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Kristie McDonald



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    RF03 - Patient Empowerment: It's about Time! (ID 45)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/28/2019, 02:30 PM - 03:30 PM, Pod 8
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      RF03.04 - Uncovering the Mysteries of Electronic Medication Reconciliation (ID 420)

      Kristie McDonald, Clinical Informatics, Island Health Authority; comox/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      Electronic medication reconciliation (eMedRec) is a complex process. For some, medication reconciliation is a new concept; for many, the first implementation of eMedRec within Island Health Authority?s Nanaimo Regional Hospital may have had unintended consequences on ordering practices, end user experiences, and the delivery of patient care.


      Methodology/Approach:
      An Island Health Authority interdisciplinary Think Tank was formed to closely examine eMedRec. Think Tank participants consisted of clinical informaticists, providers, pharmacists, pharmacy informaticists, medication safety and professional practice consultants, and educators. Workflow analysis and detailed testing were conducted over a series of four workshops. Simulating clinical and provider BPMH and reconciliation workflows, participants observed the flow of data and how it ?behaved? differently when using different synonym orders. As participants shared stories and knowledge, risks were tracked and analyzed, education and practice gaps were uncovered, and mitigation strategies unfolded. Through didactic conversation, open dialogue, and interprofessional discourse, knowledge from multiple perspectives was shared. This supported a deeper understanding of why the data behaved differently; some of the mystery and unknowns were uncovered.


      Finding/Results:
      Throughout the workshops, the Think Tank experienced data behaving in a seemingly mysterious or unpredictable fashion. Through a lens of curiosity and focused effort, members of the Think Tank identified three of the most challenging components to navigate: 1. Search struggles with result returns when searching for medication orders: 2. Conversion confusion regarding auto conversion and failure resolution: 3. Prescription paralysis related to difficulty with prescribing:


      Conclusion/Implications/Recommendations:
      Prior to the Think Tank sessions, understanding of synonyms and conversion logic was only understood by Pharmacy Informatics. It was through the common and vested interest of the Think Tank that several recommendations are underway. These include but are not limited to: -Conduct a third party vendor analysis of system parameters that might impact on auto conversion rates and ordering practices -Review Think Tank recommendations with Executive Steering to determine which will be actioned -Develop a plan for implementation of Think Tank recommendations -Host change management events -Provide education to fill current state gaps -Establish a governance structure that will clearly outline roles, responsibility, monitoring, and accountability -Implement and support front line users with changes -Create a permanent Working Group to continue to enhance eMedRec process -Build provincial networks to share ideas related to eMedRec While eMedRec continues to be a complex process within the CIS, it is vital to remain curious and unrelenting in uncovering remaining challenges. A Think Tank or small working group can provide further insight through interprofessional discussion and discourse, testing of system enhancements, and providing end users with the ability to provide ongoing feedback. Patients? care remains at the heart of why healthcare exists; unsolved challenges of eMedRec should not result in a discharge medication list that is a ?mystery? to providers or patients. Patients deserve to have a clear understanding of which medications they should be taking following discharge in order to stay safe.


      140 Character Summary:
      A Think Tank seeks to understand why end users experience challenges documenting home medications, managing conversion failures, and writing prescriptions.

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