SPECIAL EDITION
volume 4
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** Epic Wave 3 **
RWJBH-Rutgers Medical Group/ RWJ University Hospitals – New Brunswick, Hamilton, and Rahway / Bristol-Myers Squibb Children’s Hospital / CINJ Infusion Center / CINJ Physician Practice
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Top 10 Inpatient Provider Change Readiness Topics
As we transition to Epic, ten topics require inpatient provider awareness at Go-Live.
These Special Edition newsletters, covering 1-3 points each, further outline the information for easy reference.
Previously Released Topics:
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Chart Hygiene:
Best Practices for Maintaining Highly-Reliable Patient Charts
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Background
With the Wave 3 rollout, Epic will contain a single health record for each patient for all four RWJUH Hospitals (Somerset, New Brunswick, Hamilton, and Rahway), the vast majority of the RWJBH-Rutgers Medical Group practices, the Rutgers Cancer Institute of New Jersey (CINJ), the Eric B. Chandler Health Center, The Rutgers Environmental and Occupational Health Science Institute (EOHSI) and the Rutgers Athletic Performance Center (APC).
This means that there is a single medication record for each patient.
The medication list for the outpatient practice is the Home Medications.
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At each patient encounter, the medication list must be reviewed to ensure accuracy and that the patient is taking all prescribed medications as directed. Corrections must be made if a patient is not taking a medication or a provider outside of our system has discontinued, changed, or added a medication from what is currently on the list.
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Topic 7: Chart Hygiene - Admission Medication Reconciliation and Discharge Medication Reconciliation
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The Medication Review Process
- Each site that is live on Epic will have data transferred from that site’s heritage EMR. Documents, lab data, and measurements, such as vital signs, can be imported directly into Epic electronically.
- PAMI data (Problems, Allergies, Medications, and Immunizations) are transferred to Epic as lists that must be reconciled manually with information already in the Epic chart.
- Data from outside organizations are made available to Epic through Care Everywhere and must be manually accepted into our Epic record.
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The review of outside information appears as a list with an option to add to the patient’s current list or to delete the outside item if it is incorrect or already on the list.
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At the beginning of a Go-Live wave, there will be much more PAMI data that must be reconciled because:
- A high percentage of the data is new.
- Data is likely to be transferred to Epic from more than one heritage system. For example, a patient followed at CINJ will have data transferred from the heritage Aria system and from the RWJUH-New Brunswick SCM system.
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A review of outside data must be carried out BEFORE the admission medication reconciliation is done to ensure the reconciliation process is working with an accurate home medication list.
- The Review of Home Medications may be carried out (depending on the setting) by
- A Pharmacy Tech
- A nurse
- A provider (physician, APN or PA)
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The Admission Med Reconciliation Process
Admission Med Reconciliation consists of deciding which home medications will be continued while the patient is in the hospital.
The Admission Med Reconciliation process is important for several reasons:
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Ensures that all necessary home medications are continued in the hospital.
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Ensures that when the patient is discharged, all necessary home medications will be continued and/or prescribed as needed even if they were not administered in the hospital.
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Remember: all the work done in the patient Admission Med Reconciliation is reflected on the patient instructions in the After-Visit Summary (AVS).
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Process:
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Admission Med Reconciliation, ideally, should be done in Epic before writing the admitting orders.
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Admission Med Reconciliation must be done by a provider.
- For each home medication, there are 5 options --
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Order: the medication will be administered in the hospital.
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Do Not Order: the medication will not be administered in the hospital.
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Replace: a substitute for the medication will be administered in the hospital.
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Remove: the medication will not be administered in the hospital and will be removed from the patient’s home medication list.
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Order and Hold: the medication will be ordered, but will not be given until it is manually released.
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Discharge Medication Reconciliation |
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When patients are discharged from the hospital, it is important to specify the medications that the patient was:
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taking before the hospitalization and should resume or stop taking as an outpatient.
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prescribed in the hospital and should continue as an outpatient.
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receiving in the hospital that should not be continued as an outpatient.
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The Discharge Navigator
There are three modes of discharge, and each has a separate activity tab in the Discharge Navigator:
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Discharge to home or to an external facility
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Discharge and readmit to another RWJBH unit or facility on Epic
- Discharge as deceased
Each tab of the navigator has a list of activities that must be completed before discharge. You can carry out these activities by:
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Clicking on the corresponding menu item at the left of the navigator.
- Visit them sequentially by scrolling through the navigator.
- Move from each activity to the next by clicking on the down arrows at the right of each section.
