Connecting across the continuum of care

Melinda Muller MD FACP

Legacy Health System

Portland Oregon

mmuller@lhs.org

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.

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

Legacy’s 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

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

Medication Module

Home Medication List

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

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

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)

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

Compliance at Admit/Transfer

0%

20%

40%

60%

80%

EH ECH GS MP MH SC

Hospital

Per

cen

t co

mp

lian

t

Apr

May

June

July

Aug

Compliance

Successes

Medication discrepancies statistically reduced

Improvement in adverse drug event rates Patients satisfied with product More integrated care overall Being integrated into the culture