A prospective assessment of the Medicaid Web portal for admission medication reconciliation at a community hospital in Montana

2021 ◽  
Author(s):  
Lauren K Parks ◽  
Ian R McGrane ◽  
Jayme L Hartzell
Keyword(s):  
Hospital Admission ◽  
Information Exchange ◽  
Medication Reconciliation ◽  
Health Information Exchange ◽  
Improve Patient Care ◽  
The State ◽  
Quality Improvement Initiative ◽  
Medication List ◽  
Web Portal ◽  
Medication History

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Medication reconciliation (MR) is a complicated and tedious process but is crucial to prevent errors when ordering patients’ discharge medications during a hospital admission. Our institution currently uses a variety of methods to gather a patient’s medication history, including review of the medical records and electronic pharmaceutical claims data (EPCD) from a commercial health information exchange organization, as well as a patient or caregiver interview. Occasionally, more information is needed to obtain the most accurate history. To augment current methods, EPCD can also be accessed for patients with Medicaid insurance using a state Medicaid Web portal. We aimed to evaluate the utility of the Medicaid Web portal for reducing medication errors during the MR process at hospital admission. Summary A single-center, prospective, quality improvement initiative was conducted to evaluate 100 patient medication lists for all nonobstetric Medicaid patients admitted to our institution to identify discrepancies in medication lists when the state Medicaid Web portal was used in addition to standard MR methods. We found that, when EPCD from commercial organizations were available, they matched the patient’s current medication list 64% of the time. One in 4 patients had at least 1 discrepancy on their verified medication list that was identified using the Medicaid Web portal. The discrepancies identified were addressed and corrected in real time to improve patient care. Conclusion EPCD from the state Medicaid Web portal could supplement the use of current methods to obtain a more accurate medication history and reduce the number of erroneously ordered discharge medications during hospital admission.

scholarly journals Medication reconciliation in admission hospitalization: retrospective study

2020 ◽  
Vol 11 (2) ◽  
pp. 397
Author(s):  
JULIANA DORNELES ◽  
Calize O. SANTOS ◽  
Lucélia H. LIMA ◽  
Carine R. BLATT
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
Hospital Admission ◽  
Medication Reconciliation ◽  
Medication List ◽  
Porto Alegre ◽  
Medication History ◽  
Large Hospital ◽  
Anatomic Therapeutic Chemical ◽  
The City

Objective: to quantify and describe the discrepancies found in medication reconciliation (MR) in patients at hospital admission. Methods: Retrospective study performed from September to November 2018, based on data from the MR of patients at hospital admission of a large hospital in the city of Porto Alegre / RS. MR was shared with nursing (collection of patient’s medication history) and pharmacy (comparison of medication list before and during hospitalization). The referred drugs were classify according to the Anatomic Therapeutic Chemical (ATC) classification in their first level and the discrepancies were classify according to intentionality (intentional and unintentional). Results: 81 patients submitted to MR, and 80% of them had some discrepancy. Of the 328 drugs evaluated, 44.8% presented discrepancies, totaling 147 discrepancies, being intentional (n= 97) and unintentional (n= 50). The omission of medication was the most frequent discrepancies (48.3%). After identify unintencional discrepancies 50% of drug were included in prescription. Cardiovascular drugs and digestive and metabolism drugs were the groups with the highest frequency of discrepancy. Conclusion: Since 80% of prescriptions on hospital admission had some discrepancy regarding the use of medication by patients before hospital admission, it is understood the importance of performing MR as a pharmaceutical service and with the objective of increasing patient safety regarding drug therapy.

scholarly journals A web application to involve patients in the medication reconciliation process: a user-centered usability and usefulness study

2018 ◽  
Vol 25 (11) ◽  
pp. 1488-1500
Author(s):  
Sophie Marien ◽  
Delphine Legrand ◽  
Ravi Ramdoyal ◽  
Jimmy Nsenga ◽  
Gustavo Ospina ◽  
...  
Keyword(s):  
Web Application ◽  
Medication Reconciliation ◽  
Qualitative Data ◽  
Improve Patient Safety ◽  
Three Dimensions ◽  
Medication List ◽  
Medication History ◽  
Medication Discrepancies ◽  
System Usability Scale ◽  
User Centered

