Introduction

Hello Monica!

Thank you for your post. What is the role of SNOMED CT in helping create a Canadian electronic system that works fluidly ?

Thanks for the great question. I'll leave it to the rest of the community to respond from the perspective of Medication Management but you may also want to to post your question to the SNOMED CT Community and get that community's responses as well.

Thanks,

Brad

Thank you for your post. What is the role of SNOMED CT in helping create a Canadian electronic system that works fluidly ?

Thanks for all of the feedback in the forum. I have taken notes on the comments provided and will divide them up into new topics over the next few days.

Close Tanya. When I first was consulted by the Association here about whether software vendors could implement the "BPMH" project they were contemplating I said it would not be difficult to program but would be a waste of time and money (the government's) doing it in the proposed manner. But it went ahead and we developed easy, fast ways for pharmacists to complete the forms and the allotted money ran out quickly with no published clinical benefit achieved.

So the response was to make the process i.e. the documentation, more onerous so as to restrict the money flow.

For purposes of clarity, "BPMH" in BC refers to specific data inputs and reports that must be generated to receive payment for med
review payments from Pharmanet. I would argue the fundamental flaws in the project have not at all been addressed.

One component of "BPMH" I was, and still am, enthused about is the necessity to assemble a correct patient medication profile. Indeed, as soon as it was introduced I began working on a way to provide that information to physicians and to patients as part of a personal electronic health record. To do so is NOT a long term goal. It could be done in BC in a very short time using the infrastructure Excelleris has in place or the physician connectivity being introduced by Telus to the EMR systems they've purchased.

What is missing in Infoway, despite the hundreds of millions spent, is a detailed knowledge of how systems can be inexpensively and easily changed to accomplish the obvious goals that clinicians have general agreement on.

An interesting conversation. Here are a few thoughts:

1. Medication Reconciliation using a Best Possible Medication History is critical to protect patient safety, but I do think that the long term goal should be to consider this as part of a larger transition of care plan. One of the nurses here at Infoway gave me the example of a LTC patient who is being treated for bed sores going into hospital and then coming back from the hospital with a reoccurrence of those bed sores because the treatment was not continued in hospital and the hospital staff was not aware that ongoing treatment was needed. There are many pieces of information about a patient's care that need to flow across transitions of care, medication information definitely being a critical component of that.

2. If I interpret the last comments from dbronx I think what is being said is that we need the Best Possible Medication History, but where possible we should be doing this via electronic sources. Is that correct? I know from conversations with Jennifer Turple (on this thread) that in her work at the Institute for Safe Medication Practices that they have invested in creating best practices and forms for Medication Reconciliation but that the long term goal is, where possible, the electronic flow of available information. To my knowledge eMARs and Medication Reviews can be used as an additional input to a BPMH for LTC patients and other institutional patients, but this is not available for all patients.

3. As we move to electronic medication reconciliation, using drug information systems (such as Pharmanet) as a source of data, I do think we need to foster a sense within clinicians that their data is now shared data and they have a responsibility to maintain it (e.g. discontinue medications that patient's are not longer taking). Saskatchewan is doing some interesting work in a project they call PIP QIP (Quality Improvement Program) where they are educating clinicians on steps they should take to maintain drug profiles. Sandra Sabaratnam did a short presentation at the Infoway Partnership conference (available here: infocentral.infoway-inforoute.ca/@api/deki/files/9041/=Sabaratnam.pdf ) but I have seen a longer version of the presentation where she highlights more of the improvement opportunities and some of the potential patient safety risk of not maintaining drug information on the DIS. They are seeing a lot of success with this project and their education campaign.

Thanks,
Tanya

Tanya Achilles, BSc Phm, M.B.A.
Director, Clinical Interoperability
Canada Health Infoway

One of the data sources which serves as input to the care plan in our EMAR software is a med review input form which currently serves as input to the BPMH documentation requirements i.e. it includes local scripts, otcs, and pharmanet data (for what it's worth, given it's omissions). The problems with BPMH associated forms is that they have no measurable clinical benefit and are largely an exercise in unused documentation
and revenue generation.