Electronic Medication Management ( eMM )

Electronic Medication Management (eMM)

Dr Stephen ChuChief Clinical Informatician & TerminologistClinical Terminology & Information, NEHTA

2 November 2012

•Landscape, Concepts and Definitions– eMedication Management Stack– scope, concepts and definitions

Electronic Medication Management• Three key components

Contents Concepts and definitions Infrastructures

o Trigger events; messages; serviceso Registry; repository

Applications/User interface/viewer

eMM: Landscape

Electronic Medication Management• Key landscape components

eMM: Landscape

eMM Repository

SEHR/PHR

Registry/Directory

Triggers

Mes

sage

s Services

Contents

Applications

Interfaces

Queries

The Interoperability Stack

Transport/Architecture

Contents

Packaging

Concepts

- XDS- AORTA- Web services

- Message Structure- Document (CDA) Structure

- Data/Information Models- Terminologies

- Terms- Definitions

Focus of contents of this slide deck

Electronic Medication Management• The recipes and ingredients analogy

eMM: Landscape

Prescrip-tions

Dispense Records

PharmAdvice

MedsAdmin

PatientConditions

Allergies; Adv

reactions

Contra-Indicat-ions

Labs …&

others…

The data(ingredients)

hospitals Community pharmacies

CommunityLabs/paths

CommunityImaging services others …

The sources

Executive/Management

Decisions

ClinicalDecisions

The consumptions

MedicationManagement

Queries

Reviews

Reconciliation

The production (cooking) processes

Med Review Record*Reconciled Med History List *

Patient Medication Record

Medication related Reporting

Medication Profile

Medication Management Plan

Unreconciled Medication History List

The receipts

eMM Concepts and Definitions

• Definitions

Patient Medication Record• Record = documentation in writing or other permanent form• Medication record = documentation of medication

prescription, dispense and administration information (for a defined period of time

• Patient medication record = a collection of records pertinent to a patient’s medication prescription, dispense and administration information for a defined period of time• This collection of records may be persisted within a patient’s EMR

and shared EHR


• Definitions Reporting

Process of extracting data from one or more sources and converting them into a report for a specific purpose

Medication Related Reporting• A set of medication related information extracted from

one or more sources and converted into a report to meet statistical , quality and safety, epidemiological, government or regulatory requirements

• Example: Adverse drug/medication reaction reporting


• Definitions Adverse Drug Reaction

• “a response to a drug that is noxious and unintended and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function” (source: WHO)

• “An appreciably harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product, which predicts hazard from future administration and warrants prevention or specific treatment, or alteration of the dosage regimen, or withdrawal of the product”

(source: Edwards RI, Aronson JK. Adverse Drug reactions: definitions, diagnosis, and management. The Lancet 2000;356:1255-59)


• Definitions

• Adverse Drug/Medication Reaction Reporting The reporting of appreciably harmful or unpleasant

reaction, resulting from the use of a medicinal product, which may be prescribed or non-prescribed (such as an OTC medicinal product)


• Current & Past Medications

Current Medication List• A list of all medications (prescribed and over-the-counter) that an

individual should be/are known to be currently taking as identified at the time of review

Past Medication List• A list of all medications (prescribed and over-the-counter) that an

individual were known to be previously but NOT currently taking as identified at the time of review

Medication History List• A record of previously prescribed and dispensed medications

(may include over-the-counter medications) for an individual• Retrospective in nature, but can contain continuing/future meds


• Definitions

Medication Reconciliation• Medication reconciliation is a formal process of obtaining and [clinically]

verifying a complete and accurate list of each patient’s current medicines. Matching the medicines the patient should be prescribed to those they are actually prescribed. Where there are discrepancies, these are discussed with the prescriber and reasons for changes to therapy are documented. When care is transferred (e.g. between wards, hospitals or home), a current and accurate list of medicines, including reasons for change is provided to the person taking over the patient’s care. Points of transition that require special attention are*1 Admission to hospital Transfers within hospital (e.g. ED to ward; ICU to ward, etc) From the hospital to home, residential aged care facilities or to

another hospital


• Definitions

Medication Reconciliation• The process of comparing various medications lists to avoid

errors such as transcription, omission, duplication of therapy, drug-drug and drug-disease interactions*2 Based on this definition, the medication reconciliation processes

include comparing and rectifying discrepancies as well as review of medication management therapy

• It refers to the process of [clinically] reviewing the patient’s complete medication regimen on admission, at transfer and discharge, comparing it with the regimen being considered for the new care setting. The process aims at avoiding inadvertent inconsistencies in medication regimen across transition in care*3


• Definitions

Unreconciled Medication History List• Synonymous term: Unreconciled medication list• A list of patient medication compiled from collection of

known sources (paper and electronic) at a point in time. The contents of this list has not be subjected to the process of clinical verification to remove errors, inconsistencies, duplications and rectify omissions

