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Electronic Medication Management ( eMM ). Dr Stephen Chu Chief Clinical Informatician & Terminologist Clinical Terminology & Information, NEHTA 2 November 2012. Landscape, Concepts and Definitions eMedication Management Stack scope, concepts and definitions. eMM : Landscape. - PowerPoint PPT Presentation
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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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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)
eMM Concepts and Definitions
• 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)
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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)
eMM Concepts and Definitions
• 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
eMM Concepts and Definitions
• 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
The production (cooking) processes
Med Review RecordReconciled Med History List
Patient Medication Record
Medication related Reporting
Medication Profile
Medication Management Plan
Unreconciled Medication History List
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
The production (cooking) processes
Med Review RecordReconciled Med History List
Patient Medication Record
Medication related Reporting
Medication Profile
Medication Management Plan
Unreconciled Medication History List
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
The production (cooking) processes
Med Review RecordReconciled Med History List
Patient Medication Record
Medication related Reporting
Medication Profile
Medication Management Plan
Unreconciled Medication History List
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
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