List of patient's medications

I think I need to add this functionality, which I can then hand to the patient.

Definitely.

I have a very useful but never seen before request: Medication Reconcilliation (via paper).

How would it work ?

The EMR would print out what medications the patient is taking, the discontinued medications and the allergies (which should be seperate).

The patient could then go home, check their medications and report any differences.(note: not done in the office, saves time).

Ideally any medication list also should say *WHY* the patient is taking the medication. Ideally, the list would have both drug names (trade and generic). Ideally, the patient could even make their own notes on the drug list (that could be printed)("this is my white and blue blood pressure pill"), of course via the kiosk/portal. I wouldn't mind a special "Notes" field where I can make medical notes. Patient risk stratified via the HOPE trial and felt to benefit from ramipril 10mg daily [Jan 2004]. But that's ambitious. or Clomipramine 25mg daily - Notes: patient intolerant of SSRIs.

Another feature is : an ultra small medication list ! for the patient's wallet. That way they'll actually use (carry) the list. I could see it as a feature that patients would like.

In an ideal world the patient might type in their "Over the Counter" Herbs (alternative meds) and this might be checked for interactions with their real meds. []

I'd like the patients to be able to send me a note easily, "Dr. XYZ increased my atorvastatin to 80mg". and the note would go to my nurse and she'd update the list. Bigger groups have on staff pharmacists and the message would go there.

One of my patients prints his own medication list and laminates it and puts it in his wallet.

oh. while thinking of it.

A pharmacist in town and I were discussing what would be an ideal medication list. She had some good ideas. I should try to get her to give me a report.

I had a patient yesterday who's medications had completely changed over the last 6 months since I last saw her.

Her medications had completely changed since I last saw her 6 months ago, and being a non native english speaker, it was difficult to sort out.

And it didn't help when there was a mixture of generic and proprietary naming going on.

Most office system paper charts I have used have a comprehensive medication list including date, medication, quantity, sig, pharmacy and prescriber. Since some pharamcies require a diagnosis, especially if having to do "prior authorization" process, a diagnosis would be nice as well, but not essential for me. Including OTC meds in the list is also a good idea, once again to offer proof to an insurance company of what the patient has taken for a particular condition.

In urgent care, or in any multi-provider environment, a comprehensive medication list is a necessity to review before office visits and phone calls.

I need such a comprehensive list. It doesn't matter to me if the list is in the form of a report or otherwise. Ideally, it should include the meds entered by using the "search" and "medication" entry boxes as well as the "script" text box.

Synapse already maintains a comprehensive medication list ... but I believe you're asking for more.

Now, when is a medication actually prescribed? When I click on the drug? When I print it out?

I think the drug should be considered prescribed when it is faxed or printed out.

I cannot find an existing "spreadsheet" view of patient medications in Synapse that includes: start date, stop date, medication, quantity, sig, prescriber, pharmacy, and (possibly) diagnosis. The Docs button on the consult page only includes drug, quantity, and sig for new and discontinued drugs. I realize that all the information (except for the pharmacy) is actually on the Consult page if one views the "Prescription" tags, but it's not in a single sheet "spreadsheet" like format unless I completely missed something.

Medications would be a good subject for graphing as well... to follow the fluctuations in dosage for a long-term medication. This feature might be a little over-the-top on average, but a quick graph to follow dosage fluctuation for a medication a patient has been taking for, say, 10 years could be useful. It would get even more usual if cast against a lab parameter.... maybe the medication is metformin and the lab parameter is HbA1c....

Probably the better of the two.

This thread is supposed to be about printing out a list of patient medications!

Anyway, if we allow users to type into the edit box rather than adding a medication using the form, or prescription applet, then we have to parse out the medications again at the print time.

These can be saved to another table ... so you can see at a glance all the prescriptions for a patient. As opposed to using a prescription tag search.

Is this worth it? ( I think it's only that useful in a multi-user setting ... )

One of the more useful things about having my prescriptions in a versioned MS word document is that I just scroll up and see all my old prescriptions. I can say .. "Well, I repeated all your medications last time", etc. or "that cream I gave you 2 years ago was ...". I really feel a lightweight "log" with dates, that could be perused/scrolled, would be useful.

