Cone Health Fine-Tunes Medication Reconciliation Process
Health systems across the country continue to fine-tune efforts to improve transitions of care. For Greensboro, N.C.-based Cone Health, that involves improvements in getting accurate medication history data into the EHR in a timely fashion.
Cone Health, which has more than 100 care locations, has been working on its medication history program since 2005, following Joint Commission edicts that everyone needed to do a better job with transitions of care to improve patient safety.
Thomas Pickering, PharmD, has been an administrative coordinator for transitions of care at Cone Health after spending 15 years as a clinical pharmacist. He supervises and coordinates the work of pharmacy technologists who gather medication histories from patients. “Most of our efforts have been put into the incoming patients, making sure their medication list is correct on admission. And we're now starting to do a better job of getting involved at the discharge end of things.”
Thinking back to when this work began in 2005, Cone Health didn't even have an EHR, Pickering recalled. “It was a slip of paper that nurses used to jot down what the patients say they took. And that was it,” Pickering said. “The doctor would sign it and send it to the pharmacy. Then we would have to go into detective mode to figure out what the patient really was taking. It's evolved since then, and every few years, we get a little bit better resources."
Isn't it already in the computer? That is what patients often ask the pharmacy technicians interviewing them. “Well, we're getting closer to that being true most of the time,” Pickering said. “I call that the Holy Grail. That would be perfect if we always could see everybody's prescriptions.”
Cone Health recently integrated a medication history solution, MedHx, from a company called DrFirst into its Epic EHR. It connects data from 69 local and independent pharmacies serving their patient population in North Carolina.
“With each iteration and update to our software and partnerships like the one with DrFirst being our most recent, we've been able to get closer to that point where we have all the information in Epic that we need when we interview the patient,” Pickering said. “If it's not all there, then that's when we have to stop, call their pharmacy, wait through the phone menu, talk to a person and ask them to go through their fill history or fax it to us and then go back and visit the patient and verify those things. So having the electronic information be more complete has really great implications for our ability to do our work faster and more accurately.”
He said previously they had huge gaps in data. “What this offered is more complete and better data. We get more of a complete record of all patients prescriptions, much better than we had before.”
Sometimes what they receive is missing key pieces of information. It may just have the name and the strength of the medicine. It might have who prescribed it, but it won't have how the doctor told them to take it. DrFirst has artificial intelligence capabilities that will fill in a lot of that information. “If that data is not captured, they're able to infer what the most likely directions were and fill it in so that when we go to import it, the information is already in there,” Pickering explained. “That means fewer keystrokes for our folks and fewer transcription errors. So it tends to be faster and more accurate. So far, I haven't seen any problems with that. For example, it'll recognize a medication that's usually taken at night and that a 30-day supply of 30 tablets was dispensed. So it just put one tablet at bedtime into the record." All of that information is double-checked in interviews with the patients.
The AI technology also codifies prescriptions and refill requests, and reconciles medication histories when exchanged between EHR systems, payers, pharmacies and HIEs, according to DrFirst.
In surveys, the Cone Health pharmacy technicians reported that the new tools are valuable and they feel like it increases their efficiency. Pickering is still waiting for the objective data they gather to reflect those efficiency gains. But COVID restrictions have made the patient interview process more challenging in some cases, so it may take a while for the impact to show up in the productivity numbers, he said. “But subjectively, I know, we're in a lot better shape now. And I'm continuing to watch that productivity data.”
Besides the hospital settings, nurses in primary care and specialists’ offices in the health system also have access to the medication reconciliation tools.
Pickering said the work on transitions is evolutionary — it's always improving. “We're always looking for ways that we can get better information faster, and do our job better and faster. So it's going to be a never-ending process we have no matter what the technology is, because you have that interface with patients,” he said. “We never just take prescription records. We have to verify with the patient, Did you pick it up? Are you taking it? Are you taking it in a way that is different than how it was prescribed? We'll never escape that. But we’re much closer to having all that prescription information at our disposal to start with.”
