Volume 2 - Issue 3 - May 2007
Industry Spotlight: Medication Reconciliation ... What’s all the fuss?
By: Donna Carroll, Editor, The MEDITECH Community Bulletin
With patient safety initiatives in the forefront of most healthcare organizations’ strategic implementation plans, we decided to turn our Industry Spotlight on one of today’s most important patient safety standards – Medication Reconciliation.
Beginning January 1, 2006, all healthcare settings must be compiling medication lists for new and returning patients and for all patients entering a new level of care. This means each list of recently taken medications must be reconciled against the initial set of orders. For a hospital setting, this includes the admission phase, any intra-hospital transfers and the discharge phase. Finally, this complete medication list must be communicated to whoever is the next healthcare provider in the patient’s continuum of care.
The process of medication reconciliation involves three steps:
- Verification - Collection of medication history, usually performed by prescriber and/or nurse;
- Clarification - Ensuring that the medications and doses are appropriate, usually performed by prescriber and/or pharmacist; and
- Reconciliation - Documentation of changes to orders or reason for differences, performed by pharmacist.
National Patient Safety Goals - Mandatory JCAHO Requirements
The Joint Commission (JCAHO) has developed a set of National Patient Safety Goals (NPSG) which outlines the specific requirements and implementation expectations for healthcare organizations. The purpose of the Joint Commission’s NPSG is to promote specific improvements in patient safety. The goals highlight problematic areas in healthcare and describe evidence and expert-based consensus to solutions to these problems. Recognizing that sound system design is intrinsic to the delivery of safe, high quality health care, the goals generally focus on system-wide solutions, wherever possible. The goals which specifically impact the medication reconciliation process are Goals 8A, 8B and 13, as described below.
Goal 8
Accurately and completely reconcile medications across the continuum of care.
Requirement 8A:
There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.
Rationale for Requirement 8A:
Patients are most at risk during transitions in care (hand-offs) across settings, services, providers, or levels of care. The development, reconciliation and communication of an accurate medication list throughout the continuum of care is essential in the reduction of transition-related adverse drug events.
Implementation Expectations for Requirement 8A:
- The organization, with the patient’s involvement, creates a complete list of the patient’s current medications at admission/entry.
- The medications ordered for, administered to, or dispensed to the patient while under the care of the organization are compared to those on the list and any discrepancies (e.g., omissions, duplications, potential interactions) are resolved.
Requirement 8B:
A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the organization.
Implementation Expectations for Requirement 8B:
- The patient’s accurate medication reconciliation list (complete with medications prescribed by the first provider of service) is communicated to the next provider of service, whether it be within or outside the organization.
- The next provider of service checks the medication reconciliation list again to make sure it is accurate and in concert with any new medications to be ordered/prescribed.
- The complete list of medications is also provided to the patient on discharge from the organization.
Goal 13
Encourage patients’ active involvement in their own care as a patient safety strategy.
Requirement 13A:
Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
Rationale for Requirement 13A:
Communication with patients and families about all aspects of their care, treatment or services is an important characteristic of a culture of safety. When patients know what to expect, they are more aware of possible errors and choices. Patients can be an important source of information about potential adverse events and hazardous conditions.
Implementation Expectations for Requirement 13A:
- Patients and families are educated on methods available to report concerns related to care, treatment, services and patient safety issues.
- The organization encourages patients and their families to report concerns about safety.
Compliance with these requirements is assessed throughout the accreditation cycle, through on-site surveys, and the Periodic Performance Review. When an organization does not fully comply with a requirement, the organization will be assigned a requirement for improvement, and all requirements for improvement must be addressed in an Evidence of Standards Compliance (ESC) Report. Failure to resolve a requirement for improvement affects an organization’s accreditation decision, which could ultimately lead to a loss of accreditation.
Medication Reconciliation – A Solution
With these NPSG requirements in mind, and the severe penalty for non-compliance, many healthcare organizations are scrambling for an appropriate solution which is both cost-effective and easy to implement and maintain.
One such solution, MediRecon, a product of MediModules, Inc., is rising to the top of the solution list for many healthcare organizations. MediModules recently established a strategic partnership with CRH Consulting, Inc., a health IT consulting company in Massachusetts. We recently spoke with Drs. Abha Agrawal and Munish Khaneja of MediModules, and CRH Consulting’s President, Todd Babineau, to learn more about the MediRecon solution. Below is a summary of our conversation.
