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.
âTo 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,â says Jason Tipton, supervisor of clinical pharmacy operations at Carle Foundation Hospital in Urbana, Illinois. He has a doctorate in pharmacy. âTo verify that prescriptionsâparticularly for high-risk medicationsâwere being picked up, pharmacy staff used to spend a lot of time calling pharmacies.
âDuring the pandemic, that became a problem as pharmacies were overwhelmed by staff shortages and closures,â he continued. âOur 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 patientâs medication history was up to date.â
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.
âWe 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,â 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.
âDrFirst, a vendor, provides prescription history data from local and independent pharmacies in addition to the big box stores,â Tipton explained. âInstead 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. Thatâs important because it helps our pharmacists see gaps in medication use.â
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 patientâs 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 DrFirstâs 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.
âSince going live, weâve seen an evolution in the systemâs AI capability, which translates prescription signatures like dose and frequency into our systemâs standard terminology,â Tipton explains. âOver time, the AI ââhas improved so that it can accurately import data into the appropriate fields with less manual entry by our staff.
âPharmacy assistants now have access to the patientâs most up-to-date medication history, including dosage and other prescribing instructions, and they can make far fewer phone calls to the pharmacy,â 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 physicianâs 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
âAccording to DrFirst reporting data, our clinical staff reviews the outside medication history for 99% of our high-risk patients,â Tipton reported. âGiven 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 DrFirstâs average of 77%.
âBy 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,â he added.
ADVICE FOR OTHERS
These are challenging times for both retail and hospital pharmacies, industry observers say.
âNew 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,â Tipton concluded. âBy 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.â
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