Connecting across the continuum of care

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Connecting across the continuum of care

• Melinda Muller MD FACP
• Legacy Health System
• Portland Oregon
• mmuller_at_lhs.org

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Support

• This project funded under grant number
  5U18HS015904-02 from the Agency for Healthcare
  Research and Quality, U.S. Department of Health
  and Human Services. The opinions expressed are
  those of the authors and do not reflect the
  official position of AHRQ or the U.S. Department
  of Health and Human Services.

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Legacy Health System Who Are We?

• 5 hospitals
• 4 in Portland Oregon
• 1 in Vancouver Washington
• 11 Primary Care Clinics
• Multispecialty Surgical Clinics
• Level 1 Trauma Center
• Oregon Burn Center
• Rehabilitation Institute of Oregon

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Legacys hospital reconciliation process

• Utilizes EMR
• Clinics utilize EMR medication module already
• Admission/Transfer
• RN obtains list including medication/dose/sig and
  allergies and enters into the EMR
• Paper home medication list ready for physician to
  review
• MD reconciles home list with hospital orders

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Hospital process continued

• Discharge
• MD reconciles home meds with discharge meds in
  the EMR
• Prints/faxes prescriptions
• RN reviews list with patient gives to patient
• Copy of medication list sent to PCP/next provider
  of care

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Medication Module
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Home Medication List
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Clinic process

• Current list is printed from EMR given to
  patient in waiting room to review
• Patient reviews with provider during visit
• Changes/updates are made reviewed with patient
• Patient leaves with an updated list
• Documentation of review noted in EMR

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Connecting across the continuum

• Same medication module used inpatient
  outpatient
• Medication list already partially built at
  admission
• Easy access to inpatient changes when patient
  comes in for follow up
• Able to view what patient has been on in the past
• Nonemployed physicians can view through the
  hospital portal

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Difficulties

• TIME perceived as add on work for everyone
• Competing demands
• Patient care
• Other initiatives
• Patient understanding/knowledge
• Differing interpretations of medication adherence
  (not taking vs not taking today)

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Other issues

• Not all hospital departments utilize EMR
• New process revealed existing workflow problems
  was expected to fix them
• IR stretched thin maintaining 2 EMRs

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Compliance
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Successes

• Medication discrepancies statistically reduced
• Improvement in adverse drug event rates
• Patients satisfied with product
• More integrated care overall
• Being integrated into the culture