Objective
Medication reconciliation is performed on more than 50% of patients received from another setting of care or provider (inbound transition of care) or on all visits that the eligible provider (EP) believes to be relevant for medication reconciliation.
Description
The eligible provider must perform medication reconciliation for more than 50% patients transitioned into the care of the eligible provider.
The new Medication Reconciliation feature allows users to review a patient’s active medication list while importing a CCDA medical summary file that was obtained from another entity.
If medication reconciliation is performed manually by comparing a paper list to the patient’s active medications in Patient Records, you can record that this reconciliation was done. Medication reconciliation may be performed by all qualified, certified medical professionals.
Performance metric
Denominator
Count of clinical encounters (of any type) marked as inbound transitions of care.
Numerator
Portion of the denominator where medication reconciliation is performed and linked to the clinical encounter.
Ratio
The resulting percentage should be more than 50%.
Exclusion
If an eligible provider did not receive any patients from a different setting of care or a different provider during the reporting period, he/she is excluded from this requirement.
Note
To claim exclusion, EPs must select No next to the appropriate exclusion during attestation and then click the Apply button in order to attest to the exclusion.
Configuration
Access levels
All operators who perform medication reconciliation must have appropriate access to do so.
Access Levels > Records > Data Reconciliation Maintenance
Note template edits Chapter 14 - Core Objective 14 - Medication Reconciliation
Steps to add and edit access levels have not changed since previous versions of the product.
Follow the same processes as before.
Note template edits
If the workflow involves completing the medication reconciliation using a Dot code statement in a progress note, consider editing the note templates with the Dot code statements. The basic format of the statement is as follows.
.MRC: Operator ID : Date : Time : Practice ID : Encounter Code
To increase user friendliness for the staff and providers, consider building QuickText or picklist options for the Operator ID and Practice ID fields and using letter codes for the Date and Time fields. Consider adding the <<PUSH>> label marker based on workflow requirements. For more information, see the PUSH and ENTER Label Markers topic in the online help.
Example:
.MRC: <<Operator ID...>>: ||DATE|| : ||TIME|| : <<Practice ID...>>: Encounter Code <<PUSH>>
Configuration notes
If medication reconciliation has to be performed at the time of clinical data import into the EHR via a CCD/CCR/CCDA file, then the operator must have access to the Import Medical Summary line item located on the Records Reports tab on the Access Level Configuration Edit screen.
Chapter 14 - Core Objective 14 - Medication Reconciliation End user training
End user training
Notes
• Medication reconciliation can be done by several methods within the EHR. However, in order to receive appropriate credit on the performance metric, it is essential that a clinical encounter with a Transition of Care value of Inbound is created and the medication reconciliation action then be performed and linked to that clinical encounter.
In the interest of standardizing workflow processes across the organization, you may choose to train all operators to perform medication reconciliation at every visit regardless of whether it is inbound. This is completely acceptable and will not affect the metric calculations adversely.
The system will filter the required data automatically for the denominator and numerator.
• Although a new clinical encounter may be generated at the time of performing the medication reconciliation from the Rx/Medications tab OR when importing medications as part of a CCDA file OR via Dot codes from a note, McKesson recommends that users always link the
medication reconciliation event to an existing clinical encounter. This is best practice. It is best to have the clinical encounter generated prior to performing the medication reconciliation action by any one of these methods.
This will reduce the potential for errors, including duplicate clinical encounters and/or improper linkage of the medication reconciliation action to the appropriate encounter, which can result in the skewing of the metrics for multiple objectives.
To record medication reconciliation from the Rx/Medications tab of a patient’s chart with an available clinical encounter (best practice):
1. Open the patient’s chart and select the Rx/Medications tab. The Rx/Medications screen appears.
Figure 77. Rx/Medications screen
2. Click the Med Rec button. If there is a matching clinical encounter in the system for the current date and provider, the screen updates and displays Meds reconciled mm/dd/yyy hh:mm.
To record medication reconciliation from the Rx/Medications tab of a patient’s chart without a clinical encounter:
1. Open the patient’s chart and select the Rx/Medications tab. The Rx/Medications screen appears.
End user training Chapter 14 - Core Objective 14 - Medication Reconciliation
2. Click the Med Rec button. If there is no matching clinical encounter in the system for the current date and provider, the Medication Reconciliation Detail screen displays with a list of existing clinical encounters.
