Best Possible Medication History(BPMH) /Med Rec / Medication List

Rather than worrying about gatekeepers and the other general questions you raise, I think it more constructive to deal with specific problems and let the solutions happen organically. For example, there is a need for a pharmacy to provide certain documents to a physician e.g. narcotic dispenses missed, refill requests, etc. We can in the pharmacy provide those documents (in the CDA standard or other formats) and receive them. Doctors can currently receive documents in various formats from a variety of sources. All we need to do then is have someone "in charge" tell the switch facility to turn the tap on. EMRs may soon have the ability to get information other than via a central switch which would greatly facilitate the process.

In other cases, a practitioner may need to request lab, med, or physician note information which is not available from usual sources i.e. local files or the lab distribution organization. If the patient had a web page with diagnostics, disease states, meds, assessments, and care plans on it, which again the pharmacy can now in part provide, they could give the practitioner access to it. Problem solved. So all that is really required is that such a web page be provided - - not exactly rocket science these days.

BC has a different central data base system from the other provinces. In BC, almost all prescription medications (aside from HIV medications, medications provided while admitted to the hospital, and samples provided by physicians) are entered into a central system (PharmaNet) by pharmacists when a prescription is filled –in real time. Once the prescription is submitted a complete list of medications that have been filled at other pharmacies is sent back to the pharmacist for review, along with potential drug interactions from all the medication listed in the central file (PharmaNet). This is a mandatory process for all pharmacists. PharmaNet data can be accessed by Physicians and hospitals (if they sign up and get a compliant software program).
While PharmaNet does a pretty good job, it has been around for several years and doesn’t quite meet the needs of all healthcare professionals. Not everyone is set up to use it and those that do have access may misinterpret some of the data.

The BPMH form is different from PharmaNet, it's a separate step initiated for patients when there is a clinical need for a review and the patient must be currently on 5 prescription medications or more. (The BPMH is a list of current medications, (Rx and OTC) with indications, directions, and, stopped medications where relevant, and allergies) It helps consolidate a patient’s medication history into a clean list with the most up to date medications and directions for use.

It would be nice if this could all be done electronically, but currently in BC the best way to capture this information is by having a discussion with the patient, asking them what they are currently taking, how they are taking it and why they feel they are taking the medication, along with discussing if they are taking any non-prescription medications/herbal products. It is also important to note medications that have been stopped or discontinued due to drug therapy problems to prevent future usage of the medication. Currently in BC this can only be done on a form – paper based – or an electronic writable PDF or scanned paper form, aside from small projects and studies with clinical groups.

In an ideal world – PharmaNet (or any central data base that all healthcare professionals can access) should be the BPMH, but currently it’s not.

When one health care professional discontinues a medication, the other healthcare professionals the patient deals with are not always notified, many times that is because we don’t know who the other professionals are that are involved with the patient. If there was one central database or care plan that everyone had access to, this would not be an issue.

There are several challenges to solve: who is the gatekeeper of this information? How can we all connect to this information? Who should and can make changes? Who is responsible for keep it up to date? Does everyone have a specific role in a specific section? Where does the patient fit into this management?

For People outside of British Columbia – how are your prescriptions drugs currently being recorded? Is it in a central data base, or is the information just local data at the dispensing pharmacy or hospital pharmacy? Can different healthcare professionals access it or just pharmacists? do you also have separate medication list form that you have to fill out such as medication reconciliation forms, BPMH, MedsCheck?