 `title` varchar(255) default NULL,
 `begdate` date default NULL,
 `enddate` date default NULL,
 `returndate` date default NULL,
 `occurrence` int(11) default '0',
 `classification` int(11) default '0',
 `referredby` varchar(255) default NULL,
 `extrainfo` varchar(255) default NULL,
 `diagnosis` varchar(255) default NULL,
 `activity` tinyint(4) default NULL,
 `comments` longtext,
 `pid` bigint(20) default NULL,
 `user` varchar(255) default NULL,
 `groupname` varchar(255) default NULL,
 `outcome` int(11) NOT NULL default '0',
 `destination` varchar(255) default NULL,
 `reinjury_id` bigint(20)  NOT NULL DEFAULT 0,
 `injury_part` varchar(31) NOT NULL DEFAULT ,
 `injury_type` varchar(31) NOT NULL DEFAULT ,
 `reconcilestatus` varchar(255) default NULL,         <--- Status
 `reconcilenote` TEXT default NULL,                   <--- Note
 `reconciledate` DATE default NULL,                   <--- Date
 PRIMARY KEY  (`id`)
 ) ENGINE=MyISAM AUTO_INCREMENT=1 ;

Code

  interface/patient_file/summary/add_edit_issue.php b/interface/patient_file/summary/add_edit_issue.php
  interface/patient_file/summary/stats_full.php b/interface/patient_file/summary/stats_full.php
  interface/reports/prescriptions_report.php b/interface/reports/prescriptions_report.php
  library/globals.inc.php b/library/globals.inc.php
  sql/3_2_0-to-4_0_0_upgrade.sql
  sql/database.sql b/sql/database.sql

Owner and Status

Initial Design - Tony McCormick (MI2) and Thomas Wong (Intesync)

Design/Coding - EMR Technical Solutions, LLC: Verbus Counts and team

Links

• CCHIT_MU_2011_Project
• NABP Law Library: See the Law section at http://www.nabp.net