AI-powered medical history system improves care and reduces work at Carle Health

Carle Health, an eight-hospital health system in Illinois, is committed to providing the care patients need at every point in their care journey. Through collaboration and engagement, the health system strives to ensure the highest level of care by applying accurate data and innovative, evidence-based best practices.

THE PROBLEM

Medication reconciliation is an important process that ensures that patients’ medication lists are accurate and up-to-date during transitions in care, such as hospital admissions, transfers, and discharges.

“To ensure accurate reconciliation, our pharmacy technicians need to know not only what medications a patient has been prescribed, but also what they are actually taking,” says Jason Tipton, supervisor of clinical pharmacy operations at Carle Foundation Hospital in Urbana, Illinois. He has a doctorate in pharmacy. “To verify that prescriptions—particularly for high-risk medications—were being picked up, pharmacy staff used to spend a lot of time calling pharmacies.

“During the pandemic, that became a problem as pharmacies were overwhelmed by staff shortages and closures,” he continued. “Our staff could be on hold for up to an hour for a call that lasted less than a minute, which was an inefficient way to ensure a patient’s medication history was up to date.”

The result was increased workload for staff and unwanted interruptions for store staff at local pharmacies. It also caused delays in collecting medication histories, which could impact patient care.

“We pulled medication history from a standard industry feed, but the information was often incomplete as it lacked detailed prescribing instructions (SIGs) and did not capture all medication dispensing data, particularly from local or independent pharmacies,” he noted.

PROPOSAL

Carle Health explored opportunities to import more medication history data directly into its Epic electronic health record system, reducing the time staff spent manually collecting data and improving patient safety.

“DrFirst, a vendor, provides prescription history data from local and independent pharmacies in addition to the big box stores,” Tipton explained. “Instead of just showing that a medication was prescribed, the DrFirst data includes a date of sale, so we can see when the medication was dispensed. That’s important because it helps our pharmacists see gaps in medication use.”

For example, a doctor might prescribe an anticoagulant and give the patient a coupon for a month free upon discharge. The prescription appears on the patient’s medication history list, but it does not reflect the fact that he or she stopped taking it after the first month because it was unaffordable.

“The new technology would also give us more data in terms of specific medication information and prescribing instructions such as dosage and frequency,” Tipton said. “That would allow our medication history staff to be more efficient and give our pharmacy staff more accurate dosing information for recent dispensings, improving recommendations during retrieval order reviews.”

TOOK UP THE CHALLENGE

In late 2021, Carle Health integrated DrFirst’s medication history system into the Epic EHR, giving physicians, nurses, and pharmacists more data directly in the electronic record without having to make changes to their standard clinical workflows.

“Since going live, we’ve seen an evolution in the system’s AI capability, which translates prescription signatures like dose and frequency into our system’s standard terminology,” Tipton explains. “Over time, the AI ​​has improved so that it can accurately import data into the appropriate fields with less manual entry by our staff.

“Pharmacy assistants now have access to the patient’s most up-to-date medication history, including dosage and other prescribing instructions, and they can make far fewer phone calls to the pharmacy,” he continues.

The new system also became essential for the transitional care pharmacy program, which the health system implemented in 2019. Upon admission, it is important to quickly inform physicians of medication history, especially for high-risk medications such as anticoagulants.

Getting this medication information right comes down to patient safety. At discharge, pharmacy staff reviews medication lists to identify barriers that may prevent the patient from adhering to their physician’s prescriptions. This gives the pharmacy a more in-depth role in medication management and allows the organization to alert the provider of potential issues in advance.

RESULTS

“According to DrFirst reporting data, our clinical staff reviews the outside medication history for 99% of our high-risk patients,” Tipton reported. “Given that reviewing the outside medication history is a critical component of the best possible medication history process (BPMH), especially for high-risk patients, this puts our practice at a high level that is significantly above DrFirst’s average of 77%.

“By using AI technology to transform information into individual data elements in our Epic EHR, we have significantly reduced the amount of manual data entry our employees have to perform,” he added.

ADVICE FOR OTHERS

These are challenging times for both retail and hospital pharmacies, industry observers say.

“New technology gives us the opportunity to play a more in-depth role in medication management, while creating more efficient processes for things like collecting medication history and reconciling medication lists,” Tipton concluded. “By reducing the need for countless phone calls and manual processes, we can provide better care to our patients and relieve our retail partners from frequent interruptions that keep them away from their customers.”

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