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Introduction to Multidisciplinary Discharge and Medication Reconciliation (MAGIC)

Q: After selecting an entry from the e-Prescribing External Medication Claim History, do string details for the home medication pull in from the interface?
A: String details do not auto-populate on claim history medications at this time. The current NCPDP Script Standard only includes dose string information, when available, as a comment. As the NCPDP 10.6 Script Standards continue to evolve, if the interface message is able to include dose string detail in unique fields, we will look to enhance how the message is pulled into RXM to allow the dose fields to parse out and populate the corresponding fields within the Home Medication dose string.

Q: Will the color scheme stay as it looks currently in Medication Reconciliation?
A: Yes, for the combined inpatient and home medication sort within Medication Reconciliation and/or Discharge, inpatient medications appear in blue and home medications in black font.

Q: What determines access for discharge, pertaining to nurse or physician?
A: The Discharge function is available based on a user having a Discharge Desktop attached in the MIS User Dictionary. Within the Discharge Desktop, the components that can only be accessed via Discharge, like Date, Disposition, Forms, etc., can be set as View-Only. Components that integrate with other applications, such as PDoc, POM, and Nursing Assessments, continue to have access governed by the specific application’s access.
 
Q: Are discontinued medications and new medications still the same color?
A: Home medications display in the same color regardless of status. In Discharge, medications are designated with specific actions and display in Medication Reconciliation under different headers. On the Discharge Report, active medications print in a different section than the stopped medications.

Q: If a patient is held for discharge, can medications later be removed if determined to be no longer necessary?
A: Yes, even after finalization, medications can be cancelled, added, and edited.  Any changes made after finalization will immediately file as final. If a prescription has been transmitted, faxed, or printed, and is changed or cancelled, you will continue to need to tear up paper scripts or contact retail pharmacies, as is recommended now. Also, if a patient’s discharge packet has already been printed and changes are made, you should evaluate recompiling and reprinting the packet to trigger the updated report to EPS, eChart, and the Patient Portal.

Q: Can a printer be defined for controlled medications?
A: Yes, with the new setup for defaulting prescription printers, you can default a different prescription printer for controlled medication than non-controlled medications. You will also be able to determine which control schedules require use of the controlled prescription printer.

Q: Will Physician Documentation templates still go to Departmental?
A: Yes, physician documentation templates continue to file to Departmental or ITS based on your setup.

Q: Does the Physician Documentation template denote what information is included in Discharge?  
A: At this time, there is no indication within the template that a component is flagged to print on the patient report. It is possible to utilize your section setup to help convey this information to providers.

Q: Can you pull multiple laboratory results on the discharge report?
A: Yes, you can utilize as many Lab Result options as you wish within Discharge.

Q: What is the suggested workflow when for controlled substances if the state requires specific schedules to still be handwritten?
A: We have customers who put handwritten controlled medications scripts in a special area in the patient’s chart. This is done by some providers or by charge nurses. If scripts are lost, orders arecalled into retail pharmacies.  

Q: Besides the new, continue, and stop sections in the discharge report, what is the best way to indicate a change in medications?
A: Medication edits will also be flagged on the new Discharge Report. There is a section specific to “changes.”

Q: Are there more languages besides English and Spanish for PDI?
A: If your Patient Discharge Instruction vendor offers other Latin-based languages (such as Portuguese and Italian), these will be able to be accommodated within the MEDITECH system upon receipt of PIC DTS 204 and an update to PIC SR11. At this time, languages other than English and Spanish are only accommodated within EDM and printing directly from Nursing.  Changes are being evaluated to accommodate the selection of languages other than English and Spanish when printing the Discharge Packet. Please note, Drug Monographs continue to only be available in English and Spanish, so selecting a language other than Spanish would cause Drug Monographs to print in English.

Q: When re-compiling a discharge report, does the electronic chart or anywhere else in the system log all versions of the report?  
A: If a discharge packet is recompiled and reprinted, eChart will include all versions of the Discharge Report. Only the most recent version of the Discharge Report will be available in Clinical Review (EPS) and on the Patient Portal.

Q: How does the eRX claim history match the medications on the claim and the patient profile in order to grey out the medications already under the Home Medications header?
A: The system will automatically match the medications on the home medications list to the medications that are pulling into the claim history by NDC, or Trade and GPC. This is the same way we determine whether or not the medications will pull into the claim history in brackets, as they do for free text medications.

Q: How does MEDITECH recommend building the dictionaries to better match medication forms, and other dictionaries, for the Continue from Ambulatory Process?
A: MEDITECH recommends that facilities link RXM medications for Continue from Ambulatory on page four of the RXM Drug Dictionary. This linking should be based on a one to one match with the formulary medication. Please note that you can link medications that are prescribed the same way, even if they have a different strength. Then facilities should utilize/create order strings in the RXM Drug Dictionary and use those to match for Continue from Ambulatory.

