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Moving From Paper To Electronic Medication Reconciliation

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Access the webinar here: Purpose of the Call: 1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec) 2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec) 3.Identify factors that support and impede successful migration of paper MedRec to eMedRec. 4.Discuss the lessons learned from research and other organizations. 5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.

Text of Moving From Paper To Electronic Medication Reconciliation

  • 1. Moving from Paper to Electronic Medication Reconciliation November 12,

2. Welcome to our francophone attendees Bienvenue nos participants francophones Hlne Riverin Conseillre en scurit et en amlioration Safety Improvement Advisor 3. Pour nos participants francophones.. Pour accder aux diapositives franais: -Cliquez sur l'onglet "FRENCH" OU -Envoyer un courriel [email protected] Suivre la bote Chat pour les commentaires du confrencire traduit en 4. Next Webinar: December 10, 2013 at 12 noon ETMedRec Quality Audit Month Results2235 patientsOrganizations28% Met all 5 quality criteria40%99 1906 Acute Care 329 Long Term Care 3 - 4 met quality criteriaJoin us to hear about the results and how your organization should be involved. 5. Call Overview Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec. 1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.4.Discuss the lessons learned from research and other 6. Todays Speakers Dr. Elizabeth Borycki Dr. Borycki is an Associate Professor at the University of Victoria, Victoria, British Columbia Canada. Dr. Borycki has worked in numerous roles among them as a Clinical Informatics Specialist, Disease Management Specialist, Consultant and Researcher. Elizabeth teaches organizational behaviour and change management, systems evaluation, quality improvement, information/information technology management and research methods in the undergraduate and graduate programs in the School of Health Information Science. Elizabeth has co-authored many health informatics articles. More recently, she has edited two books: The Human, Social and Organizational Aspects of Health Information Systems and Comprehensive Management of Chronic Obstructive Pulmonary Disease. She was the Academic Representative for Canadas Health Informatics Association (COACH) to the International Medical Informatics Association (IMIA) 7. Todays Speakers Dr. Andre Kushniruk Dr. Kushniruk is a Professor of the School of Health Information Science at the University of Victoria and he previously served as the Director of the School of Health Information Science at the University of Victoria. Dr. Kushniruk conducts research in a number of areas including evaluation of the effects of technology, human-computer interaction in health care and other domains as well as usability engineering. His work is known internationally and he has published widely in the area of health informatics and testing of healthcare IT (including work in the area of decision support for medication reconciliation). He focuses on developing new methods for the design and evaluation of information technology and studying human-computer interaction in health care and he has been a key researcher on a number of national and international collaborative projects. His work includes the development of novel methods for conducting video analysis of computer users. Dr. Kushniruk has held academic positions at a number of Canadian universities. He was elected as a Fellow of the American Medical Information Association (FACMI) in 2009 and also served on the COACH (Canada's Organization for Health Informatics) board of directors. He holds undergraduate degrees in Psychology and Biology, as well as a M.Sc. in Computer Science from McMaster University and a Ph.D. in Cognitive Psychology from McGill 8. Please complete our 9. Moving from Paper to Electronic Medication Reconciliation (eMedRec) 10. Moving from Paper to Electronic Medication Reconciliation (eMedRec) Andre Kushniruk Elizabeth Borycki Helen Monkman Alex Kuo University of Victoria Margaret Colquhoun Alice Watt ISMP Canada Marie Owen CPSI 11. Medication Reconciliation (MedRec) A process in which providers work with patients and other providers to ensure accurate medication information is communicated across transitions of care Admission, transfer, discharge Intended to prevent harm from ineffective communication Is challenging! 12. What is eMedRec? Electronic MedRec (eMedRec) uses Health Information Systems (HIS) to access and integrate electronically stored patient medication data To support the development of the electronic Best Possible Medication History (eBPMH) and the detection and resolution of discrepancies Can be integrated with other systems such as computerized provider order entry (CPOE) 13. eMedRec: Two Unreconciled Medication Lists for (adapted from Markowitz, 2011) 14. eMedRec: Matching Two Medication (adapted from Markowitz, 2011) 15. eMedRec: Final Reconciled Medication (adapted from Markowitz, 2011) 16. eMedRec Process Flow 17. Idealized Overview of 18. What is the Current State of eMedRec? 19. eMedRec: A Review of the Literature Conducted a literature review searched PubMed and CINAHL for the term medication reconciliation. 218 unique articles, published between 2003 and October 2012 reviewed by title, abstract (where possible) and/or full article to exclude studies that did not include original research (e.g., editorials) or that lacked reference to MedRec. 