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Introduction to Multidisciplinary Discharge and Medication Reconciliation (C/S)

Q: Is the Reason for Use/PRN Reason included in the prescription details transmitted to retail pharmacies with e-Prescribing?
A: Within the 5.66 release, the Reason for Use/PRN Reason information will get sent through the “Comments” section of the transmission. This will be at the beginning of the comments section prefaced with either "As Needed for" if PRN=Y, or "For" if PRN=N.

Q: Does the care team only pull providers from the MIS Provider Dictionary or could it look to the MIS User Dictionary as well, to pull non-provider staff such as Respiratory Therapists?
A: At this time, the Care Team Member “Add” lookup is to the MIS User Dictionary, allowing any user to be selected. Selecting a user who is linked to a provider will allow the Provider Type and other details to default. Selecting a non-provider user requires the Provider Type and then allows manual entry of address and phone number fields, if you wish to add these. Entering a Care Team Member who is not available in the lookup will prompt you “Not found. New?” and allow a free text entry. There is also the “Add Me” option to allow a user to quickly add his/herself. CS ADM 7922 will allow providers who utilize the PWM Sign Up functionality to automatically be added to the Care Team as well.

Q: Does discharge data archive with Nursing documentation or is it a separate setting?
A: Customers that have purchased our SCA archiving solution can send the Discharge Patient Visit Report and Discharge Forms to the eChart. The Visit Report and Forms are sent to the electronic chart when the Discharge Packet is printed. This is set up in the MIS Discharge Customer Defined Parameters.  The Visit Report and Forms are also stored in a new MIS File Library, for all sites regardless of use of SCA. If the Packet is reprinted, the MIS File Library is called to reprint the Visit Report and Forms as they were initially generated. If the packet is recompiled and reprinted, the new version of the Visit Report and Forms will be sent to eChart, EMR, and the MIS File Library. Older versions of the Visit Report will be available in EMR and eChart. All versions of the Forms will be also be accessible in eChart.
 
Q: Are there any plans to allow to define a preferred vendor for durable medical equipment similar to the preferred pharmacy?
A: At this time, Durable Medical Equipment suppliers are not provided in the Surescripts database of retail pharmacies available for import through the e-Prescribing interface. If DME suppliers are manually built in the MIS Outside Location Dictionary as Pharmacy types, these would be available for selection when transmitting new DME prescriptions. With the future enhancement to select multiple preferred pharmacies for a patient, it would be possible to store the DME retailer on the patient for future use.

Q: Is there an audit trail on the reason for use field on either the last taken screen or on the medication itself?
A: Yes, the PRN Reason/Reason for Use is audited within the Medication Reconciliation Audit Report and can also be accessed at the medication level via View History.
 
Q: Does the reason for use lookup integrate with IMO?
A: At this time, the Reason for Use field does not integrate with IMO. PRN medications will do a lookup to the Pharmacy PRN Reason Dictionary. Non-PRN medications can utilize a Group Response Query lookup, which your MEDITECH specialist can attach to the RXM Toolbox Parameters.

Q: When reviewing the eRx med claim history, what if the patient says they were taking a different strength? Will the system still gray out the drug?
A: The match from the e-Prescribing Claim History to the home medication list within Medication Reconciliation is based on an exact mnemonic match. MEDITECH is looking to allow matches based solely on your Formulary Service Vendor’s Generic Product Code, which are designated by active ingredient, strength, form and route of administration. If the claim history medication does not match how the patient takes the medication, the user can either not pull the medication from the claim history or pull the entry forward, file, and replace with the appropriate strength. Please note, the strength is based on what is reported from the insurance claim, pharmacy fill, or order documented in the DrFirst standalone system. Discrepancies may be due to patient confusion on proper dosage or errors with how the medication was entered into the other systems.

Q: Where do the discharge dispositions pull from? Are they manually built?
A: The Discharge Dispositions are built in the MIS Discharge Disposition Dictionary, which is already in use for discharging accounts in Admissions. The new setup within your Discharge Customer Defined Parameters will allow you to list only those dispositions you wish to appear for your clinicians in the Discharge Desktops.

Q: What is MEDITECH’s definition of a care team?
A: For eligible hospitals, the Meaningful Use Measure states you must record health care team members (including at a minimum PCP, if available) for more than 10 percent of all patients seen during the reporting period. MEDITECH pre-populates the Care Team routine with providers listed on the patient’s account to streamline this process. As the ARRA requirement only specifically states a PCP must be recorded, the additional members of the care team are up to each individual institution.

