Medication History

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Medication History

• Kent Hall, MD
• Charlie Caruso, CIO
• Goodall Hospital

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Goodall Hospital, Sanford ME

• 53-bed acute care hospital
• Joint Commission Accredited
• Outpatient Visits 152,000
• ED Visits 22,000
• Inpatient admits 2,600
• Sanford Population 16,095
• York County 201,000

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Goodall Hospital, MEDITECH, and LSS

• MEDITECH C/S 5.54 PP20
• BMV October 2008
• EDM January/February 2009
• CPOE March June 2009
• LSS/MPM September 2008 through
• Maine national EHR demonstration project 2009
  (CMS)

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e-Prescribing

• Project began in January 2007
• Pilot DrFirst Rcopia with three physicians
• Included Dr. Hall for ED
• Created Goodall Enterprise Search with DrFirst
• All providers can see hospital MPI, patient meds
  when treating patient and any allergies on
  DrFirst Rcopia

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e-Prescribing

• Have 35 physicians e-prescribing in Goodall
  community
• e-prescribe approximately 3,000 scripts per month

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What was Strategy?

• Pathway to Community Health Records
• Meds and allergies could be shared prior to
  Electronic Health Records (EHR)
• Get physicians comfortable with using prior to
  full documentation of EHR

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Some Good Luck

• LSS contracts with DrFirst to integrate within
  MPM for e-Prescribing and medication history (May
  2007)
• MEDITECH contracts with DrFirst for same solution
  (January 2008)

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New Solutions Needed

• Joint Commission requires Medication
  Reconciliation on all inpatient and outpatients
• DrFirst introduces RcopiaAC for acute setting
  which will include medication history
• Goodall Hospital requested to pilot RcopiaAC

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RcopiaAC Scope

• Use push/pull method to query DrFirst for
  medications and allergies upon patient
  registration
• Show 12 months of medication history in
  alphabetical order
• Automatically print query results and file in EMR

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MEDITECH C/S
Mirth Interface Engine
ADT FEED
ADT FEEDS
RcopiaLink updates EPS database
RcopiaLink Updates AC database
http/s via Internet
RcopiaLink receives reports for inclusion in
MEDITECH ITS/EMR
DrFirst Data Center
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PERSONAL INFORMATION REMOVED
DOB and MRN Removed
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Time and Information Matter

• From pre-registration to medication query results
  back to Goodall, time lapse averages three
  minutes
• Have potential medications a patient is taking to
  help clinicians during medication reconciliation
  (Information that a patient may not be able to
  self report)

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Evolving Landscape

• Early adopter site with LSS for e-Prescribing
• Now some providers are e-Prescribing direct with
  LSS, Medical Practice Management (MPM)
• Reconciliation is on-line in MEDITECHs RXM for
  these providers

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Landscape (cont.)

• Addressing ED workflow with medication
  reconciliation and e-Prescribing in hybrid
  medical record state
• Impact of EDM to this process

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What Happens in ED?

• Printed copy gets put on chart
• Reviewed by nurse and provider
• Documentation later scanned in using MEDITECHs
  Scanning and Archiving solution

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Still Not Everything

• Issues include prescription writing outside of
  what is captured back from queried databases
  (DrFirst)
• Same true with allergies
• Helpful information, but still need to discuss
  with patient

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Future Possibilities

• Expanding other database participants (PBM,
  Surescripts and RXHub) to reflect all payors and
  pharmacies
• Integration of EDM and e-Prescribing
• Controlled substances, Category II