Electronic Medication Management

描述（申请人提供）：采用卫生信息技术可以提高用药管理的质量和安全性。随着患者在社区和医院提供者之间转移，有许多机会出现用药错误。医学研究所报告说，在门诊诊所不准确的药物清单造成了更多的致命药物不良反应比在医院设置。2008年秋季，纽约长老会医院（NYP）制定了一个跨学科的电子流程，用于协调患者从门诊到医院和从医院到门诊的药物治疗。该流程将入院时记录药物核对证明的合规性从不到40%提高到95%以上。在采用药物核对过程之前，入院前药物和出院药物作为自由文本存储在电子健康记录（EHR）中。采用后，使用NYP的门诊EHR和住院EHR共享的结构化电子药物列表管理药物。 对NYP药物协调过程的正式研究可以作为未来IT实施解决药物协调的基准。NYP流程是创新的，因为1）它不需要纸质表格; 2）它使用通常部署的商业EHR; 3）它使用基于离散的编码元素的药物列表，连接门诊和住院护理环境。 研究方法：除了提高文件的合规性，我们假设，电子药物核对过程的实施影响供应商的工作流程，药物清单的完整性，以及潜在有害的意外用药差异的比率。我们将通过聘请临床专家来评估这一假设，以审查从门诊过渡到门诊的患者的电子病历。住院病人？门诊护理设置。我们将在每个过渡点检查药物列表，并审查来自临床记录和其他电子数据源的信息。 预期结果：我们认为，一个共享的，结构化的药物清单，跨越门诊和住院护理设置是提高药物管理的质量和安全性的最佳途径。然而，在门诊和住院护理环境中使用共享电子药物清单的好处尚未得到科学证明。我们处于一个独特的位置，以评估共享药物清单的好处，以及它是否改善了我们的护理环境中的药物管理。 通过护理连续体对患者的药物治疗方案的大多数改变可能是患者的护理提供者预期的并记录在案。有时，可能存在无意的用药差异，可能会造成患者伤害。这项研究将了解采用全电子药物核对流程是否与护理机构中潜在有害的无意药物差异率的下降有关。

DESCRIPTION (provided by applicant): The quality and safety of medication management can be improved by adopting health information technology. As patients transfer among community-based and hospital providers, there are numerous opportunities for medication errors. The Institute of Medicine reported that inaccurate medication lists in ambulatory clinics caused a larger number of fatal adverse drug effects than in a hospital setting. In fall 2008, NewYork-Presbyterian (NYP) instituted an interdisciplinary, electronic process for reconciling patients' medications as they transitioned from ambulatory-to-hospital and hospital-to-ambulatory care settings. The process improved compliance of documenting attestation of medication reconciliation at hospital admission from less than 40% to over 95%. Before the adoption of the medication reconciliation process, preadmission medications and discharge medications were stored as free-text in the electronic health record (EHR). After the adoption, medications were managed using a structured electronic medication list shared across NYP's ambulatory EHR and inpatient EHR. A formal study of the medication reconciliation process at NYP can serve as a benchmark for future IT implementations addressing medication reconciliation. The NYP process is innovative because 1) it does not require paper forms; 2) it uses a commonly-deployed commercial EHR; and 3) it uses a medication list based on discrete, coded elements that bridges ambulatory and inpatient care settings. Methods: In addition to improving documentation compliance, we hypothesize that the implementation of the electronic medication reconciliation process affected provider workflow, medication list completeness, and the rate of potentially-harmful unintentional medication discrepancies. We will evaluate this hypothesis by engaging clinical experts to review electronic charts for patients who transitioned from ambulatory ? inpatient ? ambulatory care settings. We will examine the medication lists at each point of transition, and review information from clinical notes and other electronic data sources. Expected Outcomes: We believe that a shared, structured medication list that spans ambulatory and inpatient care settings is the best way to improve the quality and safety of medication management. However, the benefits of using a shared electronic medication list across ambulatory and inpatient care settings have not been proven scientifically. We are in a unique position to assess the benefits of a shared medication list and whether it improved medication management in our care setting. Most changes to a patient's medication regimen through the care continuum are likely intended and documented by the patient's care provider. Sometimes, unintentional medication discrepancies may exist that have potential to cause patient harm. This study will yield knowledge on whether the adoption of a fully-electronic medication reconciliation process was associated with a decline in rate of potentially-harmful unintentional medication discrepancies across care settings.