Q. What distinguishes MediRecon from other medication reconciliation products on the market?
A. First, and very importantly, is the fact that MediRecon was developed by physicians. Because medication reconciliation information systems can be challenging to deploy without clinician buy-in, it’s important to know that the chosen solution has not only been tested, but was actually designed by physicians who know the work flow process better than anyone else.
Furthermore, MediRecon was designed using a patient-centric approach. That is, the product ensures patients’ involvement in the reconciliation process via a bi-directional connectivity with a patient portal, MyMediList (http://www.mymedilist.org/). MyMediList is a free personal medication record offered by MediModules, Inc, free-of-charge to customers.
Q. What healthcare settings and provider types is MediRecon designed for?
A. MediRecon is an effective solution for medication reconciliation for all types of outpatient settings (including home care) and for all three stages of the inpatient process: admission, discharge, and transfer (ADT). It provides a secure, seamless workflow for all clinicians: physicians, nurses, and pharmacists.
Q. Specifically, how does MediRecon accomplish the Joint Commission’s NPSG requirements?
A. MediRecon provides extensive audit logs for all transactions, including medication edits, profile updates, and connectivity transactions. To ensure ease-of-communication with the next level of provider upon a patient’s discharge from the clinic or inpatient facility, MediRecon provides tools such as MediRecon-Fax and Secure E-mail.
According to NPSG Goal 13, the patient must be an active participant in their safety plan. MediRecon’s bi-directional connectivity with the patient portal fulfills this requirement. MediRecon provides patient-friendly printouts, which are also suitable for placing in paper records. In addition, MediRecon is built with easy-to-interface technology and is capable of interfacing with prescription claims data, as needed.
Q. How is MediRecon deployed and what resources are necessary to maintain it?
A. MediRecon is a web-based solution, so it is available anytime, anywhere. There is no need to install any software, and minimal hardware requirements. Our team will work with hospital personnel (IT and/or medical staff) during the initial deployment in order to ensure accurate setup. Alternatively, you may choose to install MediRecon on your own servers, if desired.
Q. What about interoperability with EMR/EHR or ADT systems, and security?
A. MediRecon’s use of standards, web-services technology, and XML ensure easy integration with any EMR/EHR product or ADT system. MediRecon’s multi-level security model provides strong security and ensures each record is secure, encrypted, and protects against unauthorized access.
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MediModules, Inc. will be offering a FREE webinar to anyone interested in learning more about their medication reconciliation solution. Be sure sign-up for this very informative session.
Title:MediRecon: Comprehensive Web-Based Medication Reconciliation -- Are You Ready for JCAHO?
Date:Thursday, May 24, 2007
Time:3:00 to 4:30 p.m. Eastern Time (2:00 p.m. Central / 1:00 p.m. Mountain / 12:00 p.m. Pacific)
Click here to register |
MediRecon is a web-based medication reconciliation solution developed by Dr. Abha Agrawal (CEO) and Dr. Munish Khaneja (CMO) of New York-based MediModules, Inc. For additional information or to learn more about the MediRecon solution, please contact CRH Consulting Inc. at MediRecon@crhconsult.com.
Career Corner: Contracting Options Provide Opportunity for Workers and Flexibility for Companies
By: Donna Carroll, VP Business Development & Recruitment, Systems Personnel
There is no doubt that today’s employment market is full of opportunities for the MEDITECH professional. With so many healthcare providers implementing new applications, additional modules, or just upgrading to stay current, the need for skilled implementation specialists continues to grow. However, many organizations cannot afford to increase their headcount with permanent staff. So, they turn to contractors to get the job done.
For employers, the obvious benefits of bringing in contractors are decreased employment costs, increased staffing flexibility, and maintaining budget controls. And, once the project is completed, the contractors (and associated expense) then go away. From an employer’s perspective, it makes great sense to utilize contractors for limited-duration projects.
