1. Medication Reconciliation & The TSWF Suite of AIM Forms “Medically Ready Force…Ready Medical Force” 1

2. Objectives This slide deck will take you through the following topics: ∎ What is Medication Reconciliation ∎ How to capture Medication Reconciliation requirements ∎ How to look up medications that weren’t dispensed at a local MTF “Medically Ready Force…Ready Medical Force” 2

3. Medication Reconciliation What is Medication Reconciliation? Well, according to The Joint Commission (TJC), it’s the following: ∎ “In medication reconciliation, a clinician compares the medications a patient should be using (and is actually using) to the new medications that are ordered for the patient and resolves any discrepancies” “Medically Ready Force…Ready Medical Force” 3

4. Medication Reconciliation The goal (as worded by TJC) is to “maintain and communicate accurate patient medical information” (NPSG.03.06.01), and it involves several steps ∎ The patient’s medication list needs to be obtained/updated at the beginning of the visit ∎ The clinician needs to compare the medication list against medications he/she is ordering and resolve any discrepancies (omissions, duplications, contraindications, unclear information and changes) ∎ Provide the patient with written information on the medications they should be taking at the end of the visit “Medically Ready Force…Ready Medical Force” 4

5. Medication Compliance Medication compliance is not a Joint Commission requirement, but is an element of NCQA PCMH Certification under “Medication Management” ∎ Factor 5: The practice asks patients about a problem or difficulty taking a medication; whether they are experiencing side effects; and whether the medication is being taken as prescribed. If a patient is not taking a medication as prescribed, the practice determines why. “Medically Ready Force…Ready Medical Force” 5

6. The TSWF Forms have several fields that help you perform and document these critical functions Medication Reconciliation and the TSWF AIM Forms “Medically Ready Force…Ready Medical Force” 6 ∎ An area to maintain the current medication list ∎ A way for the support staff to document that the medication list was updated

7. Medication Reconciliation and the TSWF AIM Forms “Medically Ready Force…Ready Medical Force” 7 ∎ Facilitates capture of medication compliance ∎ Allows the provider to easily document that they reconciled the patient’s medication list with any orders ∎ Captures when the list of medications is given to the patient (* New TJC Requirement for 2015) ∎ Facilitates documentation of medication education requirement*

8. Common Questions ∎ “Is it required to complete all these boxes at every visit?”  At every visit the medication list needs to be updated, if nothing else to verify that the patient is still not taking any medications. If the patient takes no medications, and no medications are prescribed that visit, then the provider doesn’t need to check any box. ∎ Why is “Medication Compliance” a provider function now?”  With the responsibility ultimately falling on the provider, the TSWF Leadership felt that overall providers have a better understanding of what the patient is supposed to be taking and can best assess the patient’s adherence to that regimen.  However, if a facility has a policy that any member of the clinical team can assess the patient’s adherence to their medications, then it can be checked by the person actually performing this function even if it isn’t the provider. “Medically Ready Force…Ready Medical Force” 8

9. Common Questions “What about updating the AHLTA Med module?” ∎ We understand that it can be difficult to completely clean up the medication list in AHLTA, especially for medications that aren’t dispensed at an MTF. (For example medications that come across from the VA will show as “active” forever.) But as much as possible the medication list in AHLTA should reflect the list on the AIM Form. ∎ Since not all clinical users use the AIM forms, this helps to ensure that everyone on the healthcare team knows what the patient is taking. ∎ Updating the medication list will also help make sure that any data transferred into the new EHR will be as accurate as possible. “Medically Ready Force…Ready Medical Force” 9

10. Common Questions “How do I know that I have the complete list of medications, especially if my patient is an unreliable historian?” ∎ Have the patient bring in all their medications at every visit ∎ Utilize PDTS in CHCS to see medications filled at outside pharmacies ∎ Utilize BHIE (or soon the Joint Legacy Viewer) to view medications prescribed by the VA “Medically Ready Force…Ready Medical Force” 10

11. How to Check a Patient’s Medications Dispensed at a Civilian Pharmacy ∎ In CHCS, you can access the PDTS menu option in two different ways:  DPRX inside of Order Entry (ORE)  PRX under the Review Clinical Results (RCR) menu option ∎ Choose how many days to go back (max is 180 days) ∎ This shows all dispensed medications. Need to verify with the patient which ones they are actively using. “Medically Ready Force…Ready Medical Force” 11

12. Viewing a Patient’s VA Medications Depending on your site, you’ll use one of these links to access the VA Medication list ∎ VA/DoD/Theater History (also known as BHIE) ∎ JLV (Joint Legacy Viewer) The next few slides show examples of what you would see with both of these methods “Medically Ready Force…Ready Medical Force” 12 (Simulated patient data)

13. VA Medications via VA/DoD/Theater History Module Choose “Outpatient Medications” to see the list using this method “Medically Ready Force…Ready Medical Force” 13

14. VA Medications via the Joint Legacy Viewer (JLV) “Medically Ready Force…Ready Medical Force” 14 Training on the Joint Legacy Viewer will be available once it has been activated at your MTF (Simulated patient data)

15. Updating the AHLTA Medication Module ∎ To add medications in the Meds module that aren’t already on the list (either from an outside pharmacy or an OTC/herbal medications) choose “Add,” then choose “Manually Enter Medications.” “Medically Ready Force…Ready Medical Force” 15 (Simulated patient data)

16. Updating the AHLTA Medication Module ∎ You can also discontinue medications as well. “Medically Ready Force…Ready Medical Force” 16 (Simulated patient data)

17. Questions? ∎ You can contact the TSWF Team on MilSuite  https://www.milsuite.mil/book/groups/TSWF https://www.milsuite.mil/book/groups/TSWF ∎ Questions about the AHLTA functionality can also be directed to your local Clinical Systems Trainer “Medically Ready Force…Ready Medical Force” 17