Abstract Objective Medication reconciliation (MedRec) can improve patient safety by resolving medication discrepancies. Because information technology (IT) and patient engagement are promising approaches to optimizing MedRec, the SEAMPAT project aims to develop a MedRec IT platform based on two applications: the “patient app” and the “MedRec app.” This study evaluates three dimensions of the usability (efficiency, satisfaction, and effectiveness) and usefulness of the patient app. Methods We performed a four-month user-centered observational study. Quantitative and qualitative data were collected. Participants completed the system usability scale (SUS) questionnaire and a second questionnaire on usefulness. Effectiveness was assessed by measuring the completeness of the medication list generated by the patient application and its correctness (ie medication discrepancies between the patient list and the best possible medication history). Qualitative data were collected from semi-structured interviews, observations and comments, and questions raised by patients. Results Forty-two patients completed the study. Sixty-nine percent of patients considered the patient app to be acceptable (SUS Score ≥ 70) and usefulness was high. The medication list was complete for a quarter of the patients (7/28) and there was a discrepancy for 21.7% of medications (21/97). The qualitative data enabled the identification of several barriers (related to functional and non-functional aspects) to the optimization of usability and usefulness. Conclusions Our findings highlight the importance and value of user-centered usability testing of a patient application implemented in “real-world” conditions. To achieve adoption and sustained use by patients, the app should meet patients’ needs while also efficiently improving the quality of MedRec.

It’s Time for Health Record Banking!

2014 ◽  
Vol 53 (02) ◽  
pp. 63-65 ◽  
Author(s):  
A. Shabo Shvo
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
State Of The Art ◽  
The State ◽  
Lessons Learned ◽  
Health Record ◽  
Health Records

SummaryThis article is part of a Focus Theme of Methods of Information in Medicine on Health Record Banking. This Focus Theme aims at describing the Health Record Banking (HRB) paradigm, which offers an alternative constellation of health information exchange and integration through sustainability of health records over the lifetime of individuals by independent and trusted organizations.It also aims at describing various approaches to HRB and reporting on the state-of-the-art HRB through actual implementations and lessons learned, as described in articles of this Focus Theme.

scholarly journals Identifying Unintentional Medication Discrepancies at Admission among Elderly Inpatients in Vietnam

2021 ◽  
Author(s):  
Phuong Thi Xuan Dong ◽  
Van Thi Thuy Pham ◽  
Linh Thi Nguyen ◽  
Thao Thi Nguyen ◽  
Huong Thi Lien Nguyen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admission ◽  
Medication Reconciliation ◽  
Negative Impact ◽  
Medication History ◽  
Medication Discrepancies ◽  
Medication Discrepancy ◽  
Chronic Medication ◽  
Elderly Inpatients

Abstract Background Elderly patients are at high risk of unintentional medication discrepancies during transition care as they are more likely to have multiple comorbidities and chronic diseases that require multiple medications. The main objective of the study was to measure the occurrence and identify risk factors for unintentional medication discrepancies in elderly inpatients during hospital admission.Methods A prospective observational study was conducted from July to December 2018 in a 800-bed geriatric hospital in Hanoi, North Vietnam. Patients over 60 years of age, admitted to one of selected internal medicine wards, taking at least one chronic medication before admission, and staying at least 48 hours were eligible for enrolment. Medication discrepancies of chronic medications before and after admission of each participant were identified by a pharmacist using a step-by-step protocol for the medication reconciliation process. The identified discrepancies were then classified as intentional or unintentional by an assessment group comprised of a pharmacist and a physician. A logistic regression model was used to identify risk factors of medication discrepancies.Results Among 192 enrolled patients, 328 medication discrepancies were identified; of which 87 (26.5%) were unintentional. 32.3% of patients had at least one unintentional medication discrepancy. The most common unintentional medication discrepancy was omission of drugs (75.9% of 87 medication discrepancies). The logistic regression analysis revealed a positive association between the number of discrepancies at admission and the type of treatment wards. Conclusions Medication discrepancies are common at admission among Vietnamese elderly inpatients. This study confirms the importance of obtaining a comprehensive medication history at hospital admission and supports implementing a medication reconciliation program to reduce the negative impact of medication discrepancy, especially for the elderly population.

