Clinical information reconciliation is the process of identifying the most accurate list of all of a patient’s medications, medication allergies, and problems by comparing the medical record to an official list of the same items obtained from a patient, hospital, or other provider.
Medicaid Promoting Interoperability Objective and Calculation
The objective is to have the EP who receives a patient from another setting or provider of care or believes an encounter is relevant performs reconciliation of medications, medication allergies, and problem list. This reconciliation process must take place electronically.
- For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP performs a clinical information reconciliation. The provider must implement clinical information reconciliation for the following three clinical information sets:
- Medication. Review of the patient’s medication, including the name, dosage, frequency, and route of each medication.
- Medication allergy. Review of the patient’s known medication allergies.
- Current Problem list. Review of the patient’s current and active diagnoses.
Denominator for calculation: Number of transitions of care or referrals during the PI reporting period for which the EP was the recipient of the transition or referral or has never before encountered the patient.
Numerator for calculation: The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: medication list, medication allergy list, and current problem list.
EXCLUSION: Any EP for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the PI reporting period is excluded from this measure.
Promoting Interoperability Discussion
A transition of care is the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Optometrists and ophthalmologists would most likely receive a transition of care from another primary care optometrist or specialty ophthalmologist. A transition of care also includes the movement of patient to another practice setting without a referral.
- When an inbound referral of an established patient is taking place, the user should check the “Transition of Care” box on the RFV screen: See Example
- In these situations, it is incumbent on the requesting provider to send you an electronic summary of care document. Upon receipt (whether before or after the encounter has been signed) and addition of the file to the patient record, the “e-TOC Document” field should be used to indicate “Received and Incorporated”: See Example
The same workflow as above can be followed for encounters with patients that have never been seen before, however it’s important to note that the Transition of Care checkbox for these patients is optional. RevolutionEHR will automatically consider all patients with a status of “New” at the time their encounter is started in the denominator of this measure. (Please note that unlike the Request/Accept Summary of Care measure, the indication of “Requested, but Unavailable” in the e-TOC Document field will not decrement the denominator for this measure)
Clinical information reconciliation should also be performed on all new patients whether they present on referral basis or of their own accord. Encounters with new patients are automatically added to the denominator without the need for the above indication on the RFV screen.
The act of performing clinical information reconciliation is accomplished by using an electronic summary of care file to build or update the patient’s medications, allergies, and problem list in RevolutionEHR. Importantly, this process requires the use of the electronic reconciliation process available in RevolutionEHR. To initiate that process, head to the location in the patient record where the summary of care document has been saved. If the file has been saved from an inbound Direct message, that folder will be the Transferred Messages Files folder in Documents/Images.
- Select the file to be reconciled and then select “Incorporate” in the lower right part of the screen: See Example
- RevolutionEHR will process the electronic file and, upon completion and the user’s selection of “Continue”, provide the user with a side-by-side comparison of the inbound document against the information in the patient record in RevolutionEHR. Note that medications, medication allergies, and problems each have their own sliders: See Example
- From here, the user can use the “Remove” and/or “Merge” buttons to update the patient’s record in RevolutionEHR. “Remove” would eliminate an item you would prefer not be part of your record while “Merge” can be used to create one instance of a medication, problem, or allergy from two. Once your work within a particulate category is complete, selecting “Consolidate” will bring both sides together to create a single master list for incorporation into the patient record: See Example
- Once each of the three categories has been reconciled and consolidated, the “Continue” button will become available and allow the user to add the information to the patient record in RevolutionEHR. A final confirmation step allows the user a final opportunity to make any changes or proceed: See Example
- Selection of “Confirm” updates that patient record and triggers the numerator for this measure.
Meeting this objective is significantly challenging because the user not only needs to perform clinical information reconciliation for patients who have been transitioned into their care, but also for any non-referred patients that have never been seen before. To be successful, users will need to develop procedures for obtaining electronic data from both their patients and other providers.