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While some systems are beginning to use internal electronic medical reconciliation, this model is the first to track external records as well. What truly sets this system apart from other electronic medication reconciliation programs is that the others still require nurses to manually enter medication information based on patient interviews.
“This is a very significant first, as drug errors are causing a national healthcare challenge,” said Donna Staton, CIO of Fauquier Health System. Studies show inconsistent medication knowledge and record-keeping threaten patient safety, causing up to 50 percent of all medication-related errors in hospitals and up to 20 percent of all adverse drug events.
Jeffrey J. Wise, MD, one of the pilot users of RcopiaAC (Acute Care), sees multiple advantages to using the system. “RcopiaAC has been a great addition for patient care,” he said. ”It provides similar benefits as an office-based EMR for the hospital. Since reducing medical errors has become a highly-publicized endeavor, I think the Rcopia product will be an essential tool for hospitals and providers,” predicted Dr. Wise. “The ability to electronically collect a patient’s medications from multiple outpatient providers on admission to the hospital is invaluable, since patients frequently forget the medications and/or dosages they are on, or they fail to bring a list with them. The hospital discharge process is also facilitated since the inpatient medications can be easily transferred to the discharge medication list.
“As a physician, the greatest benefit is that prescriptions no longer need to be written; they can be faxed or e-prescribed directly to the pharmacy. Then all of the medications are permanently stored so a provider can see when the prescriptions were last filled and how many pills were dispensed,” he noted. “The patient’s preferred pharmacy is also stored, so the next time the patient is seen at the hospital, all of this information is readily available. Hopefully, this would eliminate dosing errors and complications, which is what all patients, doctors, and hospitals desire.”
Dr. Wise further pointed out that, “Physicians should also be interested [in the new system] due to the increasing prevalence of pay-for-performance programs which will reimburse physicians at higher rates for providing better care.”
A Physician-driven Initiative
Another interesting aspect of this project is that it was largely physician driven. “Some of our physicians were using Rcopia in their offices and were so impressed by it that they approached the health system about bringing it into the hospital,” explained Staton.
“However, the acute care setting requires different functions than an office. Rcopia, as it existed, did not meet those needs, which is why our relationship with Rcopia developer, DrFirst, Inc., was so important to the success of the system.”
Consolidating Information from Many Sources
Fauquier Health System partnered with DrFirst of Rockville, Md., to develop their existing Rcopia product into RcopiaAC, specifically for use in acute care facilities. RcopiaAC compiles a patient’s current prescriptions from various existing prescription history databases like RxHub, PBM history, and SureScripts; and it also searches existing Rcopia e-prescribing participants. As e-prescribing increases, so will the RcopiaAC effectiveness. DrFirst anticipates that 90 percent of patient medication records will soon be captured when all prescription databases are available for searching. What will not be captured? There are limitations; for example, with some---but not all---self-pay medications, as well as some “mom and pop” pharmacies that do not participate with the electronic databases. Therefore, RcopiaAC does not eliminate the need to interview patients, but it supplies extensive validated data to develop a far more accurate medication list.
Value Added after Discharge
At the end of a patient’s hospital stay, the medication list is reviewed again to help ensure that any prescriptions made at the time of discharge are also without complication or duplication. New medications may also be electronically prescribed by the physician and added to the patient’s current outpatient medication list at the time of discharge. This added feature helps to avoid another source of drug errors: poor physician handwriting.
The prescription information is also provided to the patient in the form of a summary medication list that can be carried in a wallet. Patients in the pilot study have said that they appreciate receiving this list and find it helpful. The prescription list can be sent to the patient’s primary care provider to help ensure safety across the continuum of care.
Steps toward a Fully Automated System
Fauquier Hospital is excited about what RcopiaAC means to their paperless chart and electronic medical record (EMR) initiative. Current manual processes are automated through the seamless integration between the hospital’s Healthcare Information System, Meditech, and RcopiaAC. The ability to bring disparate systems together into one consolidated electronic structure is a challenge every hospital faces. Fauquier Hospital is proud of the strides they are taking as they work to achieve what some view as a very lofty goal.
Pilot Progress Report
The pilot began with a subset of the nursing staff and focused on surgical patients only. Since then approximately 20 surgeons have been trained, and on August 7, 2007, began using RcopiaAC for patient discharges. Other Fauquier clinicians are anxious to expand the scope of use out to other areas of the hospital. Next steps include the roll-out to the remaining inpatient areas and ultimately all outpatient areas, including the Emergency Department, by the end of the year.
To follow upcoming news about Fauquier Hospital’s RcopiaAC pilot findings, visit www.fauquierhospital.org online and go to “News and Information.”
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