Download eMM Key Concepts and Definitions - HL7 Wiki

Electronic Medication
Management (eMM)
Concepts and Definitions
Dr Stephen Chu
eMM Key Concepts and Definitions

Medication List
• A record of prescribed and dispensed medications for an individual
• Can be unreconciled or reconciled
• Unreconciled Medication List
 A list of prescribed and dispensed medications for an individual
that is automatically generated
 A raw list that has not undergone [human] clinical review,
validation and reconciliation processing
• Reconciled Medication List
 A list of all medications that an individual known to be taking
 The list is the outcome of comprehensive and authoritative
clinical review, validation and reconciliation
 Omissions, inconsistencies, e.g. duplicates, are identified and
rectified
eMM Key Concepts and Definitions
 Medication List
• A record of prescribed and dispensed medications for an
individual
• Can be unreconciled or reconciled
• Medication History List
 A record of previously prescribed and dispensed medications
(may include over-the-counter medications) for an individual
 Retrospective in nature, but can contain continuing/future meds
 Can be automatically [system] generated by queries performed
against databases of ePrescription and eDispense records
• Current Medication List
 A list of all medications (prescribed and over-the-counter) that an
individual should be/known to be currently taking as identified at
the time of review
eMM Key Concepts and Definitions
 Medication List
• A record of prescribed and dispensed medications for an
individual
• Can be unreconciled or reconciled
• Medication History List
• Current Medication List
•
 A list of all medications (prescribed and over-the-counter) that an
individual should be/known to be currently taking as identified at
the time of review
The concepts of “Current or Past Medication List” is temporal and
contextual in nature.
 They present significant challenges in information management
and pose serious clinical safety risks especially when merging
data from such lists automatically into clinical information
system or EHR/EMR repositories]
eMM Key Concepts and Definitions
 Medication Statement (HL7 Concept)
 Used to assert that a patient is "on" a medication
independent of the knowledge of specific events such as
prescriptions, administrations and dispenses
 used:
•
•
When we have knowledge that a patient is taking a particular
med and don't have knowledge of the underlying events (or
those events aren't relevant)
When we have knowledge that a patient is taking a particular
med and we *do* know the details about the underlying events,
but from a workflow perspective it would be inappropriate or
unnecessary to capture the details, but it's still important to
capture the patient/drug
eMM Key Concepts and Definitions
 Medication Profile
•
Comprehensive list of medications taken by a patient
with information on indications, actions, use patterns,
and may include
 precautions, side effects, contraindications, max cumulated
dose, and known allergy, intolerance histories where applicable
 Managed contraindications
 Failed therapy
 Patient preferences
•
•
May include diagnosis and pre-existing conditions to
allow contra-indication (may include supporting clinical
evidences such as diagnostic results) checks
(may include genetic profile in future)
eMM Key Concepts and Definitions

Medication Management Plan

A structured, formally defined scheme of patient medication
management strategies and actions, including:
 Patient’s demographics, problems/diagnoses and pre-existing
conditions (including allergies and intolerances)
 List of medications
 Indications, actions, contraindications, precautions and
managed contraindications, max cumulated dose where
applicable
 Patient preferences; failed therapy
 Medication [supply and administration] schedules where
applicable/necessary
 Ongoing medication management strategies/recommendations
 Next review due

May be stand alone or part of comprehensive care plan

Shared with other authorised health care providers
eMM Key Concepts and Definitions
 Medication Review
•
•
A process of systematic evaluation of a person’s
complete medication regimen and management of the
medications*1
Includes
 a comprehensive, accurate medication history of the patient
 careful examination of the purposes and actual use of
individual medications
 issues identified (including indications, actions, uses, effects
and side effects, max cumulated dose, contraindications), and
 medication management recommendations
eMM Key Concepts and Definitions
 Medication Review Record
•
•
•
Comprehensive and authoritative reviewed list of all
medications (prescribe and over-the-counter) that a
patient is current taking
And outcome of the review
Includes recommendations regarding proposed
changes and ongoing medication management where
applicable/required
eMM Key Concepts and Definitions
 Medication Documentation
•
•
•
An IHE pharmacy white paper
Identify the information requirements and structure from the
various information sources on
 known prescription, dispenses and administration
Identify a standardised reference structure and semantics for
harmonized medication data documentation to support
 procuring, representing and viewing medication data from
various sources
 Clinical consultation and patient medication management
 Medication review and reconciliation
 Secondary uses: clinical effectiveness and cost effectiveness
analysis; epidemiological and bio-surveillance analysis;
management and executive decision analysis
eMM Key Concepts and Definitions
 Medication Reconciliation
•
Medication reconciliation is a formal process of obtaining and
verifying a complete and accurate list of each patient’s current
medicines. Matching the medicines the patient should be prescribed
to those they are actually prescribed. Where there are
discrepancies, these are discussed with the prescriber and reasons
for changes to therapy are documented. When care is transferred
(e.g. between wards, hospitals or home), a current and accurate list
of medicines, including reasons for change is provided to the person
taking over the patient’s care. Points of transition that require
special attention are*2
 Admission to hospital
 Transfers within hospital (e.g. ED to ward; ICU to ward, etc)
 From the hospital to home, residential aged care facilities or to
another hospital
eMM Key Concepts and Definitions
 Medication Reconciliation
•
The process of comparing various medications lists to
avoid errors such as transcription, omission, duplication
of therapy, drug-drug and drug-disease interactions*3
 Based on this definition, the medication reconciliation processes
include comparing and rectifying discrepancies as well as review
of medication management therapy
•
It refers to the process of reviewing the patient’s
complete medication regimen on admission, at transfer
and discharge, comparing it with the regimen being
considered for the new care setting. The process aims at
avoiding inadvertent inconsistencies in medication
regimen across transition in care*4
IHE Pharmacy documents
•From: [email protected] [mailto:[email protected]] On Behalf Of Marco Demarmels
Sent: Wednesday, 20 June 2012 3:13 AM
To: [email protected]; [email protected]
Subject: [IHE-Pharmacy:] Stephen Chu's "eMM Key Concepts and Definitions" in the Pharmacy glossary
•
•Dear pharmacites
•
•I have incorporated Stephen's definitions into the IHE/HL7 Pharmacy glossary spreadsheet:
•https://docs.google.com/spreadsheet/ccc?key=0AmpTn7l3l1lfdFFQNFhzd0FqRUxaTUNneUZhTkk2YlE
•
•I deliberately left out the concept "Medication Documentation" from the glossary because it doesn't represent
•a term to be harmonized between HL7 and IHE, but rather explains the goals of the IHE Pharmacy whitepaper with
that title.
• Stephen Chu's "eMM Key Concepts and Definitions" presentation was sent around as an attachment.
•In addition to that I made it available as a Google Doc:
•https://docs.google.com/file/d/0B2pTn7l3l1lfTWpNUVpSU3dfZGc/edit
•
•I would like to thank Stephen again for this valuable contribution and the presentation today in the IHE Pharmacy
telco.
•
•Cheers Marco
IHE Pharmacy documents