Discharge Medication Reconciliation
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You can review the Home Medications if this has not been done. However, it should have been done before the admission orders are written.
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Important Note: All discharge prescriptions that are written are outpatient prescriptions and, therefore, must be authorized and signed by a licensed independent provider. Residents who are not licensed can compose discharge prescriptions, but cannot sign them. In addition, a DEA license and EPCS registration through Symantec VIP is required to sign discharge prescriptions for controlled substances.
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The Discharge Orders section displays the home medications side-by-side with inpatient medications. If a medication is both a home medication and an inpatient medication, they will appear on the same row of the lists.
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Home medications that are continued in the hospital are marked as “Continued for Admission.”
- Home medications that are continued in the hospital but with different instructions will have full details on the Inpatient side of the list.
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Hospital medications that are not on the Home Medications list will be marked as “Not Taking At Home” on the Home side.
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Medications can be ordered and grouped in several different ways: Alphabetical without grouping, or grouped by order set, therapeutic class, or reviewed status.
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For each home medication that should not be taken after discharge, click on the “Stop” icon:
- The icon will turn red, the home medication will be lined out, and the medication will be added to the “STOP taking” section of the After Visit Summary (AVS).
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For each home medication that should be continued at home, click on the right arrow icon. The medication will be displayed in green font and the medication will be added to the “CONTINUE taking your other medications” section of the AVS.
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For each home medication that needs a new prescription, click on the pencil icon.
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- This will generate an order for that medication which has to be completed and can be specified as "eRx" or "AVS only-no eRx". The “Print” option will not be available. This medication will be added to the “CONTINUE taking” section of the AVS.
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For each hospital medication that needs a new prescription, click on the plus sign icon.
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- This will also generate a prescription order which can be modified by clicking on it in the sidebar. This medication will appear in the “START taking” section of the AVS.
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To complete Discharge Med Reconciliation, you must indicate an action for:
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every home medication (continue, prescribe, or stop).
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every hospital medication (prescribe or don’t prescribe).
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Once med reconciliation is complete, you are prompted on new medication orders to confirm if you need to perform a new reconciliation.
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If you do need to reconcile and if the discharge paperwork is printed and a provider changes an order, the provider must update the reconciliation in Epic. Then, the provider needs to inform the nurse, and the paperwork needs to be re-printed.
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Epic Together's Guiding Principles:
Patient Safety & Quality, Patient Engagement; Clinician & Staff Satisfaction;
Frequent and Transparent Communication; Research & Education;
Project Approach – Configuration not customization; Optimize Financial Systems
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RWJBH-Rutgers Medical Leadership Team
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Dr. Joshua Bershad
EVP, Physician Services;
Clinical Assistant Professor of Medicine Rutgers Robert Wood Johnson Medical School
Cell: 973-202-0900
Dr. Frank Sonnenberg
Chief Medical Informatics Officer, RWJBarnabas-Rutgers Medical Group; Professor of Medicine, Rutgers Robert Wood Johnson Medical School
Cell: 908-313-6563
Dr. Carol Ash, DO, MHCDS, MBA, FACHE, CPHQ, CHCQM-PHYADV
Chief Medical Officer
Robert Wood Johnson University Hospital Rahway
Phone: 732-499-6134
Cell: 732-857-6535
Dr. Seth D. Rosenbaum, MD, MMM
SVP, Chief Medical Officer Robert Wood Johnson University Hospital Hamilton;
Clinical Assistant Professor, Department of Medicine, Rutgers-Robert Wood Johnson Medical School
Phone: 609-584-2865
Cell: 609-508-7951
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Dr. Sal Moffa
Phone: 908-685-2816
Cell: 609-238-5248
Dr. Stephen O’Mahony
SVP & Chief Health Information Officer, RWJBarnabas Health;
Clinical Associate Professor of Medicine, Rutgers New Jersey Medical School
Phone: 973-322-4231
Cell: 203-820-6519
Sheraz Siddiqui, MD
Chief of Hospital Medicine
Robert Wood Johnson University Hospital
Associate Professor, Department of Family Medicine and Community Health
Rutgers-Robert Wood Johnson Medical School
Cell: 732-986-3577
Dr. Deborah L. Toppmeyer
Professor of Medicine, Robert Wood Johnson Medical School; Chief Medical Officer, Chief, Division of Medical Oncology, Director, The Stacy Goldstein Breast Center
Rutgers Cancer Institute of New Jersey
Rutgers, The State University of New Jersey
Phone: 732-235-9692
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