Medication History/Reconciliation: Patient Care Opportunities. Lathe Bigler Sr. Director, Clinical Services September 13, 2012
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1 Medication History/Reconciliation: Patient Care Opportunities Lathe Bigler Sr. Director, Clinical Services September 13,
2 Rock n Roll Trivia What famous singer was background vocals on the Righteous Brothers You ve Lost That Lovin Feeling? a. Sheryl Crow b. Cher c. David Hasselhoff Which band holds the Guinness World Record for the highest demand for tickets for one concert (20 million online requests in 2007) a. Aerosmith b. U2 c. Led Zepplin Who was the lead guitarist for the band Guns n Roses? a. Nicky Six b. Slash c. Doug Aldrich How many albums has the band Pearl Jam released? a. 9 b. 11 c. 13 Who was the original lead singer for Van Halen from ? a. Sammy Hagar b. David Lee Wroth c. Gary Cherone Bonus Question: What movie inspired Emdeon s ACM Turn it Up? 2
3 The Continuum of Care Migration 3
4 Care Migration Case: N1H1 Pandemic CDC in million Americans infected with N1H1 246,000 needed inpatient care 11,160 died from N1H1 1 in 5 Americans received a vaccine (65 million people) All 50 states allowed pharmacies to administer vaccines (Maine was the last to allow administration by retail pharmacist). Sources: 4
5 Ongoing Services Rx provided vaccinations Flu (Influenza) Shingles (Herpes Zoster) Pneumonia (Pneumococcal) Td (Tetanus, Diphtheria) Meningitis (Meningococcal) HPV (Human Papillomavirus) Tdap (Whooping Cough) Travel vaccines Etc. 5
6 Care Migration Advantages More accessible patient care Revenue opportunities Healthcare cost reductions Real-time medical reimbursement (MedRx) Improving disease monitoring Improving vaccine quality Improving vaccine distribution Minimizes costs to consumer Increase awareness/patient education Easy access to patients Etc. Challenges Technology Access to information Healthcare training gaps Paperwork Lack of automation Reporting/measurements Etc. 6
7 More Requires More Exchanging Clinical Information Immunization/Vaccination Medication Reconciliation Lab Results Etc. 7
8 The Drivers MEDICAL HOME / ACOs INTEROPERABILITY MEANINGFUL USE HITECH ARRA 8
9 Administrative Connect Capture Normalize Share Analyze & Report Clinical 9
10 Emdeon Health Information Exchange Private HIE HIE Pharmacy Pharmacy eprescribing Medication eprescribing History Medication Retail Medical History Traditional Financial Exchange Regional HIE HIE EMc c Emdeon Clinical and Exchange Financial Exchange State HIE Emdeon Clinician Clinical Services Certified EHR* Practice EMR Management Connectivity for Clinical & EMR Connectivity Exchange Practice Direct Management Provider to Connectivity Provider for Exchange Financial and Admin Information Patient Centric Data, Data, Powered by by IBM IBM Initiate Patient Patient Outbound Outbound Reporting Reporting Hospital Clinical Messaging (example: discharge summaries) Hospital Lab Lab Orders/Results / Results Physician Secure /Direct Financial Pr Status Care eprescribing Orders Orders/Results / Clinical Messaging Utilization Public Health Public Health CDC CDC Disease Registries Disease Registries Quality Reports Quality Reports P4P Reports P4P Reports Reference Lab Lab Orders/Results / Results Payer Payer Real-time Care Alerts Real-time Traditional Care Financial Alerts Exchange 10
11 Emdeon Medication Reconciliation Phase 1 Contracting Private HIE HIE Pharmacy Pharmacy eprescribing Medication eprescribing History Medication Retail Medical History Traditional Financial Exchange Regional HIE HIE EMc c Emdeon Clinical and Exchange Financial Exchange State HIE Emdeon Clinician Clinical Services Certified EHR* Practice EMR Management Connectivity for Clinical & EMR Connectivity Exchange Practice Direct Management Provider to Connectivity Provider for Exchange Financial and Admin Information Patient Centric Data, Data, Powered by by IBM IBM Initiate Patient Patient Outbound Outbound Reporting Reporting Hospital Clinical Messaging (example: (Medication discharge History) summaries) Hospital Lab Lab Orders/Results / Results Physician Secure /Direct Financial Pr Status Care eprescribing Orders Orders/Results / Clinical Messaging Utilization Public Health Public Health CDC CDC Disease Registries Disease Registries Quality Reports Quality Reports P4P Reports P4P Reports Reference Lab Lab Orders/Results / Results Payer Payer Real-time Care Alerts Real-time Traditional Care Financial Alerts Exchange 11
12 12
13 Patient Authorization (HIPAA) Patient authorizes to their provider/physician or healthcare provider either verbally or written, to access any medical data, including medication history The acute care facility is responsible to ensure that any request for medication history information is made for an authorized purpose, as defined by HIPAA (meaning for, continuity of care, avoidance of medication errors and other treatment) /understanding/index.html 13