What about the worker’s point-of-view . . . what makes an individual want to perform contracting? There are many benefits associated with contract work, namely:
- Flexibility in Lifestyle:
- Control of career path
- Balance between business and personal obligations
- Potential for Higher Earnings:
- Higher hourly rate versus annual salary
- You are paid for every hour worked
- Increase Technical and Professional Knowledge Base:
- You can increase your portfolio of skills
- Varied work environments and projects increase your marketability
- Evaluate Potential Permanent Jobs (Temp-to-Perm):
- Evaluate work scope and corporate culture before accepting employment offer
- Network with key personnel for future opportunities
- Opportunity to Travel:
- Provides for flexibility in assignments
- Local, national, and international opportunities
Now that we know the benefits, let’s explore the potential downside. Like any career option, there are both positives and negatives associated with contracting. Some of the negatives include:
- Inconsistent work schedule (gaps in work between assignments)
- No medical benefits
- No 401(k) or pension plan
- Administrative tasks (billing, collections, tax payments, etc.)
Through my daily conversations with MEDITECH professionals, I’ve learned that the number one reason why more people don’t consider contracting is their need for affordable medical benefits, followed closely by their lack of interest in being a sole proprietor and having to perform all the administrative tasks associated with running a business. In reality, the single largest risk for both contractors and employers is the potential of being improperly classified as an ‘Independent Contractor’ according to IRS regulations. The IRS evaluates the behavioral control, financial control, and type of relationship in order to determine if a worker is an independent contractor or an employee. If a worker is incorrectly classified as an independent contractor, both the worker and employer can be held liable for employment taxes, plus a penalty.
So, how can MEDITECH professionals leverage their high-demand skills and enjoy the great benefits of a contracting career without all of the risks associated with it? Generally speaking, there are three options to consider:
Option # 1 – Consultant Employee
For those who like the idea of being a consultant, but need a steady paycheck and the camaraderie of a team and company behind you, the best option might be to seek permanent employment with a well-reputed consulting firm. In this instance, you would be paid an annual salary and benefits (versus an hourly rate), and would be assigned to a specific client or project by your employer, the consulting firm. Although you would not have to find your own work assignments, you would also have little control over which assignments you accept or decline. There are many well-established consulting firms which provide services to the MEDITECH market: First Consulting Group (FCG), Healthlink Inc. (an IBM company), Beacon Partners, CTG HealthCare Solutions (CTGHS), ACS Healthcare Solutions, and Perot Systems, to name a few.
Option # 2 – 1099 Contractor or Corporation
There are also several smaller consulting firms in the MEDITECH market which are well-reputed. Most of these firms are also well-established, but prefer a lean staffing model and service their clients by engaging independent contractors (paid on a 1099 or corporation-to-corporation basis) for specific projects, as needed. This allows these firms greater flexibility, less overhead, and the ability to offer a more competitive rate to their clients. Some of these companies include: CRH Consulting Inc., Inteck Inc., maxIT Healthcare, and Navin, Haffty & Associates, among others. Working with such firms would be an option for someone who has incorporated themselves as a business, or who legitimately qualifies as an independent contractor (see IRS Form SS-8), and does not mind performing the administrative tasks required.
Option # 3 – Contract Staffing Service Provider
So, what if you like the independence of choosing your own clients and projects, but don’t want to run your own business? An ideal solution would be to find an organization which could act as your employer, taking care of all of the administrative tasks, offering you affordable medical benefits and the option to participate in a 401(k) plan, and paying you for every hour you work plus expense reimbursement (if applicable) on a weekly basis.
There is such an organization which performs this service for thousands of contractors at everywhere from small, local companies to well-known Fortune 500 companies. Top Echelon Contracting, Inc., is a contract staffing service provider for technical, professional, and healthcare contract staffing. Top Echelon Contracting is NOT a consulting firm, nor are they a professional search firm. They do not find work assignments for contractors, nor do they recruit contractors for companies. Their sole function is to handle the financial, legal, and administrative responsibilities associated with hiring contract staff, and they’ve been doing it nationwide since 1992. Contractors become an employee of Top Echelon Contracting, which coordinates everything involved in the employment process including:
- Employment Paperwork and Forms (W-4, I-9, etc.)
- Employee Benefits Administration (medical, dental, vision, life insurance, 401(k), etc.)