Figure 78. Medication Reconciliation Detail screen
3. Click the New button to create a new clinical encounter for the current date and provider on the Clinical Encounter New screen.
Chapter 14 - Core Objective 14 - Medication Reconciliation End user training
5. Click the OK button to save the encounter. The Medication Reconciliation Detail screen displays again with the new clinical encounter highlighted.
Figure 80. Medication Reconciliation Detail screen
6. Click the Save button to link the medication reconciliation action to the clinical encounter.
NOTE: From the Medication Reconciliation Detail screen, you can choose an existing encounter from the list (without creating a new one) if you want to link the medication reconciliation action to an old encounter. McKesson does not recommend this method, and it should be avoided as much as possible.
To record medication reconciliation through a Dot code in a progress note:
Operators may find a few variations of the basic format of the Dot code if they’ve been configured as suggested. If the operator ID, date, time, practice ID, and encounter code will be entered in free text, it is essential to train all operators to enter each of these values between the colons (:). The format for the .MRC Dot code is as follows.
.MRC: Operator ID : Date : Time : Practice ID : Encounter Code For example:
.MRC: ABC : 02/10/2014 : 10:00AM : 123 : 18
The Encounter Code field refers to the clinical encounter to which this medical reconciliation will be linked. If an encounter code is not specified, the system will try to match an existing clinical encounter that has the same date as the medication reconciliation action. If there is more than one clinical encounter with the same date, the system will match by operator ID.
The operator ID field is the only required field for this Dot code. The remaining fields will default to the progress note’s date and time and the current practice ID (if available). If an encounter code was entered, the practice ID will default to the practice ID for the matching clinical encounter.
The medication reconciliation record includes the operator and practice who performed the action and the date/time the action was performed (using the hh:mm am/pm and mm/dd/yy formats).
When no time parameter is listed, the .MRC Dot code uses the time of the note as the default time.
If documenting the medication reconciliation via the .MRC Dot code, the time entered for the
End user training Chapter 14 - Core Objective 14 - Medication Reconciliation
medication reconciliation must be later than the time of the clinical encounter to which it is linked.
Therefore, if you also are creating a clinical encounter via the .ENC Dot code, ensure that the time indicated in the .ENC Dot code is earlier than the time associated with the .MRC Dot code.
To review a patient’s medication reconciliation history:
1. Open the patient’s chart.
2. Select Show > Data Reconciliation > Medicaton Rec. History.
3. Enter your EHR password. The Medication Reconciliation History screen appears.\
Figure 81. Medication Reconciliation History screen
The items on the list may be sorted and filtered by date range, practice, and operator.
All items on the list should have an entry in the Encounter column for appropriate credit on the performance metric.
Chapter 14 - Core Objective 14 - Medication Reconciliation End user training
If the medication reconciliation is not linked appropriately to a clinical encounter, the Encounter column for that entry is blank. These entries are not counted toward the performance metric.
Figure 82. Medication Reconciliation History screen
End user training Chapter 14 - Core Objective 14 - Medication Reconciliation
Chapter 15 - Core Objective 15 - Summary of Care Record
Objective
The eligible provider (EP) who transitions or refers his/her patient to another setting of care or provider of care provides a summary of care record for more then 50% of transitions of care and referrals.
Description
The EP who transitions or refers his/her patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals.
When transferring or referring the care of a patient to another practice/facility/provider, create a summary of care record. Per CMS, the information included in the record must be as follows:
• Patient name
• Referring or transitioning provider’s name and office contact information (EP only) • Procedures
• Diagnosis for visit (problems addressed) • Immunizations
• Laboratory test results • Vital signs
• Smoking status
• Functional status, including activities of daily living, cognitive and disability status • Demographic information
For more information on the requirements, refer to the following CMS tip sheet: http://
www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/
Stage2_EPCore_15_SummaryCare.pdf.
In the certified version of the EHR, the summary file generated can be printed or electronic.
Electronic summaries are created in the preferred CCDA (Consolidated Clinical Document
Performance metric Chapter 15 - Core Objective 15 - Summary of Care Record
Architecture) format.
Performance metric
There are three separate measures that each EP must satisfy to meet this objective successfully.