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Medical Reconciliation Successful at Goodall Hospital Thanks to E-Prescribing
By Laura Gater

Goodall Hospital, a 58-bed acute care facility in Sanford, Me., has implemented a medical reconciliation program that successfully links physicians with the facility’s information network to efficiently obtain patient medication history. The hospital provides services such as inpatient, surgery, emergency medicine, radiology, laboratory, physical rehabilitation, occupational health, and pain management.

All hospital care providers now have medication and allergy information for the patients they are treating—data that may help to avoid adverse reactions or events during any patient’s visit.

The program, which was implemented in the fall of 2006, was piloted by the emergency department (ED) because of its high patient volume and its need for drug interaction information. Once established in the ED, the solution was rolled out to the rest of the hospital.

Medical reconciliation combines automated information and a one-on-one patient interview to obtain his or her full medication history. Goodall features a query tool via its DrFirst software that automatically searches for patients’ medication histories upon registration. This information is then printed to a specific department, and a copy is integrated into the patient’s electronic medical record.

DrFirst is a provider of physician connectivity services through its Rcopia e-prescription management system. New prescriptions and renewals are sent electronically to the patient’s pharmacy. Rcopia checks for patient insurance eligibility, formulary compliance, and medication lists obtained through RxHub from payers, pharmacy benefits managers, and SureScripts pharmacy fill history. It offers clinical decision support tools to check prescriptions for drug-drug and drug-allergy interactions and appropriate dosing.

What’s unique about DrFirst is that it is not confined to a stand-alone e-prescribing system. Instead, it provides unique application and connectivity solutions for ambulatory and acute care environments, solutions that focus on secure data sharing and interoperability. Physicians, patients, and healthcare stakeholders can receive benefits from e-prescribing and close continuity-of-care gaps.

Medical reconciliation, combined with e-prescribing, are improving the level of patient care at Goodall, according to Chief Information Officer and vice president of business process improvement Charlie Caruso. The tools are enhancing patient care and safety, along with offering workflow improvements to provider offices, in the form of more accurate information and less calls to the pharmacies.

“Goodall Hospital offered e-prescribing to its medical staff at a subsidized rate as a means to begin the steps toward creating an electronic community health record,” explains Caruso. “E-prescribing was seen as a low-cost, high-benefit initiative that could be implemented quickly with little hospital involvement. This project was done with support by our medical staff. This step represented the first form of using computer-based technology in many of the physician practices in our community.”

Medication reconciliation is not necessarily saving the hospital any money, but its value cannot be discounted when it comes to patient safety. Along the way, the hospital had to clear a couple of hurdles.

“The barriers to implementing medication reconciliation along with e-prescribing at Goodall have been addressing workflow changes, which have certainly been manageable, and adaptation to the technology,” Caruso says.

By adopting medication reconciliation, Goodall hoped to become compliant with Joint Commission standards and improve patient safety whenever possible. “It has met expectations; however, I believe that organizations initially were looking for an ‘easy button’ to accomplish this. The realities of limited sources of obtaining accurate information still come down to the exchange between a provider and patient,” says Caruso.

Workflow changes at Goodall needed to be addressed to best utilize the new electronic system. Historically, the provider wrote the scripts. Now, that is generally the responsibility of office support staff, such as medical assistants or nurses. They may queue up a patient, enter demographics if necessary, and queue scripts for the provider. The provider reviews and then enters his or her personal identification number on the back end. 

Physician practices wrote prescriptions on paper, but all that changed with Rcopia. Now, someone in the practice must identify the patient correctly and be able to respond to eligibility coverage and allergy interactions when entering the script, definitely a little more involved than just writing out a prescription.

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.