- Weekly Payroll funding and processing including:
- Federal Income Tax Withholding
- Social Security (employee and employer share)
- Medicare (employee and employer share)
- Federal Unemployment
- State Income Tax Withholding
- State Unemployment Insurance
- State Disability Insurance (if applicable)
- Workers’ Compensation Premiums
- Year-end W-2 Forms
- Expense Reimbursements (if applicable)
- Direct Deposit into Employee Bank Accounts
Benefits to Contractors
Contractors who are employed by Top Echelon Contracting enjoy the following benefits:
- Weekly Paycheck:
- Direct deposit
- Applicable expense reimbursement
- Itemized payroll statements
- W-2 Payroll Tax Withholdings and Matches:
- Tax withholdings, filings, and matches handled by Top Echelon Contracting
- Top Echelon Contracting maintains responsibility for government compliance on its employees
- Workers’ Compensation Coverage:
- Coverage nationwide for approved job descriptions
- Hotline with access 24 hours a day, 7 days a week
- Human Resources Services:
- Benefit specialist to answer any benefits questions you may have
- Employee Handbook with policies and procedures
- Optional Benefits:
- Three new health insurance plans available (effective July 1, 2007) to employees working an average of 30 hours or more per week
- Dental Insurance
- Vision Insurance
- Life Insurance
- Accidental Death & Dismemberment Insurance
- Aflac (Short-Term and Long-Term Disability, etc.)
- 401(k) Savings Plan:
- Eligible to join at the end of six months of continuous employment
- Retirement planning tools and investment consulting through Financial Services
Benefits to Companies
Some of the benefits to companies utilizing a contract staffing service provider include:
- Reduce Employment Costs
- Increase Staffing Flexibility
- Reduce Payroll Tax Issues
- Reduce Benefits Administration
- Reduce Unemployment Exposure
- Reduce Workers’ Compensation Exposure
- Maintain Budget Controls
- IRS Protection Against Employee Misclassification
For more information about Top Echelon Contracting, Inc., please visit their web site at http://www.topecheloncontracting.com.
Whatever option best suits your preference, we encourage you to explore a contracting or consulting career. As a professional search firm, I work with companies discussed in all three of the options and have numerous opportunities for candidates with MEDITECH skills from the Clinical, Financial, and Administrative application suites. If you'd like to learn more about contracting or consulting, feel free to call me at 413-258-4511. I’d be happy to listen to your specific needs and help advise you on a career path. All the best! - Donna
Recent News: AHIP Quality and Safety Proposal – Setting a Higher Bar
The Board of Directors of America’s Health Insurance Plans (AHIP) released their new strategy to improve the safety and quality of medical care. Highlights include “establishing a new national entity to evaluate and compare the safety, efficacy and cost effectiveness of new and existing healthcare treatments and technologies, including prescription drugs and medical devices.” Other proposals include FDA reform, more emphasis on best practices, development of tools to manage chronic conditions, research proposals and the creation of a medical dispute resolution system.
More info: http://www.ahip.org/content/fileviewer.aspx?docid=19476&linkid=167556
Worth a Read: Articles of Interest to the Healthcare IT Field
At Your Service
By: Greg Goth
HealthCare Informatics, April, 2007
A look at a ground-breaking achievement from Omaha-based Alegent Health in which consumers can use an online program to find out hospital procedure prices based on their health insurer and plan. A further look at other future-thinking initiatives that are differentiating some healthcare organizations from their local market competitors.
Read article
Infection Protection
By: Kayt Sukel
HealthCare Informatics, March, 2007
The CDC’s National Healthcare Safety Network (HCSN) deployed in 2005, has combined three previously existing infection control systems created by CDC's Division of Healthcare Quality Promotion — the National Nosocomial Infection Surveillance System, the Dialysis Surveillance Network and the National Surveillance System for Healthcare Workers — into a single, Web-based reporting and analysis platform. The joining of these systems has allowed hospitals to use the same system to track both patients and healthcare workers in a facility. Successes are shared in this article that also talks about mandatory infection control reporting in some states.
Read article
Improving the Interface of Care with Medication Reconciliation
By: Fred M Eckel, RPh, MS
Pharmacy Times, November, 2005
The role of the community pharmacist in hospital Medication Reconciliation and patient safety is an important one. Teamwork between the patient’s pharmacist and the hospital pharmacist is seen as vital in this view from a community pharmacist.
Read article
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