This document summarizes two presentations from a webinar on approaches to medication reconciliation using technology. The first presentation describes Toronto East General Hospital's implementation of electronic medication reconciliation using their Cerner EHR system. The second presentation describes Whitehorse General Hospital's use of Iatric Software's Patient Discharge Instructions system to conduct medication reconciliation at admission and discharge when an EHR is not available. Both implementations have improved medication reconciliation processes but also face challenges around physician engagement, customization of reports, and integration with other systems.

1. www.saferhealthcarenow.ca
Using technology to support MedRec:
Two hospitals, two approaches.
Andrew Liu, HBSc., BSc.Phm., RPh., Clinical Manager, Department of
Pharmaceutical Services, Toronto East General Hospital, ON.
Josianne Gauthier, B. Pharm, M. Sc Pharm, CRE, Clinical Pharmacist and
Team leader of Medication Reconciliation Implementation, Whitehorse
General Hospital, YT.
September 2014

2. www.saferhealthcarenow.ca
Welcome also to our
francophone attendees
Bienvenue à nos participants
francophones
Hélène Riverin
Conseillère en sécurité et en amélioration
Safety Improvement Advisor
Bienvenue!

3. www.saferhealthcarenow.ca
Pour nos participants francophones..
Pour accéder aux diapositives en
français :
-Cliquez sur l'onglet « FRENCH »
OU
Envoyer un courriel à
helene.riverin@csssvc.qc.ca
Surveiller la boîte « Chat » pour voir
les commentaires des
conférenciers traduits en
français

4. www.saferhealthcarenow.ca
Safer Healthcare Now! website
http://www.saferhealthcarenow.ca/EN/events/
NationalCalls/2014Webinars/Pages/default.aspx
ISMP Canada website
http://www.ismp-canada.org/medrec/#webinars
Safer Healthcare Now! MedRec Community of Practice
http://tools.patientsafetyinstitute.ca/Communities
/MedRec/default.aspx
For real time notification of content posting, “like” the
Medication Reconciliation Network on Facebook
www.facebook.com/MedicationReconciliation
All Safer Healthcare Now! webinars are posted within the
week to the following locations:

5. www.saferhealthcarenow.ca
Cross Canada MedRec Check-Up
To have something
added to this map,
please contact:
medrec@ismp-canada.
org

6. 6 www.saferhealthcarenow.ca
NOW AVAILABLE for
download on the Safer
Healthcare Now!, ISMP
Canada and Canada Health
Infoway websites. Toolkit
developed to support
organizations migrate from
a paper-based system to an
electronic system for
MedRec.

7. www.saferhealthcarenow.ca
Safer Healthcare Now! MedRec
2014-2015 Year-at-a-glance
• Feb. 2015- 2nd MedRec Quality Audit
Month
– Information Call/Kick Off- Jan. 6th, 2015.
– Quality Audit Results- Mar. 31st, 2015.
• 6 national calls/webinars
• Updates to Home Care Getting Started Kit
• Updates to MedRec Cross Canada
Check Up Map
• Developing MedRec FAQ documents
7

8. www.saferhealthcarenow.ca
www.ismp-canada.org
8
ISMP Canada MedRec Projects
2014-2015
• Doc Mike Evans YouTube video- MedRec
• MyMedRec- Free app to help
patients/families keep a list of
their medications (For Blackberry,
Android and iPhone)

9. www.saferhealthcarenow.ca
www.ismp-canada.org
MedRec Stay Informed and Connected
Receive ISMP Canada’s MedRec Newsletter
Hear about:
– Upcoming MedRec webinars
– New toolkits
– National MedRec Audit Month
– New MedRec publications
– MedRec related workshops
Join Now!
email bcarthy@ismp-canada.org or
visit http://www.ismp-canada.org/register/medrec.php

10. 10 www.saferhealthcarenow.ca
Please complete our poll

11. www.saferhealthcarenow.ca
Audience Poll
Click on the arrow icon
and then click on the appropriate location on the slide in
response to this question:
Which information system is in use in your
facility?
Cerner Meditech Other
11

12. Setting a New Standard in Quality and Value
e-Medication Reconciliation on Admission - Cerner
Andrew Liu, RPh. Clinical Manager
Dept. Pharmaceutical Services
September 9, 2014

