Design and implementation of an application and associated services to support interdisciplinary medication reconciliation efforts at an integrated healthcare delivery network

Eric G Poon, Barry Blumenfeld, Claus Hamann, Alexander Turchin, Erin Graydon-Baker, Patricia C McCarthy, John Poikonen, Perry Mar, Jeffrey L Schnipper, Robert K Hallisey, Sandra Smith, Christine McCormack, Marilyn Paterno, Christopher M Coley, Andrew Karson, Henry C Chueh, Cheryl Van Putten, Sally G Millar, Margaret Clapp, Ishir Bhan, Gregg S Meyer, Tejal K Gandhi, Carol A Broverman, Eric G Poon, Barry Blumenfeld, Claus Hamann, Alexander Turchin, Erin Graydon-Baker, Patricia C McCarthy, John Poikonen, Perry Mar, Jeffrey L Schnipper, Robert K Hallisey, Sandra Smith, Christine McCormack, Marilyn Paterno, Christopher M Coley, Andrew Karson, Henry C Chueh, Cheryl Van Putten, Sally G Millar, Margaret Clapp, Ishir Bhan, Gregg S Meyer, Tejal K Gandhi, Carol A Broverman

Abstract

Confusion about patients' medication regimens during the hospital admission and discharge process accounts for many preventable and serious medication errors. Many organizations have begun to redesign their clinical processes to address this patient safety concern. Partners HealthCare, an integrated delivery network in Boston, Massachusetts, has answered this interdisciplinary challenge by leveraging its multiple outpatient electronic medical records (EMR) and inpatient computerized provider order entry (CPOE) systems to facilitate the process of medication reconciliation. This manuscript describes the design of a novel application and the associated services that aggregate medication data from EMR and CPOE systems so that clinicians can efficiently generate an accurate pre-admission medication list. Information collected with the use of this application subsequently supports the writing of admission and discharge orders by physicians, performance of admission assessment by nurses, and reconciliation of inpatient orders by pharmacists. Results from early pilot testing suggest that this new medication reconciliation process is well accepted by clinicians and has significant potential to prevent medication errors during transitions of care.

Figures

Figure 1
Figure 1
Generic process of medication reconciliation at inpatient admission and discharge.
Figure 2
Figure 2
Invocation of the PAML Builder.
Figure 3
Figure 3
(A) PAML Builder application: Patient with outpatient medication information residing in two electronic sources. (B). PAML Builder application: PAML being constructed by admitting clinician.
Figure 4
Figure 4
Viewing the PAML as inpatient orders are written.
Figure 5
Figure 5
Generating the discharge medication list. To help the provider generate the discharge medication list, the CPOE system at this institution lists all the active inpatient medication lists under the ‘discharge medications’ column. To turn any of the active inpatient medications into a discharge medication, the provider simply has to check the ‘select’ box next to that medication. With the medication reconciliation project, the pre-admission medication list becomes available at this workflow point. Therefore, if the active inpatient medication list is different from the pre-admission medication list, the provider can reconcile the two lists at this point.
Figure 6
Figure 6
Cross-functional flowchart: typical PAML Builder use for medical patient.
Figure 7
Figure 7
Cross-functional flowchart: typical PAML Builder use for elective surgical admission.
Figure 8
Figure 8
Cross-functional flowchart: typical PAML Builder use at patient discharge.
Figure 9
Figure 9
Information model for the PAML repository.

Source: PubMed

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