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Medication Reconciliation – A Field of Onions (Part 3)

January 24, 2012
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Exploring and Validating the Provider Process Issues for Successful Medication Reconciliation

Medication Reconciliation and Peeling Back an OnionIn the first two parts of this series we reviewed the fact that although medication reconciliation is recognized as being extremely challenging, there was progress being made in 2011.  Some of that progress, the prototype user experience, earned a standing ovation from physician leadership in HCIT. 


In this post, we will wrap up the topic by discussing the provider organizational process issues, where the many critical contexts of medication reconciliation (MR or Med Rec) come together.  We’ll draw heavily from a presentation by Vickie Kamataris of Novaces in which she effectively peeled back the layers of the MR onion with great clarity.  Titled “Medication Reconciliation:  Putting a Dent in One of Healthcare’s Toughest Problems,” and delivered in August 2011, you’ll find it here.

Kamataris has the talent, skills and experience stemming from her nursing and Six Sigma master black belt training to make some very intelligent points.  What follows are the fundamental dimensions and implications for action from her presentation.


A.  Unreliable Med Rec is recurrently identifiable as the root cause of every major inpatient process failure.  That’s true for preventable readmissions, attainment of quality goals, personal time and energy management of healthcare providers (especially nurses and doctors).  Also included are avoidable waste such as non-value-added activities, and the effective management of transitions of care (admission and discharge being the granddaddies). There are different approaches to problem solving, depending on the problem.

Implication:  The Med Rec process must be understood and addressed as a prerequisite to any inpatient improvement project.  This requires the correct use of tools, as shown in the figure above.




Dr. Bormel,
This is a fitting final installment for your Med Rec series. I do admit that to date, I simply haven't had the time to devote an hour for review of the presentation by Vickie Kamataris. Therefore, my question may not appear very enlightened.

The CEO of our hospital is pro-IT, and understands its importance in terms of both quality care and financial viability. He actually drives much of our advanced adoption. We have a CIO and CMIO who are both of the same mind.

Our CFO is a "number cruntcher" who really has her hands full with day-to-day operations, reporting, and high level planning. With all of the C-level exec already supporting our IT initiatives, how important is it for her to actually participate in our IT planning sessions other than to approve our investments?

Doc Benjamin

Doc Benjamin,

Thanks for your kind words and candor.

Vickie Kamataris made many useful and provocative points. I would say that, for managers with operational responsibilities within enterprise-class provider organizations (at least one hospital combined with some spirit of responsibility for the patient's continuity of care, such as having integrated ambulatory clinics or a health plan for employees), this one hour video is a must watch.

One specific issue came up in the presentation and the Question-and-Answer section. That was the need to have the CFO (someone with finance credentials from finance) on the improvement project from the beginning. She notes that great projects are likely to have real revenue benefits, as well as reduction in costs, as a by product of focusing on increasing value and decreasing waste. If you dont have the CFO on the team during the problem definition phase, you will probably never get their validation, much less their complete buy-in, nor is it possible that they can adequately share in the credit. We all need those things to ensure sustainability of the gains through subsequent planning and budgeting. To say that more simply, care optimization is ongoing and requires sustained funding. This requires attention to all impacted stakeholders. The CFO is high on that list.

This is completely consistent with my personal experience on multiple occasions. Even having the CEO on board isn't always enough to protect a plan in the eleventh hour that has an impact on how the organization accounts for activities and costs.