139 articles remained that met the inclusion criteria The following characteristics were also recorded: Type of MedRec Points of care Outcome 20. Type of MedRec Processes ranged from: Entirely paper-based hybrid (i.e. combination of paper and electronic) entirely electronic MedRec (eMedRec). The numbers of studies for each type of medication reconciliation were similar: paper (35 studies) hybrid (40 studies) electronic (44 studies) some of the papers did not explicitly state or describe what type of MedRec was used and therefore could not be 21. Key Findings: Points of Care The articles collected dealt with MedRec as it occurs at different points of care. most of the articles focused on hybrid processes few articles looked at eMedRec processes across different points of 22. Key Findings: MedRec Investigations at Different Points of CareQuantitative Measures of Medication 23. Key Findings: Information Technology (IT) and eMedRec Information technology has been used in the eMedRec process to do the following: Generate the best possible medication lists (BPMHs) Electronically support human MedRec processes providing electronic sources of data providing electronic tools for comparing lists and detecting and resolving medication 24. Examples of eMedRec Studies Boockvar et. al (2011). Medication Reconciliation: Barriers and Facilitators from Perspectives of Resident Physicians and Pharmacists (J. of Hospital Medicine) Focus groups and observation of VA eMedRec tool Participants agreed about central goal of eMedRec to prevent errors, but disagreed if it achieved goal Participants varied in how they sequenced the task using the tool When time was limited, physicians considered other responsibilities higher priority Barriers included: competing tasks, unreliable sources of information and need for 25. Schnipper et al. (2009). Effect of an Electronic Medication Reconciliation Application and Process Redesign on Potential Adverse Drug Events (Arch Int Med) Performed a controlled randomized trial Intervention was an eMedRec tool and process redesign involving physicians, nurses and pharmacists Main outcome was unintended discrepancies between preadmission meds and admission or discharge meds that had potential for harm (PADEs) Found that the eMedRec tool and process redesign was associated with a significant decrease in 26. Kushniruk et al. (2011). Cognitive Analysis of a Medication Reconciliation Tool conducted think aloud usability tests and clinical simulations of use of an eMedRec tool Both artificial cases and real cases observed Found Pharmacists and physicians approached cognitive process of using eMedRec tool differently Significant differences found in accuracy of task and time spent by pharmacists as compared to physicians Led to implications for redesign, customization and 27. What is the Current State of eMedRec in Canada? 28. eMedRec in Canada There is a move from paper to eMedRec to improve efficiency and safety to integrate MedRec with information systems Paper Based MedRecHybrid 29. eMedRec in Canada We conducted an online survey of eMedRec practices in Canada to assess the current state of eMedRec Method: online survey conducted in spring 2013 Participants: 2799 people were invited to participate 212 people responded included physicians, nurses, pharmacists, administrators, QI professionals, and health IT 30. Where is eMedRec Implemented in Canada? 31. Type of eMedRec in 32. Perceived Success of eMedRec in 33. Ranked Reported Motivators for 34. Factors that Led to Successful eMedRec 35. eMedRec in Canada eMedRec functionality was highly variable, with not all functions used Most respondents indicated no additional resources (e.g., human, financial) were allocated to sustaining eMedRec (61%) 36. What are the Advantages of eMedRec? Potential Advantages of eMedRec include: Improved standardization of documentation Improved legibility of information Improved communication between providers Improved accessibility of documentation Potentially improved eMedRec compliance through implementing: Soft stops - reminders that eMedRec needs to be completed for a patient) Hard stops - orders cannot be placed until eMedRec is 37. What are the Advantages of eMedRec? Decision support tools assist in comparing medication lists identifying discrepancies providing warnings for drug interactions or allergies Integration with computerized provider order entry (CPOE) to facilitate improved ordering processes Improved efficiency of many medication-related processes in health care organizations (Poon et al., 2006) 38. Key Aspects of Implementing eMedRec Senior leadership support is important The transition to eMedRec will require sustained resources, perseverance, clear accountability, preparation and dedication to achieve success Understand the current state of an organizations HIS is critical to implementing eMedRec Example: In planning to implement CPOE, it is valuable to pair eMedRec implementation with CPOE implementation because efficacy is improved when they are implemented 39. Assessment of Organizational Readiness Before implementation, organizations should determine the following: What HIS they currently have in their organization What they plan to implement in terms of eMedRec tools The HIS inputs and outputs eMedRec All involved must be aware of the type of HIS already in place (e.g., electronic health records) Have a common understanding of the definition of eMedRec and the components of 40. Workflow Standardization, Organizational Policy and Procedures Implementing eMedRec usually requires changes in workflow Important to communicate critical aspects of the process such as: The overall plan for implementing and sustaining eMedRec across the organization Health professional