At Cone Health, located in Greensboro, North Carolina, upon entrance, at transitions of care within the hospital and at discharge, clinical personnel were making numerous phone calls to local pharmacies to reconcile patient drug histories, because of missing information from their previous medication history sources.
After they gathered the data, they had to enter it manually into the patient record, greatly increasing the chances of human error and the possibility of adverse drug events (ADEs).
“It was the perennial problem which each and every health system has to document patients’ home medicines, ” said Tom Pickering, administrative coordinator for alterations of care at Cone Health. “I’ve been involved with this effort at Cone Health because it began back in 2005, once the pharmacy got involved. Back then it was a slip of paper that the nurse could jot down the medicines on, and the doctor would sign it and send it to the pharmacy.
” We would spend a lot of time clarifying, or questioning if things were right on there or complete, ” he continued. “Then we got the electronic health record and things got better. And then we managed to have some prescription information coming into our Epic EHR, but it was intermittent. There were issues with completeness; occasionally it was’t all of the information that was out there, we were’t getting everything. “
So, in an attempt to better the improvements that came with the EHR, Cone Health turned into the MedHx system from health IT vendor DrFirst.
“The bottom line was we’d get more data and the data would be better, ” Pickering explained. “It was to improve upon the supplier of our electronic prescription data by having more connections with pharmacies and more sources for their information, so that by simply looking in our EHR we would be able to see virtually all of that patient’s prescription information, with fewer holes in the data. “
The second part of the solution was better information, because DrFirst maintained its technologies could fill in some of the blanks on some of the lost information that Cone Health received and could make it a little bit easier and quicker to import the information into the supplier organization’s record.
“Our previous provider of information got it from the pharmacy benefit manager or claims history, ” Pickering recalled. “So we knew if you got a prescription and paid cash for it, it wouldn’t show up. We just knew it wasn’t as complete. What DrFirst’s product proposal was, was that they would connect directly with pharmacies, and not rely on insurance claims as the sole source of information. So, additional sources of information. “
MEETING THE CHALLENGE
Cone Health has a group of pharmacy technicians that do medication history interviews. They go in the individual ‘s room using a notebook and they speak to the patient for their medications. They review what Cone Health already has in its system, and they search for further data coming in from the external sources as a means to help the patient to piece together an accurate list of what they’re taking and how they’re taking it.
“It’s switching back and forth from our EHR into the external sources of information and using that information to piece together what the individual is taking, ” Pickering said. “Most of the time patients don’t have a perfect handle on everything, so we’re able to run their memory and talk to them about recent prescriptions that we see.
“Having more of the data in there at our fingertips at the time of interview reduces the number of times that we must interrupt the interview because the patient doesn’t know any of these facts, and we have to go call their pharmacy and receive information, and come back and revisit them, ” he added. “With more complete data in the time of this initial interview, it makes the job a little bit easier to do. “
In the first 3 months following the MedHx implementation, Cone Health clinical staff experienced a 21% increase in accuracy and completeness of drug history, which resulted in a 10% increase in their ability to collect timely and accurate medication histories.
“Measuring this job is very challenging, ” Pickering noted. “It’s a challenge to get objective data of improvement because of the nature of this job and variation between patients and how much time it takes with certain patients. So that is a challenging thing.
“What DrFirst did was they have a pre- and post-implementation survey, ” he continued. “That revealed that, among all of the Cone Health users, not my folks in pharmacy, but all the doctors and nurses in the community, everyone using our version of Epic, there was an improvement in their pride together with this part of the job. “
Among the questions was just for prescribers. It concerned how complete they thought the information was at the time they were discharging patients from the hospital. That indicated a substantial improvement in their impression of how complete the information is now over what it was before implementation of this new system.
ADVICE FOR OTHERS
“My peers would understand exactly the trouble.Everyone’s facing the same difficulties, ” Pickering commented. “There’s this continual evolution of the healthcare data that is available and methods to obtain it. Therefore it’s getting better through the years. I would tell my peers that any way they are able to increase the quantity of prescription data coming into their system is a massive advantage. And they would easily agree. “
One of the biggest barriers to conducting accurate medication histories in a timely manner is the basic demand for information, he added.
“And I must say, when you’re interviewing patients, it’s quite common for patients to say, ‘Isn’t that information from the computer? ‘” he concluded. “Well, ‘ in the computer’ is a extremely simplified thing for them. But it’s actually very intricate. Any way you can get more info flowing in that you can rely on is going to enhance your ability to do medication histories. “