Topic: Facility: All Clinics using full Cerner EMR Audience: Providers and Clinical Support Staff Overview: Effective Date: 03/24/2014 Contact: Helpdesk@iuhealth.org 962-2828 Attn: Cerner Ambulatory A formal medication reconciliation is required for Meaningful Use Stage 2, as part of an ACO, and by IU Health policy for certain patient populations. These include New patient appointments, following discharge from an inpatient facility, any time a Summary of Care document is received from a non-iuh facility, and for patients who have been residents in a long term care facility or rehabilitation center. New tools will be implemented in Cerner to facilitate the process of identification of qualifying patients, and for performing reconciliation. Clinic staff may update the medication list as agents of the provider; however only a provider (resident, NP, PA, or physician) may complete the reconciliation. Support Staff Workflow Changes Clinic Visit Record In order to identify patients who qualify for reconciliation, a new section will be added to the AMB and OB Clinic Visit Records. Initially, this form will not be required; however, it is strongly recommended that this documentation be adopted into the workflow. This form will become required in the future. Page 1 of 5
Medication List Updates In order for the provider to complete medication reconciliation, the medication list must be reviewed and updated via the Document Medication by Hx button. NOTE: This may be a process change for many clinics, as staff are accustomed to updating the med list directly from the Medication List Profile. However, at this time, we recommend that staff incorporate updating the med list from Document Medications by History into the med list review process for every patient. The following guidelines are recommended for support staff updates: COMPLETE: Acute medications (antibiotics, prednisone tapers, etc.) that were prescribed for a short duration, and have exceeded the end date. Complete should also be used to remove duplicate historical medications CANCEL/DC: Prescriptions that the patient states they are no longer taking because a provider told them to stop taking DOCUMENT COMPLIANCE: NOT TAKING: Prescriptions that the patient is not taking, for any reason other than specific instruction from a provider A new signature type of "Per Patient" has been created for the purpose of appropriately documenting a Cancel/DC.This signature type is intended to be used when patient states that a provider specifically told him/her to stop taking a prescription. Items canceled with a Per Patient signature type will route to a physician for cosignature. Ambulatory CIS recommends that for this action, the Ordering Provider should be changed to the attending provider for the day s visit. Page 2 of 5
Medication List Updates (Con t) When the review of the med list is complete, UNCHECK the box Leave Med History Incomplete, then sign. Unchecking this box will trigger the Status icon for Meds History (as viewed from the Medication List) to update from a blue circle with an exclamation point to a green checkmark. This is the only visual indicator to the provider that the med list is updated and ready for reconciliation. Page 3 of 5
Provider Workflow If the screening performed by support staff on the Clinic Visit Record indicates that a reconciliation is required, an alert will fire when the patient s chart is opened, directing the provider to complete a reconciliation. This same alert will fire again at chart close if the reconciliation has not been completed. Because of some limitations with the Medication Reconciliation tool, mostly related to the Renewal process, it is highly recommended that providers review and update the medication list, including sending any renewals, PRIOR to launching the Outpatient Reconciliation window. Additionally, it is strongly recommended that the medication reconciliation be completed PRIOR to ordering any on-site medications or immunizations. Once updates are complete, launch the reconciliation tool by selecting Reconciliation and Outpatient. Medications that were addressed prior to opening the reconciliation tool will automatically populate the Right hand column (Orders After Reconciliation). Items that have not yet been addressed will appear on the Left (Orders Prior to Reconciliation). Page 4 of 5
Provider Workflow (Con t) Hovering over any item on the list will cause a detail window to open, displaying the full order details for that medication. For items that have a compliance status of Not Taking or Not Taking as Prescribed, an icon will appear to the left of the patient name. This order detail window will display any additional information documented regarding the reason for noncompliance. If indicated, additional actions can be taken on the remaining medications, to continue or discontinue, from this view. If no other updates are required, the provider may choose to Acknowledge Remaining Home Medications and Sign to complete. NOTE: Any In-Office Medications (wheelchair icon) that were ordered prior to launching the tool will appear on the reconciliation tool. These meds must be marked Do Not Continue, indicating that they are not to be continued as a home medication, before signing. Page 5 of 5