roles and responsibilities for each task Clear time expectations for tasks to be completed How the changes will affect all health professional tasks and roles. Changes in organizational policies and 41. Workflow Standardization, Organizational Policy and Procedures Observation of workflow and clinical simulations are increasingly being used around the world to assess the impact of new information systems upon workflow best undertaken in a setting similar to, or in the actual setting where eMedRec takes place. Observation and clinical simulations can be used to: diagram workflows, Assess the impact of the technology upon care processes Identify potential sources of technology-induced errors Design the eMedRec interface Design policies, procedures and training Address cumbersome workflows and potential pitfalls of workflows prior to 42. Selection and Procurement of eMedRec Solutions Organizations must carefully weigh a number of considerations related to the selection and procurement of eMedRec technology: What information technology is currently available in the organization? What features and functions of an eMedRec solution will be: mandatory for an implementation nice to have (but not required) will be implemented at a later 43. Selection of eMedRec Solutions Ideally the features and functions of eMedRec allow for the following: Display of current medications and eBPMH lists side-by-side. Complete information on: current, previous, active and discontinued medications, to facilitate comparison Flagging of discrepancies in medications Medication display on a timeline so that the user understands what medication is to be/was given and when Modification of medications from the same screen e.g. continue, discontinue, hold, or change Integration with CPOE (if applicable) so that new medications can be easily 44. System Reliability Assessment of system reliability and the creation of reliability targets is an essential aspect of implementing eMedRec. A back-up plan if eMedRec fails or goes down i.e., downtime policies and procedures Electronic or paper back- up available in the event that there are technical difficulties that prevent MedRec from being done 45. Usability A usable eMedRec system will lead to: Higher rates of compliance Fewer workarounds Less training More efficient eMedRec processes Fewer technology-induced errors be better for infrequent users or users with lower levels of computer 46. Cost For any implementation to be a success it is important to identify project and long term maintenance costs. Ensure commitment and support of senior management through an executive sponsor dedicated to this project Ensure that sufficient financial resources are available to implement and sustain eMedRec Determine the impacts of using new eMedRec processes upon physicians, nurses and pharmacists Ensure that there is sufficient staff with enough time to be able to conduct eMedRec on an ongoing basis Conduct periodic evaluations to ensure that all health professionals are complying with eMedRec processes Budget for evaluation and 47. Safety eMedRec has the potential to: reduce errors introduce errors into the MedRec process. To fully benefit from eMedRecs ability to decrease errors: Ensure that health professionals are educated in and aware of their role in all aspects of eMedRec processes Encourage health professionals and patients to report near misses and errors that arise, in order to refine eMedRec processes to ensure system reliability and maximize the benefits of eMedRec Ensure a well defined evaluation plan is in place to track the compliance with and outcomes of implementing 48. Issues and Challenges in Moving to eMedRec From Survey and Literature Inadvertently increasing workload by requiring electronic entry of medications Integration issues Changing the way users communicate Resistance to adopting new 49. Recommendations Understand current workflow before implementing Understand how eMedRec can integrate with existing and planned health information system infrastructure Obtain management and financial support (including ongoing for sustainability) Need to carefully stage eMedRec implementation 50. Need for Evaluation Throughout the Implementation Process Workflow evaluation and usability testing Integration with existing infrastructure Adequacy of training Evaluation of Error and Performance Number and % of patients reconciled accuracy of reconciliation frequency of 51. Development of a New Paper to eMedRec Toolkit To support managers and health care professionals who are considering or moving to eMedRec Funded by Canada Health Infoway Work conducted by AE Informatics, University of Victoria professors, ISMP Canada and CPSI Will be made available through ISMP Canada and 52. 53. Toolkit: Table of Contents What is the current state of eMedRec? What are the stages in implementing eMedRec? What should be considered after eMedRec is implemented? How should eMedRec be evaluated? Lessons Learned Checklists Ideal features procurement and pre-implementation Evaluation 54. Toolkit: Checklists and 55. Conclusions eMedRec can be an important tool for safety and lead to a range of benefits There are number of factors that influence success of eMedRec implementations Work based on national survey, literature review and interviews has lead to development of the: Electronic MedRec Implementation Planning Kit Further information: [email protected] 56. Thank-you! 57. 58. Upcoming MedRec Webinars Dec 10, 2013Canadian Quality Audit Month ResultsJan 14, 2014The Marquis Project - Dr. Jeffrey SchnipperFeb 11, 2014Engaging Patients in MedRecMarch 25, 2014 MedRec in Home 59. Please complete our