1. Electronic Medication Management (eMM) Concepts and Definitions Dr Stephen Chu

2.  Medication List A record of prescribed and dispensed medications for an individual Can be unreconciled or reconciled Unreconciled Medication List  A list of prescribed and dispensed medications for an individual that is automatically generated  A raw list that has not undergone [human] clinical review, validation and reconciliation processing Reconciled Medication List  A list of all medications that an individual known to be taking  The list is the outcome of comprehensive and authoritative clinical review, validation and reconciliation  Omissions, inconsistencies, e.g. duplicates, are identified and rectified eMM Key Concepts and Definitions

3.  Medication List A record of prescribed and dispensed medications for an individual Can be unreconciled or reconciled Medication History List  A record of previously prescribed and dispensed medications (may include over-the-counter medications) for an individual  It is retrospective in nature  Can be automatically [system] generated by queries performed against databases of ePrescription and eDispense records Current Medication List  A list of all medications (prescribed and over-the-counter) that an individual should be/known to be currently taking as identified at the time of review eMM Key Concepts and Definitions

4.  Medication List A record of prescribed and dispensed medications for an individual Can be unreconciled or reconciled Medication History List Current Medication List  A list of all medications (prescribed and over-the-counter) that an individual should be/known to be currently taking as identified at the time of review The concepts of “Current or Past Medication List” is temporal and contextual in nature.  They present significant challenges in information management and pose serious clinical safety risks especially when merging data from such lists automatically into clinical information system or EHR/EMR repositories] eMM Key Concepts and Definitions

5.  Medication Profile Comprehensive list of medications taken by a patient with information on indications, actions, use patterns, and may include  precautions, side effects, contraindications, 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)

6. eMM Key Concepts and 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 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

7. eMM Key Concepts and Definitions  Medication Review A process of systematic evaluation of a person’s complete medication regimen and management of the medications* 1 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), and  medication management recommendations

8. eMM Key Concepts and Definitions  Medication Review Record Comprehensive and authoritative reviewed list of all medications (prescribe and over-the-counter) that a patient is current taking Includes recommendations regarding proposed changes and ongoing medication management where applicable/required

9. eMM Key Concepts and Definitions  Medication Documentation An IHE pharmacy white paper Identify the information requirements and structure from the various information sources on  known prescription, dispenses and administration Identify a standardised reference structure and semantics for harmonized medication data documentation to support  procuring, representing and viewing medication data from various sources  Clinical consultation and patient medication management  Medication review and reconciliation  Secondary uses: clinical effectiveness and cost effectiveness analysis; epidemiological and bio-surveillance analysis; management and executive decision analysis

10.  Medication Reconciliation Medication reconciliation is a formal process of obtaining and 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 *2  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 Key Concepts and Definitions

11.  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 *3  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 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 *4 eMM Key Concepts and Definitions