Discrepancies Between the Medication List in Electronic Prescribing Systems and Patients' Actual Use of Medicines

2019 ◽  
Vol 34 (5) ◽  
pp. 317-324
Author(s):  
Cille Bülow ◽  
Christine Flagstad Bech ◽  
Kirstine Ullitz Faerch ◽  
Jon Trærup Andersen ◽  
Helle Byg Armandi ◽  
...  
Keyword(s):  
Health Care ◽  
Medication Reconciliation ◽  
Health Care Systems ◽  
Electronic Prescribing ◽  
Medication List ◽  
Medication History ◽  
Danish Health ◽  
Current Medication ◽  
Actual Use ◽  
Care Systems

Discrepancies between electronic prescribing systems and patients' actual use of medicines can result in adverse events and medication errors and have serious consequences for the patients. The discrepancies can be identified when performing a thorough medication reconciliation. Computerized health care systems throughout the Danish health care sector are integrated with the Shared Medication Record (SMR). In the SMR, current medication and medication prescriptions are registered. The aim of this study was to evaluate the number and types of discrepancies between medications listed in the SMR and an updated medication list, obtained through a thorough medication reconciliation, for patients admitted in Danish hospitals. Pharmacists listed the number and type of discrepancies for 412 patients. A total of 1,004 discrepancies were registered, with a mean number of 2.4 medication discrepancies per patient. For 25% (n = 101) of the patients, no discrepancies were found, 20% (n = 86) had one discrepancy, and 16% (n = 66) had five or more discrepancies. More than 50% of the patients had one or more medications in the SMR that the patient did not administer, and 12.6% used medications that were not listed in the SMR. This shows that the SMR should not be used as the only source of information when recording medication history.

scholarly journals Effect of health information exchange on recognition of medication discrepancies is interrupted when data charges are introduced: results of a cluster-randomized controlled trial

2017 ◽  
Vol 24 (6) ◽  
pp. 1095-1101 ◽  
Author(s):  
Kenneth S Boockvar ◽  
William Ho ◽  
Jennifer Pruskowski ◽  
Katherine E DiPalo ◽  
Jane J Wong ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Information Exchange ◽  
Medication Reconciliation ◽  
Health Information Exchange ◽  
Controlled Trial ◽  
Insurance Plan ◽  
Medication Discrepancies ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
And Control

Abstract Objectives To determine the effect of health information exchange (HIE) on medication prescribing for hospital inpatients in a cluster-randomized controlled trial, and to examine the prescribing effect of availability of information from a large pharmacy insurance plan in a natural experiment. Methods Patients admitted to an urban hospital received structured medication reconciliation by an intervention pharmacist with (intervention) or without (control) access to a regional HIE. The HIE contained prescribing information from the largest hospitals and pharmacy insurance plan in the region for the first 10 months of the study, but only from the hospitals for the last 21 months, when data charges were imposed by the insurance plan. The primary endpoint was discrepancies between preadmission and inpatient medication regimens, and secondary endpoints included adverse drug events (ADEs) and proportions of rectified discrepancies. Results Overall, 186 and 195 patients were assigned to intervention and control, respectively. Patients were 60 years old on average and took a mean of 7 medications before admission. There was no difference between intervention and control in number of risk-weighted discrepancies (6.4 vs 5.8, P = .452), discrepancy-associated ADEs (0.102 vs 0.092 per admission, P = .964), or rectification of discrepancies (0.026 vs 0.036 per opportunity, P = .539). However, patients who received medication reconciliation with pharmacy insurance data available had more risk-weighted medication discrepancies identified than those who received usual care (8.0 vs 5.9, P = .038). Discussion and Conclusion HIE may improve outcomes of medication reconciliation. Charging for access to medication information interrupts this effect. Efforts are needed to understand and increase prescribers’ rectification of medication discrepancies.

