Medication Reconciliation

As a computer professional with over 25 years of experience in health care, I spent months moving ECLIPSE through the maze to get it ONC-ATCB certified as a Complete EHR with CCHIT. I personally certified ECLIPSE on every possible measure, plowing through extensive test scripts and getting interpretations of test criteria from CCHIT and other sources.

Yesterday, a doctor told us that – when it comes to Medication Reconciliation (170.302j) – he’d rather take the word of all the “experts” he’s seen at seminars who indicated that he must perform medication reconciliation for all his patients.

So let’s examine the facts. First of all, once you own certified technology, the only things you’re responsible for reporting are covered in 170.302n – Automate measure calculation and 170.304j – Calculate and Submit Clinical Quality Measures. You may report on a subset of these – depending on your degree and scope of practice.

Next, let’s examine Appendix A from the CCHIT Automate measure calculation
test script. Here’s the only section that references medication reconciliation:

“The EP, eligible hospital or CAH who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation”

Thus, medication reconciliation is performed if a patient meets one of 2 conditions:

  • The patient was referred by or otherwise transitioned from another physician to your care.
  • You think it’s necessary.

And the requirement for Stage 1 is as follows:

“The EP, eligible hospital or CAH performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP…”

In other words, it’s not required that you actually perform any medication reconciliations unless your practice derives patients from physician referrals (or the patient switched doctors – which falls into the “you think it’s necessary” category in real life). And for patients who meet the criteria, if you perform the reconciliation for just over half of them, you’ve satisfied the requirement. Certified technology should handle both of the above situations and ECLIPSE is directly certified to perform medication reconciliation without 3rd party tools that require a subscription.

So… finally… how do you perform a medication reconciliation in ECLIPSE? Let’s return to the CCHIT test script language I used for the certification:

“Select an existing patient record and display two or more medication lists as separate lists. One list must be a current medication list in the patient’s electronic record.  Compare the two lists.”

ECLIPSE maintains a medication list internally as part of the patient’s EHR on the History tab. Simply right-click for the context-sensitive menu, change the view and compare. You’ve just performed a medication reconciliation.

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