• This is a “raw list” likely to be machine generated and has not undergone [human] clinical review, validation and reconciliation processing


• Definitions

Reconciled Medication History List• Synonymous term: Reconciled medication list• A set of patient medication compiled from collection of

known sources (paper and electronic) at a point in time. The contents of the list have been subjected to comprehensive clinical verification processes, which include comparison of data from various sources, validation with data origins such as prescribers and dispensers. Omissions, inconsistencies, e.g. duplicates, are identified and rectified to ensure accuracy, consistency, currency and as error free and omission free as possible

• Medication reconciliation processes may be or are typically conducted on admission, transfer or discharge of patient


• Definitions

Medication Review• A process of systematic evaluation of a person’s

complete medication regimen and management of the medications*4

• Includes a comprehensive, accurate medication history of the patient careful examination of the purposes and actual use of

individual medications issues identified (including indications, actions, uses, effects

and side effects, max cumulated dose, contraindications), and medication management recommendations


• Definitions

Medication Review Record• Comprehensive and authoritative reviewed list of all

medications (prescribe and over-the-counter) that a patient is current taking

• Outcome of the review Includes recommendations regarding proposed

changes and ongoing medication management where applicable/required


• Definitions

Profile specific attributes (such as feature, skills, knowledge, quality,

capability, reputation) of something, an object, a person, an organization, a society/population that provide evaluation of the characteristics or features and support generalisation about the structure and behaviours of the target object, person, organization, society/population

Medication Profile• A set of information about characteristics of a patient’s medication use

• Medication Management Profile A set of information about a patient’s characteristics, which are

relevant to safe medication management for this patient


• Medication Profile: Scope

Medication Profile• Comprehensive list of medications taken by a patient with

information on indications, actions, use patterns, and may include precautions, side effects, contraindications, max cumulated dose,

and known allergy, intolerance histories where applicable Managed contraindications Failed therapy Patient preferences

• May include diagnosis and pre-existing conditions to allow contra-indication (may include supporting clinical evidences such as diagnostic results) checks

• (may include genetic profile in future)


• Definitions

Medication Management Plan• A structured, formally defined scheme of patient medication

management strategies and actions, including: Patient’s demographics, problems/diagnoses and pre-existing

conditions (including allergies and intolerances) List of medications Indications, actions, contraindications, precautions and managed

contraindications, max cumulated dose where applicable Patient preferences; failed therapy Medication [supply and administration] schedules where

applicable/necessary Ongoing medication management strategies/recommendations Next review due

• May be stand alone or part of comprehensive care plan• Shared with other authorised health care providers


• Definitions

Medication Statement (HL7 Concept) Definition: an assertion or statement that a patient is "on"

a medication independent of the knowledge of specific events such as prescriptions, administrations and dispenses

used:• When we have knowledge that a patient is taking a particular med

and don't have knowledge of the underlying events (or those events aren't relevant)

• When we have knowledge that a patient is taking a particular med and we *do* know the details about the underlying events, but from a workflow perspective it would be inappropriate or unnecessary to capture the details, but it's still important to capture the patient/drug

Electronic Medication Management• Medication Administration Records

eMM: Landscape

Complexity

Data components

(processing,… etc)

Prescribed √Dispensed √Administered ??? Administration/conformance Profile:

- Max cumulated dose- Omission frequency + reasons- Dose variation frequency + reasons- Frequency variation frequency + reasons- Intermittent + PRN frequency + reasons

Queries

Reviews

Reconciliation


Med Review RecordReconciled Med History List



Medication Profile



The receipts

How useful clinically is a comprehensive or complete list of patientmedication admin record?Or would profile of patient’smedication administration/conformance be more useful?

Electronic Medication Management• Medication List Views

eMM: Landscape

Complexity

Data components

(processing,… etc)

Long term meds listShort term/episodic meds listIntermittent meds listPRN meds list

Types of med list view

Queries

Reviews

Reconciliation





Medication Profile



The receipts

Top down and bottom up approaches

Medication data requirement analysis

Prescrip-tions

Dispense Records

PharmAdvice

MedsAdmin

PatientConditions

Allergies; Adv

reactions

Contra-Indicat-ions

Labs …&

others…

The data(ingredients)

hospitals Community pharmacies

CommunityLabs/paths

CommunityImaging services others …

The sources

BottomUp

Topdownanalysis

ComplementaryCross-referencingValidating Adequacy, accuracyreusability and consistency checks

Executive/Management

Decisions

ClinicalDecisions

The consumptions

MedicationManagement

Queries

Reviews

Reconciliation





Medication Profile



The receipts

Electronic Medication Management• Three key components

Contents Concepts and definitions Infrastructures

o Trigger events; messages; serviceso Registry; repository

Applications/User interface/viewer

eMM: Landscape

Medication data – how they are used: through application/Interface design

Electronic Medication Management ( eMM )

Documents

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