13. 13
Inpatient Care
Beds 516
Inpatients 20,000/yr
Emergency visits 70,000/yr
• Single site community teaching hospital serving southeast Toronto
• TEGH has over 2,500 employees and 440 physicians

14. Setting a New Standard in Quality and Value
14
Toronto East General Hospital 2006
•Mostly paper chart
•Separate electronic pharmacy information system (MS Meds)
•Cerner Powerchart (Labs)
•No provincial electronic drug profile access yet

15. Setting a New Standard in Quality and Value
15
Medication Communication Problems
•Transcription errors (paper MAR)
•Slow turnaround of written/reconciled orders
•Unlinked MAR / Pharmacy med profile  inaccuracies
•Previous Best Possible Medication History (BPMH) lost in archived chart
•BPMH lost in current chart
Challenging Med Rec

16. Setting a New Standard in Quality and Value
16
Path to eMed Rec
•2008 Cerner Pharmnet (Pharmacy)
–linked to electronic chart (Powerchart)
•2009 Computerized Provider Order Entry (CPOE) and e-Medication Administration Record (eMAR)

17. Setting a New Standard in Quality and Value
17

18. Setting a New Standard in Quality and Value
18
Path to eMed Rec
•2010 Existing e-medication history documentation and reconciliation modules
–Real-time BPMH documented using standardized drug library, readily available for all patient visits
–BPMH could be directly converted to inpatient orders
•2011+ e-Clinical documentation expanded
–Including standard Med Rec consultation note
–Real-time med rec data auditing

19. Setting a New Standard in Quality and Value
19
Med Rec @ TEGH
•Proactive and retroactive approach
•Elective surgical patient pathway (proactive)
–Preoperative clinic pharmacist
–Inpatient surgeon / resident
•Acute inpatient pathway (mostly retroactive)
–Inpatient clinical pharmacists
–Most responsible physician

20. Setting a New Standard in Quality and Value
20

21. Setting a New Standard in Quality and Value
21

22. Setting a New Standard in Quality and Value
22

23. Setting a New Standard in Quality and Value
23

24. Setting a New Standard in Quality and Value
24
Benefits of eMed Rec
•Simple, efficient ordering of multiple medications
–Reconciliation tool
•Virtually no transcription errors
•BPMH readily available for all future encounters
•Real-time availability of BPMH
•Foundation for Med Rec on discharge
•Automatic drug product translation in Pharmacy dispensing system (single Cerner ‘interface’)
•Enhanced real-time auditing possible

25. Setting a New Standard in Quality and Value
25
Challenges of eMed Rec
•Standardized use of application features
–‘fill in the blank’ fields such as compliance data not readily viewable by provider (use Med Rec note)
•Details:
–Difficult to track history of medication changes (Med Rec note)
–Inflexibility of display options
–‘Live’ BPMH (?proxy access for staff/students in training)
–Pushing alerts/flags to providers
–Complexity of data mining
•Does not correct incomplete Med Rec, inaccurate info
•Duplicate documentation due to e-prescriptions
•Downtime

26. Setting a New Standard in Quality and Value
26
Conclusion
•Perfection vs Progress
•Upfront key supports (CPOE, eMAR, Drug library) facilitated success
•Simplicity  reproducibility
•Success: downstream demand for 100%

27. Setting a New Standard in Quality and Value
27
Toronto East General Hospital, 825 Coxwell Avenue, Toronto, Ontario, M4C 3E7
Tel: (416) 461-8272 Fax: (416) 469-6106
www.tegh.on.ca
Acknowledgements:
Kieu Lee, Heidi Huang
Questions: Andrew Liu anliu@tegh.on.ca
Thank you!

