Electronic Medication Management

说明(申请人提供)：采用健康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，出现用药错误的机会很多。医学研究所报告说，与医院环境相比，门诊诊所不准确的药物清单导致的致命药物不良反应数量更多。2008年秋天，纽约长老会(NYP)建立了一个跨学科的电子流程，用于协调从门诊到医院和医院到门诊护理环境的患者的药物。该流程将入院时记录药物调节证明的依从性从不到40%提高到95%以上。在采用药物调节程序之前，入院前药物和出院药物以自由文本形式存储在电子健康记录(EHR)中。在采用后，药物使用结构化的电子药物列表进行管理，该列表在NYP的门诊EHR和住院患者EHR之间共享。NYP对药物对账过程的正式研究可以作为未来解决药物对账的IT实施的基准。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清单，该清单连接了门诊和住院护理设置。 方法：除了改善文件遵从性外，我们假设电子药物对账流程的实施影响了提供者的工作流程、药物清单的完整性以及潜在有害的非故意药物不符率。我们将通过聘请临床专家来评估这一假设，审查从门诊过渡的患者的电子病历？住院病人？非卧床护理环境。我们将检查每个过渡点的药物清单，并审查来自临床笔记和其他电子数据来源的信息。 预期结果：我们认为，共享的、结构化的、跨越门诊和住院护理环境的用药清单是提高用药管理质量和安全性的最佳方式。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。我们处于独特的地位，可以评估共享药物清单的好处，以及它是否改善了我们护理环境中的药物管理。 通过护理连续体对患者用药方案的大多数改变很可能是由患者的护理提供者有意并记录下来的。有时，可能存在可能导致患者伤害的意外用药差异。这项研究将提供关于采用完全电子化的药物对账过程是否与不同护理环境中潜在有害的意外药物差异率下降有关的知识。

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.