Q: What types of users can access Discharge?
A: Any user you link to a Discharge Desktop in the MIS User Dictionary can access Discharge. Within the Discharge Desktop, the components that can only be accessed via Discharge such as Date, Disposition, Forms, etc. can be set as View-Only. Components that integrate with other applications, like PDoc, POM, and Nursing Assessments continue to have access governed by the specific application’s access.

Q: Is there an audit trail when toggling between Continue, Stop, and Renew for home medications, so if a PA chooses to Stop a medication but the attending decides to continue it instead, there is a place to identify that change?
A: At this time, edits to the home medication discharge actions are not audited. We are reviewing with Development for possible options to log these actions.

Q: Can the warning that there are some meds that have not yet been reconciled highlight the medications that are outstanding when flagged to make it easier for the user to address them?
A: This functionality does not yet exist, but has been noted as an idea for future development.

Q: Can the warning be a hard stop or is it a soft stop? Can the warning present before finalizing?
A: The unreconciled medications warning is a soft stop, if presented upon filing the medications component. You can set a hard stop for finalization, if you opt to set the AOM Customer Parameter to require reconciliation of all home medications for finalization. The warning is not presented upon finalization.

Q: If a nurse calls a provider to reconcile an outstanding home medication during Discharge, can they indicate it’s a verbal order and can that be audited? Does the action flow to the sign queue?
A: New prescriptions can be queued to a provider’s sign queue, but the medication reconciliation actions of “stop” or “continue” can not at this time.  This request will be brought to Development for potential inclusion in the upcoming Medication Reconciliation Special Topics Focus Group. At this time, a nurse could record the actions within the Discharge Medications component then place a “Verbal Discharge Order” through OM that can queue to the provider for e-sign. Within the discharge order, queries can be utilized to recordthe actions the nurse took for the provider to review, if this meets the protocols for your facility.

Q: What module does the discharge report reside in?
A: The Discharge Visit Report report is built in MIS, but pulls when compiled from various applications based on how it is built. Once the report is generated through use of printing the discharge packet, the report is stored in the MIS File Library, which is an internal structure.

Q: When the packet is printed, is there a patient signature field that can get added and then scanned back into the system?
A: A signature page will print with the discharge packet allowing for the page to be signed and scanned into MEDITECH.

Q: Does the Discharge Report pull onto the EMR? If so, what is the report called?
A: Yes, the Discharge Report will be available from EMR through the Other Reports panel. The report will utilize an EMR ID that you assign.  A new EMR ID for “Patient Visit Report(s)” is being created, if you wish to utilize it.

Q: Can the Discharge Report be sent through an HL7 interface to an OV system?
A: At this time, the Discharge Report can not be sent through an HL7 interface. However, the content of the Discharge Report will be incorporated into the Continuity of Care Document (CCD) and Patient Health Summary (PHS) and be able to be provided to other care providers through use of Direct Messaging or a CCD interface.

Q: On the Medication Purpose field, can you make the field required?
A: Yes, in the 5.66 release, via the RXM Action Set dictionary, you can make almost every field/prompt in the RXM application required. 

Q: Is the Reason for Use field dictionary driven standard content or free text?
A: If the medication is PRN Y, the Reason for Use field is a lookup into your PHA PRN Reason Dictionary. If the medication is PRN N, the Reason for Use field is a Group Response query that your organization builds and is attached by MEDITECH in your RXM Toolbox Parameters. This field also accepts free text.

Q: In 5.66, should the Med Days/Quantity appear in Yellow? Physicians are seeing this, think it is required, then enter a quantity, thus turning it into a script? How should this function?
A: Qty or Days are always required when writing a new prescription. Only required fields should be appearing in yellow. Please report this issue, if you have not already, to your RXM Applications Specialist.
 
Q: Will physicians need to PIN twice - once with Med Rec and then following the Orders or has this been streamlined into one function?
A: In the discharge routine, each ordering session will require a pin, if applicable or required. For example, if the user does all of their Med Rec action and ambulatory orders, referrals, or new prescriptions in one session, then the user would only have to pin once.

Q: Can you recall nursing assessment values or are those just viewable?
A: Nursing assessment query values can be recalled into Physician Documentation, this is existing functionality.
 
Q: Is anyone Live with the 5.66 Discharge routine?
A: Yes, please contact your RXM Application Specialist for site references.

