Carle Health, an eight-hospital health system based in Illinois, is dedicated to giving patients the care they need at every point in their healthcare journey. Through collaboration and engagement, the health system aims to ensure the highest level of care by applying accurate data and innovative, evidence-based best practices.

THE PROBLEM

Medication reconciliation is a critical process that ensures patients' medication lists are accurate and up to date during transitions of care, such as hospital admissions, transfers and discharges.

"To ensure accurate reconciliation, our pharmacy technicians need to know not only the medications a patient has been prescribed but what they are actually taking," said Jason Tipton, inpatient pharmacy operations supervisor at Urbana, Illinois-based Carle Foundation Hospital. He holds a doctorate in pharmacy. "To verify that prescriptions – especially for high-risk medications – were being picked up, the pharmacy staff was spending a lot of time making phone calls to pharmacies.

"During the pandemic, that became a problem because pharmacies were overwhelmed by staffing shortages and closures," he continued. "Our staff could be on hold for up to an hour for a conversation that lasted less than a minute, which was an inefficient way to make sure a patient's medication history was up to date."

The result was an increased burden on staff as well as unwelcome interruptions for the retail staff at local pharmacies. It also caused delays in medication history collection that could affect patient care.

"We were pulling medication history from a standard industry feed, but the information was often incomplete because it lacked detailed prescription instructions (sigs) and failed to capture all medication fill data, especially from local or independent pharmacies," he noted.

PROPOSAL

Carle Health researched options for importing more medication history data directly into its Epic electronic health record system so staff could spend less time manually gathering data while improving patient safety.

"Vendor DrFirst delivers medication history from local and independent pharmacies in addition to the big box retailers," Tipton explained. "Instead of showing only that a medication was prescribed, the DrFirst data would include a sold date so we could see when the medication was dispensed. That's important because it helps our pharmacists see gaps in medication adherence."

For example, a physician may prescribe an anticoagulant and provide the patient with a coupon at discharge for one month free. The prescription shows up on the patient's medication history list but doesn't reflect that they stopped taking it after the first month because it wasn't affordable.

"The new technology would also give us more data in terms of specific medication information and prescription instructions such as dose and frequency," Tipton said. "That would allow for our medication history staff to work more efficiently and give our staff pharmacists more accurate dose information for recent dispenses, thus improving recommendations during admission order reviews."

MEETING THE CHALLENGE

At the end of 2021, Carle Health integrated the medication history system from DrFirst into the Epic EHR, making more data available to doctors, nurses and pharmacists directly within the electronic record without any changes to their standard clinical workflows.

"Since going live, we've seen an evolution in the AI function of the system, which translates prescription sigs such as dose and frequency into our system's standard terminology," Tipton explained. "Over time, the AI has improved so that it can accurately import data into the appropriate fields with less manual entry by our staff.

"Pharmacy techs now get access to the most up-to-date medication history for the patient, including dose and other prescription instructions, while eliminating a large proportion of phone calls to pharmacies," he continued.

The new system also became key to the transitional care pharmacy program, which the health system had implemented in 2019. At admission, it's important to get medication history to physicians quickly, especially for high-risk medications like anticoagulants.

Getting these medication details right boils down to patient safety. At discharge, pharmacy staff reviews medication lists to identify barriers that could prevent the patient from adhering to the physician's orders. This gives pharmacy a more in-depth role in medication management and enables the organization to notify the provider in advance of possible issues.

RESULTS

"According to reporting data from DrFirst, our clinical staff is consulting the external medication history on 99% of our high-risk patients," Tipton reported. "Considering that reviewing external medication history is a critical part of the best possible medication history (BPMH) process, specifically for high-risk patients, this puts our practices at a high level that is significantly above DrFirst's peer average of 77%.

"By relying on the AI technology to convert information into discrete data elements in our Epic EHR, we have significantly reduced the amount of manual entry required by our staff," he added.

ADVICE FOR OTHERS

It's a challenging time for both retail and hospital pharmacies, industry observers say.

"New technology gives us the opportunity to take a more in-depth role in medication management while creating more efficient processes for things like gathering medication history and reconciling medication lists," Tipton concluded. "By reducing the need for numerous phone calls and manual-based processes, we can provide better care to our patients and unburden our retail partners from frequent interruptions that take them away from their customers."

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