Unless you have a fairly exceptional memory when seeing a lot of patients, what good is a medication list without dates? For the patient's printed list as well -- I think it would be the unusual patient that would remember the dates when they started and stopped a number of medications.

Jerry, there is a medication history available which shows when you stopped/started a drug, and shows the reasons given.

the name tab on this shows each drug's history as well.

oops, forgot to post this.

Superior Medication Management is what EMR is all about. Throw in a portal and you should be able to do wonderful things. The biggest limitation with the medications thus far is the inability to differentiate between "Allergies" and "Discontinued Medications". Some patients came to me with a list of 5 allergies, over the last 5 years we have discontinued 5 medications, so there list has 10 entries. Some times I would like to just send a list of the patient's "true" "allergies".


Allergies (defined to me as medications the patient should never have again)(not just Meds that increase the IgE [] and cause swelling/rash ). This is different from D/Cing an SSRI to attempt the trial at another one.

I would also like to assign a provider for most medications. The patient needs to remember that I don't prescribe Remicade and their good rheumatologist should do that.

[quote user="Jason"]

oops, forgot to post this.

Superior Medication Management is what EMR is all about. Throw in a portal and you should be able to do wonderful things. The biggest limitation with the medications thus far is the inability to differentiate between "Allergies" and "Discontinued Medications". Some patients came to me with a list of 5 allergies, over the last 5 years we have discontinued 5 medications, so there list has 10 entries. Some times I would like to just send a list of the patient's "true" "allergies".


Allergies (defined to me as medications the patient should never have again)(not just Meds that increase the IgE [] and cause swelling/rash ). This is different from D/Cing an SSRI to attempt the trial at another one.

I would also like to assign a provider for most medications. The patient needs to remember that I don't prescribe Remicade and their good rheumatologist should do that.

[/quote]



I agree, the medication list should be able to easily differentiate allergies vs adverse reactions. Unless working in a solo environment, the medication list has to easily display the prescriber, and if an MA or RN is given the task of some routine refills it should reflect which ancillary staff actually faxed or printed the refill. Can this be done currently with a custom SQL report?

[quote user="Jason"]

oops, forgot to post this.

Superior Medication Management is what EMR is all about. Throw in a portal and you should be able to do wonderful things. The biggest limitation with the medications thus far is the inability to differentiate between "Allergies" and "Discontinued Medications". Some patients came to me with a list of 5 allergies, over the last 5 years we have discontinued 5 medications, so there list has 10 entries. Some times I would like to just send a list of the patient's "true" "allergies".


Allergies (defined to me as medications the patient should never have again)(not just Meds that increase the IgE [] and cause swelling/rash ). This is different from D/Cing an SSRI to attempt the trial at another one.

I would also like to assign a provider for most medications. The patient needs to remember that I don't prescribe Remicade and their good rheumatologist should do that.

[/quote]



I agree, the medication list should be able to easily differentiate allergies vs adverse reactions. Unless working in a solo environment, the medication list has to easily display the prescriber, and if an MA or RN is given the task of some routine refills it should reflect which ancillary staff actually faxed or printed the refill. Can this be done currently with a custom SQL report?

the information on who the prescriber is, and who printed the refill is available already - no need for a custom report.

See print history, and medication history.

Graham,

Thanks for your email explanation of where to find the "MedicationHistory". Doing searches on the forum for "Medication History" wasn't very revealing. So "Medication history" is a "function" and can be accessed with the "?" button on the main Synapse screen, or made accessible by a function key. I see that the notes do indeed print there. The "notes" would work for me as an explanation as to whether the pt had an allergy vs an adverse reaction.

Jerry

For me it also appears as the 4th choice on the function table above the consult editor area. Perhaps your preferences have reduced the size of this table? ( It's user configurable ).

Medication favorites

How about preferencing a drug with ! so that tells synapse to look up in your favorites instead ?

Re: Medication favorites

That sounds good for starters, some drugs have maybe 20+ choices, and I only ever use 1 or 2 of them, so just a favorites list alone would be useful...I still would like to have favorites with the sig and quantity if possible.