Q: If you have residents at your facility and one resident starts with the patient and another takes over patient care, do all of these individuals need to sign off? Is this the same with physician assistants and the attending?
A: If the resident starts the document and the attending views and signs, then the resident is not required to sign. If the resident is required to sign, there is a “Queue Co-signer” parameter that can be set to only send the report to the co-signer to sign when the resident has signed the report first.

Q: Can you expand on Forms Data, such as what types they can be?
A: There is a new MIS Forms Dictionary located off of the new 5.66 MIS Discharge Menu. The form types can be based on either NUR/PCS Assessments or custom NPR reports.

Q: Can I move PCS items to the Patient Report in the new Discharge Plan?
A: Yes, as demonstrated, you can setup your Patient Report to include NUR  have both POM queries and PCS queries populate fields in the new discharge plan. This is set up in the new MIS Report Format Dictionary

Q: Can you edit medications once they are submitted?
A: If the discharge plan has been finalized and is no longer in holding area, the prescriptions are now filed in RXM application and considered final as they have been printed, faxed, or transmitted to patient’s pharmacy. In this scenario, the prescriptions would be need to cancelled in the discharge routine and re-entered. The original prescription would then need to be collected and discarded. It the medication was faxed or transmitted, a phone call to the patient’s pharmacy would need to be made. The patient’s discharge packet can then be recompiled or printed.

Q: Does MEDITECH’s prescription label meet the new NY State requirements?
A: We have offered custom prescription solutions to assist our NY customers with NY prescription regulations. Please contact your RXM Applications Specialist for assistance in this area.

Q: Where is the visit report format built?
A: The Discharge report is built in the new MIS Report Format Dictionary located off the 5.66 MIS Discharge Menu. These reports are then associated in the Discharge Customer Defined Parameters.

Q: Can you build or add in report format logos? Can you define separate pages based on data, such as forced page breaks?
A: You will have the ability to add custom NPR headers and trailers in the MIS Report Format Dictionary. In C/S, logos can be associated in NPR.

Q: Will the “commons” auto jump to the big list in the lookup?
A: In 5.66, RXM end users will be able to seamlessly toggle automatically or manually to their Favorites, Common, and All Meds lookups. In the RXM Customer Defined Parameters Formulary tab, customers can define whether or not the search engine will automatically toggle to the All Meds lookup, if the seeded search is not found in Favorites or Common list.

Q: Can you print the visit report in both English and Spanish?
A: For OV Patient Instructions Content (PIC), the system will check your organization’s PIC Parameters to determine what languages are available, e.g. Portugese, Italian, to be printed. Monographs are only available in English or Spanish, based on your Formulary Service Vendor Pharmacy load. At this time, the patient’s discharge visit report is available in English.

Q: Is it possible to indicate multiple preferred Pharmacies?
A: At this time the functionality does not exist for multiple preferred Pharmacies. However, MEDITECH is currently working on a project to allow for multiple preferred Pharmacies within the system. There is a Development Design Project tracking this enhancement and will be completed by the end of 2013.

Q: Is MEDITECH working with Dr. First to expand what drugs the patient is on at admission for a more accurate list? Currently, the system looks to the insurance claims but if the patient pays cash, for example, can we draw from the local pharmacy’s system to obtain that information as well?
A: If the Pharmacy is registered with Surescripts as a “fill data” Pharmacy, MEDITECH can currently draw from the local pharmacy’s system. However, this would be up to each individual Pharmacy to register.

Q: Can each field be defined as unknown when entering a medication or is the use of “unknown” restricted to the dose or strength?
A: Upon indicating that a medication is a “Reported Unknown Strength” only the Strength and Dose will update to Unknown. No other fields can be marked as unknown, unless those are built into the system. For example, Units and Frequency could have an option of “Unknown” built into their respective look ups, but this enhancement will only update the strength and dose to Unknown.
 
Q: Could the new Reason for Med integrate with the POM Clinical Indication field when using Continue from Ambulatory?
A: Currently, the new Reason for Use enhancement does not integrate with the Clinical Indication within POM. However, as other customers have brought this up as desired functionality, MEDITECH will begin discussions with the right MEDITECH staff in order to move forward with this functionality.

Q: Where does the physician see the attention required flag?
A: The Attention Required flag can be seen through a Physician Documentation report, with the appropriate Home Meds component or through Medication Reconciliation on the patient’s profile.