28. Medication Reconciliation Using Iatric Software
Josianne Gauthier B.Pharm, M.Sc Pharm, CRE
Clinical Pharmacist
Whitehorse General Hospital

29. Context

30. Whitehorse General Hospital
•55 acute care beds
•210-230 admissions/month
•52 Family Physicians
•6 Surgeons
•180 Nurses
•5 Pharmacists

31. Information Systems
•Meditech 5.64 (MAGIC workstation)
•Patient Discharge Instructions (Iatric Systems)
–For Med Rec at Admission and Discharge
•Medical chart is mostly paper-based
•No territory-wide Electronic Medication Record (EMR)

32. Implementation of PDI
Patient Discharge Instructions (PDI) software purchased from Iatric Systems
Development of process and reports by clinical pharmacist with physicians, community pharmacists and nursing
Started using PDI for every Med Rec at Admission
Started using PDI for Med Rec at Discharge
(pilot project with clinical pharmacist and 2 physicians)
Roll-out to other physicians
2011
2011 - 2012
May 2012
Sept 2012
2013

33. PDI Training
•Med Rec Team:
–2 nurses in Emerg and on the ward
–2 nurses in the Pre-Op Clinic
–Clinical Pharmacist
–Physician “champion”
•One-on-one training and in small groups of physicians
•Instruction Manual and video tutorial

34. Software allows to:
1) Gather electronically Home Medication history and print Med Rec at Admission form
2) Compare Home Medications and Hospital Medications and generate a comprehensive Discharge Order along with patient hand-outs

37. Discharge Process
•When planning for discharge, physician logs into PDI
•Clinical Pharmacist, in collaboration with physician, can also log into PDI and prepare Med Rec at Discharge
•Current hospital medications are “pulled over” from Meditech
•Reconciliation by a “simple click”

41. Discharge Process
•Discharge Orders, Medication List and Medication Schedule are printed
•Physician or pharmacist indicate in “Physician’s Orders” where to fax
•Physician or pharmacist gives Medication List or Medication Schedule to patient with explanation of changes and new medications

47. Successes
•Over 20 physicians trained on using the program
•Over 120 Med Rec at Discharge performed this year
•Better patient understanding, empowerment, involvement in their care
•Community partners very appreciative of improved communication

48. Challenges
•Development and customization of reports is time-consuming
•Limited information systems knowledge/support
•Physician engagement
•Users comfort with computer technology
•Time required for patients with complex medication profiles

49. Conclusion
•Systematic review of Home and Hospital Medications prevents errors;
•Good overall satisfaction with process and software used;
•Improved communication between patient and health care providers is worth the effort!
•Questions? josianne.gauthier@wgh.yk.ca

50. www.saferhealthcarenow.ca
Please input your questions
All questions will be addressed
at the end of the webinar
Ask questions or send feedback
via the “chat” box
• Select “All participants”
• Type message
• Click “Send”
All Participants

51. 51 www.saferhealthcarenow.ca
Please complete our poll

52. www.saferhealthcarenow.ca
Upcoming MedRec Webinars
52
Thank you for attending
Our next MedRec webinar will take
place in October 14th, 2014.
Topic: Ambulatory MedRec
Details to follow.

53. www.saferhealthcarenow.ca
Safer Healthcare Now! website
http://www.saferhealthcarenow.ca/EN/events/
NationalCalls/2014Webinars/Pages/default.aspx
ISMP Canada website
http://www.ismp-canada.org/medrec/#webinars
Safer Healthcare Now! MedRec Community of Practice
http://tools.patientsafetyinstitute.ca/Communities
/MedRec/default.aspx
For real time notification of content posting, “like” the
Medication Reconciliation Network on Facebook
www.facebook.com/MedicationReconciliation
All Safer Healthcare Now! webinars are posted within the
week to the following locations:

54. www.saferhealthcarenow.ca
www.ismp-canada.org
54
We encourage you to report
medication incidents
Practitioner Reporting
https://www.ismp-canada.org/err_report.htm
Consumer Reporting
www.safemedicationuse.ca/

55. www.saferhealthcarenow.ca
www.ismp-canada.org
Medication Safety Self-Assessment®
• Hospitals (acute care)(2006) – free for Ontario*
• Long-term care (2012) – free for Ontario*
• Complex Continuing Care and Rehabilitation
(2008) – free for Ontario*
• Community and Ambulatory Pharmacy (2007) –
free for Ontario*
• Operating Room Medication Safety Checklist
(2009) – free for Ontario*
• Oncology (2012)
• Anticoagulant Safety (VTE) – free for Ontario*
• HYDROmorphone Safety Self-Assessment (2014)
- $50
* Supported by the Ontario MOHLTC
For more information visit www.ismp-canada.org/MSSA or email mssa@ismp-canada.org