scholarly journals Completeness of Medication Reconciliation by Pediatric Residents at Hospital Admission for Asthma

2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Ashley Martin ◽  
Jaime McDonald ◽  
Joanna Holland
Keyword(s):  
Hospital Admission ◽  
Medication Errors ◽  
Medication Reconciliation ◽  
Retrospective Chart Review ◽  
Drug Dose ◽  
Oral Drug ◽  
Medication History ◽  
Resident Physicians ◽  
Quality Improvement Interventions ◽  
Time Of Admission

Background: Medication errors at hospital admission, though preventable, continue to be common. The process of medication reconciliation has been identified as an important tool in reducing medication errors. The first step in medication reconciliation involves documenting a patient’s best possible medication history (BPMH); at the authors’ tertiary pediatric hospital, this step is completed at time of admission by resident physicians. Objectives: To describe and quantify the completeness of admission BPMH by resident physicians for pediatric inpatients with asthma. Methods: This single-centre, retrospective chart review evaluated documentation of admission medication reconciliation for pediatric inpatients with asthma who were admitted between January 2016 and December 2017. Medication reconciliation forms were deemed incomplete if records for asthma medications were missing drug name, inhaler strength or oral drug dose, directions for use, or evidence of reconciliation. Results: A total of 241 charts were evaluated, of which 97 (40%) had incomplete documentation for at least 1 medication; in particular, 48 (37%) of the 130 inhaled corticosteroid orders were missing inhaler strength. For most of the charts with incomplete medication history (68% [66/97]), no reason was documented; however, review of the medication reconciliation forms and physician notes revealed that families might have been unsure of a patient’s home medications or physicians might have left it to the pharmacy to clarify medication doses. Conclusions: Documentation of inhaler medications on admission medication reconciliation forms completed by resident physicians for pediatric patients with asthma was often incomplete. Future quality improvement interventions, including resident and patient education, are required at the study institution. Collaboration with pharmacy services is also likely to improve completeness of the medication reconciliation process. RÉSUMÉ Contexte : Bien qu’elles soient évitables, les erreurs de médication au moment de l’admission à l’hôpital sont encore répandues. Le processus du bilan comparatif des médicaments a été reconnu comme étant un outil important pour réduire ces erreurs. La première étape du bilan comparatif des médicaments vise à décrire le meilleur schéma thérapeutique possible (MSTP) du patient; dans l’hôpital pédiatrique tertiaire des auteurs, les médecins résidents se chargent de cette étape au moment de l’admission. Objectifs : Décrire et quantifier le degré d’exhaustivité du MSTP réalisé par les médecins résidents pour les patients en pédiatrie souffrant d’asthme. Méthodes : Cet examen rétrospectif unicentrique des dossiers a permis d’évaluer l’élaboration du bilan comparatif des médicaments à l’admission en pédiatrie des patients souffrant d’asthme entre janvier 2016 et décembre 2017. Les formulaires de bilan comparatif des médicaments étaient jugés incomplets si les dossiers relatifs aux médicaments contre l’asthme n’indiquaient pas le nom du médicament, la force de l’inhalateur ou la dose orale du médicament, le mode d’emploi ou les preuves de conciliation médicamenteuse. Résultats : L’évaluation portait sur 241 tableaux; au moins 1 médicament manquait dans la description de 97 d’entre eux (40 %); en particulier la force de l’inhalateur ne figurait pas dans 48 (37 %) des 130 ordonnances relatives aux corticostéroïdes administrés par inhalation. La plupart des tableaux dont l’histoire pharmacothérapeutique était incomplète (68 % [66/97]) n’en indiquaient pas la raison; cependant, l’examen des formulaires du bilan comparatif des médicaments et les notes des médecins ont révélé que les familles n’étaient peut-être pas certaines des médicaments que le patient prenait à domicile ou que les médecins auraient pu laisser aux pharmaciens le soin de clarifier les doses. Conclusions : La description des médicaments administrés au moyen d’inhalateurs au moment de l’admission, figurant sur les formulaires du bilan comparatif des médicaments remplis par les médecins résidents pour les patients en pédiatrie souffrant d’asthme, était souvent incomplète. De futures interventions sur l’amélioration de la qualité, y compris les instructions données au patient et au résident, sont nécessaires dans l’institution où s’est déroulée l’étude. Il est probable que la collaboration avec les services de pharmacie améliorerait l’exhaustivité du processus du bilan comparatif des médicaments.

