Carle Health, an eight-hospital health system based in Illinois, is dedicated to providing patients with the care they need at every point in their healthcare journey. Through collaboration and commitment, the health system aims to ensure the highest level of care by applying accurate data and innovative, evidence-based best practices.
PROBLEM
Medication reconciliation is an important process to ensure a patient’s medication list is accurate and up-to-date during care transitions, such as admission, transfer, and discharge.
“To ensure accurate reconciliation, our pharmacy technicians need to know not only what medications patients have been prescribed, but also what medications they are actually taking,” said Jason Tipton, supervisor of inpatient pharmacy at Carle Foundation Hospital in Urbana, Illinois. He has a doctorate in pharmacy. “To verify that prescriptions—especially for high-risk medications—have been received, pharmacy staff spend a lot of time calling pharmacies.
“During the pandemic, that became an issue because pharmacies were overwhelmed by staffing shortages and closures,” he continued. “Our staff could wait up to an hour for a conversation that lasted less than a minute, which is an inefficient way to ensure a patient’s medication history is up to date.”
The result is increased staff burden and unwanted disruption to retail staff at local pharmacies. It also causes delays in collecting medication histories that can impact patient care.
“We pulled medication history from industry standard feeds, but the information was often incomplete because it lacked detailed prescription instructions (signatures) and did not capture all prescription data, especially from local or independent pharmacies,” he noted.
PROPOSE
Carle Health has been researching solutions to import more medication history data directly into the Epic electronic health record system so staff can save time on manual data collection while improving patient safety.
“The DrFirst provider provides medication history from local and independent pharmacies in addition to major retailers,” Tipton explains. “Instead of just showing prescription information, DrFirst data will include the dispense date so we can see when the medication was dispensed. That’s important because it helps our pharmacists see gaps in medication adherence.”
For example, a doctor might prescribe an anticoagulant and provide a patient with a coupon upon discharge for a free month of medication. The prescription would appear on the patient’s medication history but would not reflect that they stopped taking the medication after the first month because they could not afford it.
“The new technology will also provide us with more data on specific medication information and prescribing instructions such as dosage and frequency,” Tipton said. “This will allow our medication history staff to work more efficiently and provide our pharmacists with more accurate dosage information for recent dispensings, thus improving recommendations during admission prescription review.”
Facing the Challenge
In late 2021, Carle Health integrated the medication history system from DrFirst into the Epic EHR, giving physicians, nurses, and pharmacists access to more data directly in the electronic record without changing their standard clinical workflow.
“Since its launch, we have seen an evolution in the system’s AI functionality, translating prescription signatures like dosage and frequency into the system’s standard terminology,” Tipton explains. “Over time, the AI has improved to be able to input accurate data into the appropriate fields with less manual input by our staff.
“Pharmacy technicians can now access a patient’s most recent medication history, including dosages and other prescription instructions, eliminating the need for phone calls to the pharmacy,” he continued.
The new system also plays a key role in the transition care pharmacy program the health system implemented in 2019. Upon admission, it is important to provide physicians with a medication history promptly, especially for high-risk medications like anticoagulants.
Having accurate medication details is critical to patient safety. Upon discharge, pharmacy staff review medication lists to identify barriers that may prevent patients from following their doctor’s orders. This gives pharmacies a deeper role in medication management and allows the organization to alert providers to potential problems in advance.
RESULT
“According to DrFirst reporting data, our clinical staff is taking external medication histories for 99% of our high-risk patients,” Tipton reports. “Considering that taking external medication histories is a critical part of the best possible medication history (BPMH) process, especially for high-risk patients, this puts our performance at a significantly higher level than the DrFirst average of 77%.
“By relying on AI technology to convert information into discrete data elements within the Epic EHR, we have significantly reduced the amount of manual data entry that staff have to perform,” he added.
ADVICE FOR OTHERS
Industry observers say these are challenging times for both retail pharmacies and hospitals.
“New technology gives us the opportunity to take a deeper role in medication management while creating more efficient processes for things like collecting medication history and reconciling medication lists,” Tipton concluded. “By reducing the need for repeated phone calls and manual processes, we can provide better patient care and relieve our retail partners of the frequent interruptions that keep them from reaching their customers.”
Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: [email protected]
Healthcare IT News is a publication of HIMSS Media.
The HIMSS Healthcare AI Forum is scheduled for September 5-6 in Boston. Learn more and register.