Q: Can you Discontinue medications in the Continue from Ambulatory routine?
A: There are radio buttons in Medication Reconciliation to Review, Stop, and Edit Inpatient medications once they have been ordered though Continue from Ambulatory.
 
Q: Are you able to finalize some prescriptions in Discharge while not finalizing all of them? For example, a consulting physician wishes to finalize their meds but not the entire profile.
A: Yes, prescriptions can be printed upon submission. At that time, they would be finalized. Any prescriptions that are not printing at submission are not finalized until they are printed or the medications component has been finalized.

Q: In relation to Preferred Pharmacy, can the search be discreet enough to find specific pharmacies when there are multiple of that chain in same location/area?
A: Users are able to search for a Pharmacy by various search criteria, such as: Name, City, State, ZIP, Phone, and Fax #. You will also be able to narrow the search criteria even further by searching by any of the following options: 24-Hour, ERX, Retail, Mail Order, LTC, and Speciality. Once the pharmacy search compiles based off of the search criteria, users will receive a list of the Pharmacies matching the search criteria from which they can select. If a pharmacy is selected, the pharmacy information will also be viewable on the bottom of the search screen to ensure the user is selecting the correct one.

Q: In Discharge, with the Care plan/Goals text box, can canned text be added?
A: The Care Plan/Goals component is a free text component and, at this time there is no way to pull in any canned text or have text default in automatically to this component. A proposal has been entered with Development for future consideration and the feedback from this event has been added, as well.

Q: Within the Discharge routine, is there spell check for any of the text boxes?
A: When utilizing a CDS and capturing free text information, there is no spell check available. There are, however, multiple ways to set up Customized Screens to capture various pieces of information, so that they do not require free text entries.
 
Q: Can Convert From Ambulatory be accessed from the Discharge desktop?
A: Continue or Convert from Ambulatory is, currently, only done within the Medication Reconciliation routine. Performing this action will allow you to continue your home medications into inpatient medications. If the system finds a one to one match, then the home medication will continue directly into an inpatient medication. If there is not a one to one match found, the system will bring the user to the CPOE Type Ahead lookup, where they will need to select a medication in order to convert the home medication. Within the Discharge routine, you have the ability to Convert an inpatient medication to an outpatient prescription.

Q: Can you undo a finalized Discharge?
A: Finalization of the patient's medications, orders, and referrals only occurs once for the patient's discharge. Once a profile has been finalized, there is no way to take away this action or "unfinalize" the patient's discharge. Even though you cannot undo finalization, users will still have the ability to make edits and add to a patient's medication, orders, and referrals lists after the discharge is finalized. Any actions that are taken after the profile has been finalized will be considered automatically finalized.
 
Q: Can we download the Dr. First pharmacies prior to installing eRX?
A: At this time, you will not be able to import pharmacies from DrFirst to your Outside Location dictionary prior to installing eRX, as this involves a contract with DrFirst and setup within the eRX Suite. We would recommend following up with your DrFirst contact and eRX Implementation Specialist for more information on loading Pharmacies prior to installing.

Q: In Discharge, how do you enter "Next Dose Due" to print on the Discharge Report?
A: For nurses capturing next dose due within Discharge, this information would need to be captured via the comments field on the medications, at this time. This information could then be setup to pull onto a custom NPR report or pull onto a PDOC template via the Scripts component. Development will be beginning to work on a Development Project to create a way to capture the next dose due for medications at the time of Discharge.

Q: Can we use Discharge if we do not have POM?
A: No, you will need a PCM license in order to utilize the Discharge routine.

Q: Can you sort Medication Display?
A: We have sorting capabilities now within Discharge and Med Rec. The new sorting display in 5.66 allows for a combined sort, where users can see both inpatient meds and home medications under the same header by drug class.

Q: Can you continue therapeutic substitutions by Ambulatory?
A:
At this time, we are not able to Continue therapeutic substitutions from Ambulatory. We do have design from Development to address therapeutic substitutions. The design process for this enhancement should start with our next round of changes.

Q: Does Continue from Ambulatory allow for comments to flow?
A:
Currently, Continue from Ambulatory does not allow for comments to flow from the home medication to the inpatient medication. This has been brought to Development’s attention and an enhancement will address comments flowing, as the PRN reason does now in 5.66.

Q: Are you able to convert IV Medications in Discharge?
A:
Currently, we are unable to convert inpatient IV medications to outpatient prescriptions. We do have a proposal in with Development to request this functionality. At this time, if a physician wants to send a patient home with an IV type med, they would need to order it as a new Rx via the NEW button in Discharge.