Electronic Medication Management
(eMM)
•Landscape, Concepts and Definitions
– eMedication Management Stack
– scope, concepts and definitions
Dr Stephen Chu
Chief Clinical Informatician & Terminologist
Clinical Terminology & Information, NEHTA
2 November 2012
eMM: Landscape
 Electronic Medication Management
• Three key components
 Contents
 Concepts and definitions
 Infrastructures
o Trigger events; messages; services
o Registry; repository
 Applications/User interface/viewer
eMM: Landscape
 Electronic Medication Management
• Key landscape components
Trigger
sRegistry/
Directory
eMM
SEHR/
Repository PHR
Queries
Contents
Interfaces
Services
Messages
Applications
The Interoperability Stack
Transport/Architecture
- XDS
- AORTA
- Web services
Packaging
- Message Structure
- Document (CDA) Structure
Contents
- Data/Information Models
- Terminologies
Concepts
- Terms
- Definitions
Focus of contents of
this slide deck
eMM: Landscape

Electronic Medication Management
• The recipes and ingredients analogy
The receipts
The production
(cooking) processes
The consumptions
Medication Management Plan
Reconciliation
Medication
Management
Medication Profile
Reconciled Med
History List *
Reviews
Med Review Record*
Clinical
Decisions
Unreconciled Medication History List
Queries
The data
(ingredients)
Prescrip
-tions
The sources
Patient Medication
Record
Pharm
Advice
hospitals
Dispense
Records
Community
pharmacies
Executive/
Management
Decisions
Medication
related Reporting
Meds
Admin
Community
Labs/paths
Patient
Conditions
Allergies;
Adv
reactions
Community
Imaging services
ContraIndicat
-ions
others …
Labs …
&
others…
eMM Concepts and Definitions
• Definitions
 Patient Medication Record
• Record = documentation in writing or other permanent
form
• Medication record = documentation of medication
prescription, dispense and administration information (for
a defined period of time
• Patient medication record = a collection of records
pertinent to a patient’s medication prescription, dispense
and administration information for a defined period of
time
• This collection of records may be persisted within a patient’s EMR
and shared EHR
eMM Concepts and Definitions
• Definitions
 Reporting

Process of extracting data from one or more sources and
converting them into a report for a specific purpose
 Medication Related Reporting
• A set of medication related information extracted from
one or more sources and converted into a report to meet
statistical , quality and safety, epidemiological,
government or regulatory requirements
• Example: Adverse drug/medication reaction reporting
eMM Concepts and Definitions
• Definitions
 Adverse Drug Reaction
• “a response to a drug that is noxious and unintended and
occurs at doses normally used in man for the prophylaxis,
diagnosis or therapy of disease, or for modification of
physiological function” (source: WHO)
• “An appreciably harmful or unpleasant reaction, resulting
from an intervention related to the use of a medicinal
product, which predicts hazard from future administration
and warrants prevention or specific treatment, or
alteration of the dosage regimen, or withdrawal of the
product”
(source: Edwards RI, Aronson JK. Adverse Drug reactions: definitions,
diagnosis, and management. The Lancet 2000;356:1255-59)
eMM Concepts and Definitions
• Definitions
• Adverse Drug/Medication Reaction Reporting
 The reporting of appreciably harmful or unpleasant
reaction, resulting from the use of a medicinal product,
which may be prescribed or non-prescribed (such as an
OTC medicinal product)
eMM Concepts and Definitions
• Current & Past Medications

Current Medication List
•

A list of all medications (prescribed and over-the-counter) that an
individual should be/are known to be currently taking as identified at
the time of review
Past Medication List
•
A list of all medications (prescribed and over-the-counter) that an
individual were known to be previously but NOT currently taking as
identified at the time of review
 Medication History List
• A record of previously prescribed and dispensed medications
(may include over-the-counter medications) for an individual
• Retrospective in nature, but can contain continuing/future meds
eMM Concepts and Definitions
• Definitions
 Medication Reconciliation
•
Medication reconciliation is a formal process of obtaining and
[clinically] verifying a complete and accurate list of each patient’s
current medicines. Matching the medicines the patient should be
prescribed to those they are actually prescribed. Where there are
discrepancies, these are discussed with the prescriber and reasons
for changes to therapy are documented. When care is transferred
(e.g. between wards, hospitals or home), a current and accurate list
of medicines, including reasons for change is provided to the person
taking over the patient’s care. Points of transition that require
special attention are*1
 Admission to hospital
 Transfers within hospital (e.g. ED to ward; ICU to ward, etc)
 From the hospital to home, residential aged care facilities or to
another hospital
eMM Concepts and Definitions
• Definitions
 Medication Reconciliation
•
The process of comparing various medications lists to
avoid errors such as transcription, omission, duplication
of therapy, drug-drug and drug-disease interactions*2
 Based on this definition, the medication reconciliation processes
include comparing and rectifying discrepancies as well as review
of medication management therapy
•
It refers to the process of [clinically] reviewing the
patient’s complete medication regimen on admission, at
transfer and discharge, comparing it with the regimen
being considered for the new care setting. The process
aims at avoiding inadvertent inconsistencies in
medication regimen across transition in care*3
eMM Concepts and Definitions
• Definitions
 Unreconciled Medication History List
• Synonymous term: Unreconciled medication list
• A list of patient medication compiled from collection of
known sources (paper and electronic) at a point in time.
The contents of this list has not be subjected to the
process of clinical verification to remove errors,
inconsistencies, duplications and rectify omissions
• This is a “raw list” likely to be machine generated and has
not undergone [human] clinical review, validation and
reconciliation processing
eMM Concepts and Definitions
• Definitions
 Reconciled Medication History List
• Synonymous term: Reconciled medication list
• A set of patient medication compiled from collection of known
sources (paper and electronic) at a point in time. The contents
of the list have been subjected to comprehensive clinical
verification processes, which include comparison of data from
various sources, validation with data origins such as prescribers
and dispensers. Omissions, inconsistencies, e.g. duplicates, are
identified and rectified to ensure accuracy, consistency,
currency and as error free and omission free as possible
• Medication reconciliation processes may be or are typically
conducted on admission, transfer or discharge of patient
eMM Concepts and Definitions
• Definitions
 Medication Review
•
•
A process of systematic evaluation of a person’s
complete medication regimen and management of the
medications*4
Includes
 a comprehensive, accurate medication history of the patient
 careful examination of the purposes and actual use of
individual medications
 issues identified (including indications, actions, uses, effects
and side effects, max cumulated dose, contraindications), and
 medication management recommendations
eMM Concepts and Definitions
• Definitions
 Medication Review Record
•
Comprehensive and authoritative reviewed list of all
medications (prescribe and over-the-counter) that a
patient is current taking
• Outcome of the review
 Includes recommendations regarding proposed
changes and ongoing medication management
where applicable/required
eMM Concepts and Definitions
• Definitions
 Profile

