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What functionalities do I need to have implemented to perform medication reconciliation?

Medication errors are among the most common type of medical error.  Preventable medication errors are associated with 1 of 5 injuries or deaths from error and are a result of poorly designed systems.  Medication errors typically occur at transition points in the care system.  Almost half of medication errors in hospital settings occur on admission or discharge.  Medication errors in the outpatient setting happen most often when new medications are ordered or existing orders are rewritten.   Such errors may be related to omissions, duplications, dosing errors, or drug interactions.  They can be avoided by the medication reconciliation process, which compares a patient’s medication orders to a list of all of the medications that the patient has been taking and then resolving any discrepancies.  

Despite the potential of medication reconciliation to reduce medication errors and adverse drug effects, the process is a challenge for many healthcare organizations and practices.  Without an electronically compiled list, a provider must piece together an accurate medication history using information from multiple sources, including the patient, his/her caregiver, primary care physician, specialists, outpatient medical records, hospital discharge summaries, and community pharmacies.  In addition, physicians, nurses, and pharmacists typically use different tools and protocols for obtaining the medication history from the patient.  This uncoordinated set of activities often leads to patients being interviewed multiple times or results in incomplete medication histories.  

Although you could perform medication reconciliation by comparing paper-based medication lists, an electronic process for medication reconciliation more accurately and efficiently addresses the medication reconciliation process.  The home (or pre-admission) medication list could be compiled by leveraging the patient’s EHR and possibly the computerized provider order entry (CPOE) systems.  Providers would still need to ensure that the medication lists are complete (e.g., by interviewing the patient), but your certified EHR technology is capable of providing a user with the ability to electronically compare two or more medication lists (e.g., between the home, externally provided medication list and the current medication list in the certified EHR technology).     

Menus Set Objective for Eligible Professionals and Eligible Hospitals:  

  • The eligible professional or eligible hospital who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation.

Measure:

  • Perform medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the eligible professional or eligible hospital’s inpatient or emergency department.  

Exclusion:

  • Any eligible professional that was not on the receiving end of any transition of care during the EHR reporting period.

Note that this is a menu set objective for Stage 1 of the EHR Incentive Program, meaning that this objective is one of 10 menu set objectives of which providers must choose 5 out of these 10 of these objectives.  Stage 1 for those providers who participate in the program during its first years is expected to last for two years (from 2011 to 2013).  Stage 2 is expected to tighten the requirements for meeting this objective.  

The eligible professional or hospital who receives a patient from another setting of care or provider of care or who believes an encounter is relevant should be the one to perform medication reconciliation.  CMS defines medication reconciliation as the process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or provider.  Transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, and rehabilitation facility) to another.  CMS also defines relevant encounter as an encounter during which the eligible professional or hospital performs medication reconciliation due to a new medication or long gaps in time between patient encounters or for other reasons determined appropriate by the eligible professional or hospital.

CMS recognizes that all EHR technology may not support automated medication reconciliation so it does not require this during Stage 1.  Thus, it is acceptable for the EHR to present you with patient medication information that supports the reconciliation of medications and that non-electronic means are used to determine whether there are any discrepancies.  

The ability to calculate this measure is included in the certified EHR technology.  The denominator for this measure is the number of transitions of care during the EHR reporting period for which the eligible professional or hospital inpatient or emergency department was the receiving party of the transition. Only those transitions of care related to patients whose records are maintained using certified EHR technology are included in the denominator.  The numerator is the number of transitions of care in the denominator where medication reconciliation is performed.  

Related Resources:

EHR Incentive Program Final Rule – CMS’ rules and regulations for demonstrating Meaningful Use.  See pages 44362-44363 for detailed information on the medication reconciliation objective.
Medication Safety Issue Brief: Medication Reconciliation – Issue brief on medication reconciliation that highlights the causes of and solutions to medication errors.
Medication Reconciliation – Article on AHRQ’s Patient Safety Network (PSNet) provides background and helpful information on medication reconciliation and other suggested resources.
Medications at Transitions and Clinical Handoffs (MATCH) - Medication Reconciliation Toolkit – The toolkit developed by Northwestern Memorial Hospital provides materials to support the launch of a hospital-based medication reconciliation program.  Included are curricula and training materials.  
Using medication reconciliation to prevent errors – This Joint Commission article discusses risk reduction strategies to prevent errors using the medication reconciliation process.
Discussion Topics: Implementing Reconciling Processes – The Massachusetts Coalition for the Prevention of Medical Errors provides materials related to the reconciling medications.
Prevent Adverse Drug Effects (Medication Reconciliation) – The Institute for Healthcare Improvement Get Started Kit with instructions for implementing medication reconciliation in your organization.  

Developed by the Health Resources and Services Administration as a resource for health centers and other safety net and ambulatory care providers who are seeking to implement health IT.
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