14 Hospital/Acute Care Hospital inpatient care Number of discharges annually: 36.1 million Average length of stay in days: 4.9 Hospital outpatient department care Number of annual outpatient department visits: 96.1 million Hospital emergency department care Number of annual emergency department visits: million Number of emergency department visits resulting in hospital admission: 17.1 million Number of emergency department visits resulting in admission to critical care unit: 2.2 million Approx. 268 million medication reconciliations Source: 14
15 Medication Reconciliation 10% of hospital admissions are due to medication allergies, interactions or medication errors Electronic med rec captures 95% of current patient medications as compared to just 70% when relying on a patient interview alone (based on geographic location). 19 additional minutes of staff time to achieve the 95% threshold using standard phone- and fax-based follow-ups 90% of patients seen consented to having their medication history accessed electronically Source: 15
16 Medication Reconciliation "the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. JCAHO Medication Reconciliation Process The medication reconciliation process comprises five steps: 1. Develop a list of current medications; 2. Develop a list of medications to be prescribed; 3. Compare the medications on the two lists 4. Make clinical decisions based on the comparison 5. Communicate the new list to appropriate caregivers and to the patient. 16
17 Medication History Data Sources PBM Billed scripts to PBM Delivered at request of facility via EHR Pharmacy Claims Data Billed data Cash State Medicaid (Government) Stay may participate in HIE or direct to facility 17
18 Medication Reconciliation Requires Additional Data and Collaborative Patient Care Many medications are used for multiple conditions; all diagnoses not readily available Patients use multiple physicians PCPs often do not have time to work with clinical pharmacists to reconcile medications Patients use multiple pharmacies or pay cash, creating lack of visibility Patients may not remember what they are taking Lack of awareness of medications in patient home Disparate health It systems make data sharing difficult Hospital and emergency events create frequent misalignments in established medication therapy 18
19 Potential Effects of Ineffective Medication Reconciliation Ineffective medication reconciliation upon hospital admission: Up to 50% of medication errors Up to 20% of future ADEs More than one-third of patients had at least one discrepancy in one study 140 discrepancies in 81 patients (1.7/pt) 65 omissions 59 wrong dose/frequency 16 wrong drug 32.9% discrepancies rates as potentially moderate harm; 5.7% severe harm According to the AHRQ, unintended medication discrepancies occur in 14% of patients upon discharge Sources: American Academy of Pediatrics, Journal of General Internal Medicine, AHRQ 19
20 Emdeon Medication History/Reconciliation Medication history based on Pharmacy claims information, not PBM information. Emdeon claim switching customers can authorize Emdeon to deliver medication history results to physicians and acute care facilities Medication History: delivering patient medication history at the point of care during the eprescribing experience (no fee) Medication Reconciliation: delivering patient medication history at the point of admittance into an acute care facility (service fee) Emdeon Master Patient Index *Request *Response Pharmacy Claims Emdeon Info Transaction Data Repository Emdeon Medication History Service Physician/Acute Software Application 20
21 Patient Service Opportunity Can provide better coordination of patient medication data Available 24x7 to participating hospitals Designed to retain patient medication history when patient changes insurance carriers May prevent or reduce adverse drug interactions Designed to be readily available in the ER physicians access medication history via their eprescribing software or existing workflow 21
22 Participation Emdeon needs its pharmacy customers to participate in our medication history/ reconciliation services initiative by executing additional documentation to provide authorization to utilize the information for such purposes. Please ask your sales or account manager representative if you have questions about how to participate in our medication history/reconciliation services initiative. 22
23 Questions Thank You! 23
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