The document discusses medication reconciliation, which is defined as a process to obtain and document a complete list of a patient's pre-admission medications and reference this list when writing admission, transfer, and discharge orders. It provides background on medical errors from medication issues and the importance of medication reconciliation. It then describes the medication reconciliation process, which involves verifying the patient's medication list with them and reconciling the list at discharge.

2. Ambulatory Inpatient Periodic Reconciliation Post-discharge Reconciliation Admission Reconciliation Discharge/Transfer Reconciliation

9. Admission/Inpatient/Discharge Medication Reconciliation Process: Information Flow Inpatient Med List Inpatient Med List ’ DischargeOrders A highly heuristic and humanistic process performed during admission Minor modifications as more info become available Medication Reconciliation at Discharge Pt dx/condition Discharge Process Admission Process EMR Notes EMR Med Lists D/C Summary or Orders Pt & Family Outpt MDs Pharmacies Pre-Admission Med List Pre-Admission Med List ’ Pre-Admission Med List ’

11. Development of the PAML

27. Architecture Med Mapping/Classification EMR’s Hosp1 D/C Hosp2 D/C Med Reconciliation Service API Application Common Med List Other Apps Decision Support Site Rules DDI DLI For- mulary Allergies FDB Medisp NDFF RxNorm Patient Gateway Claims (RxHub, etc) Retail Pharm LTC

28. Multi-Usage Drug Terminology: Making Sense of the Tower of Medication Terminology Babble

30. Where is Drug Terminology Needed? EHR Consumer CPOE Ambulatory EMR Retail Pharmacy Hospital Pharmacy System PBM Administering Nurse Monitoring ADEs, FDA, CDC

38. Systemic Interoperability Taxonomy* No PC/information technology Fax/Email Structured messages, non-standard content/data Structured messages, standardized content/data *CITL Report on Healthcare Information Exchange and Interoperability Secure e-mail of free text and incompatible/proprietary structured messages, HL-7 msgs Machine-organizable data 3 PC-based and manual fax, e-mail, or scanned documents Machine-transportable data 2 Mail, phone Non-electronic data 1 EDI of structured messages with controlled terminology Machine-interpretable data 4 Examples Description Level

39. 10-Year Cumulative Net Return Level 4 in billions $(200) $(100) $- 0 $100 $200 $300 $400 1 2 3 4 5 6 7 8 9 10 Years Level 1 Level 2 Level 3

41. Order = Dispense = Administer Orderable Item Dispensable Item Administrable Item ?? Sometimes, Always, or Maybe ?? Amox. 500mg Q6H Amox. Susp. 250mg/5ml 80ml Bottle Amox. Susp. 500mg (10ml) PO Q6H

44. Common entry point for CPOE Med: Amoxicillin Oral Med: Amoxicillin Oral

48. Putting it Together Packaged Drug 0247-0372-00 Manufactured (Dispensable) Drug Fluoxetine HCl oral 20 mg capsules Dista Labs Formulation Fluoxetine HCl oral 20 mg capsules Routed Generic Fluoxetine HCl oral Ingredient Fluoxetine HCl Brand Name PROZAC Label Name Fluoxetine HCl 20 mg cap Manufacturer Dista Labs Dose Form Capsule Strength 20 mg Route oral Clinical Drug Fluoxetine HCl 20 mg capsules

49. Orderable Dispensable Administrable Monitorable

60. Robust Data Model

61. RxNav

67. “ I Don’t Want to Make the Wrong Mistake.” Yogi Berra John Poikonen, Pharm.D.