Future Sustainability of the Florida Health Information Exchange

2013 ◽  
Vol 15 (3) ◽  
pp. 38-46
Author(s):  
Alice M. Noblin ◽  
Kendall Cortelyou-Ward
Keyword(s):  
Health Care ◽  
Information Sharing ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Care Industry ◽  
The State ◽  
Care Industry ◽  
Basic Services

Florida began the journey to health information connectivity in 2004 under Governor Jeb Bush. Initially these efforts were funded by grants, but due to the downturn in the economy, the state was unable to support growth in 2008. The American Recovery and Reinvestment Act (ARRA) of 2009 provided funding to further expand health information exchange efforts across the country. As a result, Florida was now able to move forward and make progress in information sharing. Harris Corporation was contracted to provide some basic services to the health care industry in 2011. Since then, the Florida HIE has begun to take shape and information sharing is occurring. The ARRA funding will end in 2014 and the Florida HIE must have a plan to survive into the future. This plan must address challenges such as the recruitment of new users, integration of new services, and ultimately long term sustainability.

scholarly journals Consolidated Person Level Health Data Improve Tuberculosis Surveillance and Patient Care

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Mariette Smith ◽  
Alexa Heekes ◽  
Arne Von Delft ◽  
Themba Mutemaringa ◽  
Nicki Tiffin ◽  
...  
Keyword(s):  
South Africa ◽  
Patient Care ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Digital Health ◽  
Care Facility ◽  
Improve Patient Care ◽  
Health Data ◽  
Register Data ◽  
Western Cape

IntroductionElectronic tuberculosis (TB) register systems influence policy decisions, resource allocation and patient care in many ways, but their limitations have been demonstrated in many high-burden settings like South Africa. While digital health systems in the Western Cape, South Africa have improved over time and benefited from implementation of a unique patient identifier, questions about quality and completeness of register data remain. A Health Information Exchange (HIE), established in 2015, daily integrates routinely-collected person level health data from electronic sources in the Province, including laboratory, dispensing, clinical and encounter data, as well as disease register data for HIV and TB. Objectives and ApproachUsing TB-related datapoints from various electronic platforms and resources, an algorithm was developed to infer cases, visit and treatment information, comorbidities and mortality - defined as a “cascade”. The cascade is recompiled daily incorporating new information added to the HIE, and presented to health care workers and managers as filterable, downloadable reports on an electronic platform. TB Register and inferred cascade data were compared for 2018. ResultsThere were 40,227 cases in the register after 3,010 duplicate entries were eliminated by consolidating personal identifiers and duplicate entries across facilities into single TB episodes. 13,729 additional cases were identified in the HIE cascade. Of these, 6,984 had evidence of treatment; 4,143 were diagnosed and treated only in hospitals - thus less likely to be recorded in the registers. Updated patient contact details and allocation of a primary care facility based on patient visit history, aided in patient care. Conclusion / ImplicationsLeveraging a consolidated environment for person-level health data can substantially enhance and verify disease registers. Appropriate tools can render these data accessible and actionable to improve patient care, minimise errors and missed opportunities to close treatment gaps, and increase accuracy of surveillance and reporting on a programmatic level.

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