specific attributes (such as feature, skills, knowledge, quality,
capability, reputation) of something, an object, a person, an
organization, a society/population that provide evaluation of
the characteristics or features and support generalisation
about the structure and behaviours of the target object,
person, organization, society/population
 Medication Profile
• A set of information about characteristics of a patient’s
medication use
• Medication Management Profile
 A set of information about a patient’s characteristics, which are
relevant to safe medication management for this patient
eMM Concepts and Definitions
• Medication Profile: Scope
 Medication Profile
•
Comprehensive list of medications taken by a patient
with information on indications, actions, use patterns,
and may include
 precautions, side effects, contraindications, max cumulated
dose, and known allergy, intolerance histories where applicable
 Managed contraindications
 Failed therapy
 Patient preferences
•
•
May include diagnosis and pre-existing conditions to
allow contra-indication (may include supporting clinical
evidences such as diagnostic results) checks
(may include genetic profile in future)
eMM Concepts and Definitions
• Definitions

Medication Management Plan
•
A structured, formally defined scheme of patient medication
management strategies and actions, including:







•
•
Patient’s demographics, problems/diagnoses and pre-existing
conditions (including allergies and intolerances)
List of medications
Indications, actions, contraindications, precautions and managed
contraindications, max cumulated dose where applicable
Patient preferences; failed therapy
Medication [supply and administration] schedules where
applicable/necessary
Ongoing medication management strategies/recommendations
Next review due
May be stand alone or part of comprehensive care plan
Shared with other authorised health care providers
eMM Concepts and Definitions
• Definitions
 Medication Statement (HL7 Concept)
 Definition: an assertion or statement that a patient is
"on" a medication independent of the knowledge of
specific events such as prescriptions, administrations and
dispenses
 used:
•
•
When we have knowledge that a patient is taking a particular
med and don't have knowledge of the underlying events (or
those events aren't relevant)
When we have knowledge that a patient is taking a particular
med and we *do* know the details about the underlying events,
but from a workflow perspective it would be inappropriate or
unnecessary to capture the details, but it's still important to
capture the patient/drug
eMM: Landscape
 Electronic Medication Management
• Medication Administration Records
The production
(cooking) processes
The receipts
Medication Management Plan
Complexity
(processing,
… etc)
Reconciliation
Medication Profile
Reviews
Queries
Reconciled Med
History List
Med Review Record
Unreconciled Medication History List
Patient Medication
Record
Prescribed √
How useful clinically is
Dispensed √
a comprehensive or
Administered ???
complete list of patient
medication admin record?
Or would profile of patient’s
medication administration/
conformance be more useful?
Medication
related Reporting
Data components
Administration/conformance Profile:
- Max cumulated dose
- Omission frequency + reasons
- Dose variation frequency + reasons
- Frequency variation frequency + reasons
- Intermittent + PRN frequency + reasons
eMM: Landscape
 Electronic Medication Management
• Medication List Views
The production
(cooking) processes
The receipts
Medication Management Plan
Reconciliation
Medication Profile
Complexity
(processing,
… etc)
Reviews
Queries
Reconciled Med
History List
Med Review Record
Unreconciled Medication History List
Patient Medication
Record
Medication
related Reporting
Data components
Types of med
list view
Long term meds list
Short term/episodic meds list
Intermittent meds list
PRN meds list
Medication data requirement analysis

Top down and bottom up approaches
The production
(cooking) processes
Top
down
analysis
The receipts
The consumptions
Medication Management Plan
Reconciliation
Medication
Management
Medication Profile
Complementary
Cross-referencing
Validating
Adequacy, accuracy
reusability and
consistency checks
Reviews
Reconciled Med
History List
Med Review Record
Clinical
Decisions
Unreconciled Medication History List
Queries
Patient Medication
Record
Executive/
Management
Decisions
Medication
related Reporting
Bottom
Up
The data
(ingredients)
Prescrip
-tions
The sources
Pharm
Advice
hospitals
Dispense
Records
Community
pharmacies
Meds
Admin
Community
Labs/paths
Patient
Conditions
Allergies;
Adv
reactions
Community
Imaging services
ContraIndicat
-ions
others …
Labs …
&
others…
eMM: Landscape
 Electronic Medication Management
• Three key components
 Contents
 Concepts and definitions
 Infrastructures
o Trigger events; messages; services
o Registry; repository
 Applications/User interface/viewer
Medication data – how they are used:
through application/Interface design