Q:  Can you explain more on the process of how the non-formulary drug is handled when the Replace by Pharmacy is selected in the new Continue from Ambulatory routine?
A: With the 5.66 priority pack 3 enhancement to the Continue from Ambulatory routine, providers now have the ability for their Pharmacy to determine what drug should be placed if the original reported medication is not on the hospital’s formulary. If this enhancement is turned on in your system and all required string information is completed, a non-formulary drug can be sent to Pharmacy upon filing. When this reaches Pharmacy, it will display on the Pharmacist Desktop as a Non Formulary Item and show a link out to the Ambulatory medication. The pharmacist is then responsible for changing the med. This helps to streamline the process at the hospital, reducing clicks for the provider, and ensuring the patient receives the right medication. The provider still has the ability to replace the medication themselves, if they choose, and this functionality remains the same.

Additional information will be available shortly on MEDITECH.com regarding this functionality, but the setup is found within the RXM Customer Parameters and the RXM Action Set Dictionary.

Q: Is there a setting to control the blue headers that appear in Discharge listing the drug types?  Is it at the user default level or more global?
A: The blue headers that displayed during the presentation were the drug classes. The RXM Sorting Enhancement can be used to display the Drug Class. This is defined in one of the following: RXM Customer Defined Parameters, RXM Action Set Dictionary or RXM User DefaultsDictionary. This information can also be sorted on the fly by clicking the top sorting header and changing the display.

If using Drug Class as your sort, this can be further defined in the Customer Defined Parameters by Drug Class Sort. The two options are Drug’s AHFS Class or Top Tier.

Q: If a Discharge type note is started in PDoc, does that flow to the Discharge routine?
A: Yes, a discharge type note can be started in Physician Documentation and this document will be available within the Discharge Routine, regardless of status.

Q: In the Prescriptions component of Discharge, can we display the individual ordering provider per medication?
A: Within the Prescription component, the system will display the user that entered the medication onto the patient’s profile. This information displays to the right hand side of the drug information. Within Med Rec, the sorting enhancement can be used to view the ordering provider.

Q: Are there plans to allow a prescription to be easily changed to a reported medication?
A: MEDITECH is aware of the desired functionality to allow a prescription to be changed to a reported medication. MEDITECH currently has a Development Design Project tracking this project.

Q: Does the full ED Departure Packet display in the EMR?
A: Yes, the ED Depart Packet will display in the EMR under the Other Reports panel.

Q: Are you able to add a free text PRN reason instead of needing to use one from the lookup?
A: Yes, the PRN reason for use and Medication reason for use can either be selected in the lookup or entered as free text.

Q: Do you need to use the immunizations routine for the vaccines to display in Discharge?
A: Yes, the immunizations routine would need to be used, outside of the Discharge routine, in order for vaccines to display within Discharge. Currently, vaccines are view only and cannot be accessed from Discharge.

Q: Does the print packet include signature lines?
A: Yes, when the patient packet is printed, it will automatically include the signature page.

Q: Are there any plans to use the Reason for Use dropdown for the Medication Purpose prompt as well?
A:
The dropdown was not added to the Medication Purpose prompt because the information will automatically pull into this prompt when defined on the drug string.  This prompt primarily will be used to change the medication purpose.

Q: Does the same new functionality exist in when accessing through PDoc as you can through Med Rec?
A:
Yes. When accessing the Medication Reconciliation through Physician Documentation, the provider will be in the actual Med Rec routine where all of the new functionality exists. 

Q: Will there be any changes in PHA for Pharmacists to do Med Rec in PHA?
A:
There are no additional changes in PHA for assisting with Medication Reconciliation. With Meaningful Use Stage 2, the 60% requirement for physicians to be using Med Rec, your physicians really need to be the ones completing this process in order to meet the measure.
 
Q: When ordering a Chest Xray for example, you are brought to the problem list.  Is there any way to suggest problems based on the order?
A:
There is no way to suggest problems for diagnostic orders, but all active problems from the patient’s profile will be able to be selected for the follow up orders. 

Q: Where are the new Discharge Forms?
A:
The Discharge Forms can be created within the new Discharge Forms Dictionary in MIS.
 
Q: Is there a standard Discharge Form provided by MEDITECH?
A:
There are no standard Discharge Forms included as standard content. However, MEDITECH does offer a standard header and trailer that can be added to any forms you create. 

Q: Are there any plans for the last dose taken for converted medications to be treated similarly to the First Dose functionality?
A:
Development is currently looking into how to incorporate the last taken information when looking at the first dose warning in POM. Along with looking at the last taken information for the first dose, Development is also looking to include the last given dose when converting the inpatient medication to a prescription.