This post is to start the (initial) discussion around the electronic medication reconciliation (MedRec) process.
Currently, several districts use SMT for the MedRec process. Eventually, the MedRec process will be an integrated part of an electronic prescribing and administration system (e.g. MedChart). However, this option is still quite far into the future and due to SMT being a sunset product, districts need a viable alternative.
At Te Manawa Taki (TMT) we have looked at the option of using the Orion MedMan application as a temporary replacement, until an integrated solution is available.
For that integrated solution, we need a national agreement on the core MedRec process and the requirements. This will then be the base for the further development of an integrated solution.
Attached to this post you can find five documents:
The second sheet shows the five different options for updating the Medications Summary in the Orion’s MedMan application.
he third sheet shows a suggested work flow, utilising only three of the five options.
And the fourth sheet show a Taranaki version with MedChart instead of paper chart.
MedRec Requirements v0.1.docx (34.0 KB)
This is a list of proposed requirements for the core MedRec process that can be used as a base for further development of an integrated eMedRec solution in an ePA system (MedChart).
TDHB MedRec Forms.docx (1.6 MB)
This document shows the current MedRec forms used at Taranaki District
Medication History Form
Medication Reconciliation Form
Discharge Summary
TDHB eMedRecProcess0.3.vsd (491 KB)
This shows the workflow with the Taranaki District forms used in the MedRec process.
Some general remarks:
Need to work towards a uniform terminology.
Need to agree on a national core MedRec process.
Need to agree on the requirements.
The focus will be on an integrated MedRec solution, as part of an ePA system. The reconciled meds will feed into other sources, e.g. ToC/Discharge Summary and the MDR.
This post is to just get the discussion started. You can compare the documents with your existing work flows and documents and identify any gaps or inaccuracies.
Eventually, we can take this discussion to a more formal national level, e.g. the eMeds Oversight Group.
If any questions, please don’t hesitate to contact me.
As an Architect in the Digital Medicines Team at Te Whatu Ora, I can say that Medicines reconciliation in MedChart, - via integration with the NZ e-Prescription Service (NZePS) and the new national Medicines Data Repository (MDR) - is a lot closer than suggested here. With regard to terminologies, these national systems are predicated on the exclusive use of NZ Medicines Terminology (NZMT) to code medications and standards-based information models. It’s also important to recognize the various settings in which medicines reconciliation takes place - both in-patient and community
Hi team - we have developed e-med rec through Intersystems Trakcare at MercyAscot, which similarly uses the Medicines Data Repository (MDR) for med history and NZePS for prescribing. It’s not yet live but the development is pretty much done. I’ve since moved on and now only involved on an advisory level, but Stephen Choong and Sera McGarry have carried on the work as informatics pharmacists (will recommend they join e-Health forum so they can follow this conversation).
Would be keen to compare notes with med rec users from other systems like MedChart / SMT, and contribute to any conversations around standards from the user perspective of an alternative e-med rec product.
Hi - I know this is a bit outside scope but improving things at the GP and pharmacy end and having one source of information would be a big picture solution… any possibility this can be part of the discussion?
Good point @mca . . . is the topic limited to a single-episode-of-care when someone goes to hospital and leaves again?
Med Reconciliation occurs at EVERY transfer of care episode and it is generally GPs who do the most manual medication reconciliation because we receive ALL ToC documents . . ED, post-discharge, outpatient, etc.
If there is going to be work done that will impact our system broadly, can there be a focus on renal patients? These patients have high levels of medicines + frequent episodes-of-care, shared across many providers and prescribers. If a medication reconciliation process worked for renal patients, across 1 year, that would be amazing. Focusing on renal patients would also have an impact on health equity, as renal patients disproportionately contend with higher levels of negative social determinants of health.