Think back to the last encounter you had with a healthcare provider. One of the first questions you were asked was, “What medications are you taking currently?” Whether it was in an acute setting like the emergency room, a routine annual visit, or even at the dentist’s office, this information is vital to ensure that you receive appropriate care.
It was not until 2005, when The Joint Commission selected medication reconciliation as one of its National Patient Safety Goals, that the practice of verifying a medication list became a routine process in the delivery of patient care. However, despite the recognition of its importance, medication reconciliation has experienced slow adoption, initially for lack of a best practice approach. The process of tracking down an accurate medication list was laborious for clinicians. The data used by physicians, nurses, and pharmacies was recorded in differing levels of granularity and formats. Protocols varied in when and how often medication reconciliation should be completed.
In 2006, the topic of medication reconciliation reached national importance when the Institute of Medicine report, “Preventing Medication Errors,” stated that as many as 50 percent of all medication errors, and up to 20 percent of adverse drug events in the hospital, are due to poor communication. Around the same time, the Institute of Healthcare Improvement identified medication reconciliation as one of its tenets in its 100,000 Lives Campaign. More recently, the ONC made medication reconciliation a requisite item for Meaningful Use certification.
With many healthcare systems transitioning to risk-sharing reimbursement models, it is time to elevate medication reconciliation beyond a transactional task to a more comprehensive approach that I refer to as “medication management.” Being able to manage a patient’s medication list has wider impacts on the healthcare system than just the episode of care. Under risk-sharing reimbursement models, the financial health of a hospital network is tied to quality outcomes and performance metrics. Not only are these hospitals at risk for earning less revenue, but they also face penalties for substandard care. In 2013, over 2,200 hospitals paid approximately $280 million in total penalties due to excess 30-day readmissions. Hospitals have deployed care coordination initiatives to improve the discharge process, but have failed to recognize that proper medication management throughout the care continuum, from admission to post-discharge, is critical to meet the metrics in value-based payment models.
Given that patients often access care from different facilities with disparate technologies, coordinating this care and maintaining a consistent therapeutic plan and medication list become increasingly challenging. When you add payers into this mix of stakeholders, the need to manage medication regimens to optimize outcomes while reducing costs is paramount.
Medication management incorporates reviewing the medication list not only for accuracy, but also for optimization of therapeutic regimens and patient adherence. This requires negotiation between the patient, healthcare providers, and pharmacist. It is unrealistic to discharge patients on 12 medications and expect absolute adherence to a complicated and disruptive drug schedule. Yet, lack of adherence to a medication regimen is a known risk factor for readmissions and worsening morbidity and mortality.
How can technology help? As healthcare networks expand through mergers, acquisitions, and new partnerships, it is important to share medication regimens and create shared care plans that allow for simplifying medication regimens without the tradeoff of efficacy. Simplifying the medication regimen requires addressing the frequency medications are taken, access to pharmacy that can dispense the medication, and finding suitable alternatives at lower costs. However, this is not feasible unless there is a holistic view of the patient medical record.
Interoperability is the bridge that can share information among systems, facilities, and providers. As simple as it may sound, many health organizations fail in ensuring that the entire ecosystem surrounding the patient is fully aware of the medication management plan. The deleterious impacts are patients being on the wrong medication regimens, getting sicker, and then readmitted.
Medication reconciliation, on the surface, appears straightforward. Yet its path to adoption has been stop and start. Transitioning from paper to an EMR process was slow until the technology mirrored the workflow. Now at another pivot in the way healthcare is delivered, technology again needs to mirror the clinical and business drivers behind medication management. The key is employing an interoperability strategy that reinforces medication management (not just reconciliation), shared care plans, and patient engagement. With this approach, medication management will be a collaborative process that will position healthcare systems to achieve its metrics in the new environment of payment reform.
