Medication reconciliation

Discussion in 'Synapse' started by Graham, Jan 9, 2011.

  1. Graham

    Graham Developer Staff Member

    Got something working .. not pretty yet, needs tarting up the CSS etc. Will report back it it's too slow for my nurse.
  2. Jason

    Jason Developer / Handyman Staff Member

    Do you get these letters before they come ?

    What about OCR the referral typed medication list / Parse / try to match medications to the database, display a list of the matched medications and get the nurse to confirm the matches. Add the ones that didn't get matched or make changes.

    Aren't your letters electronic ?
  3. Graham

    Graham Developer Staff Member

  4. Jason

    Jason Developer / Handyman Staff Member

    Graham Plans: After Selecting the Dose - future prescribing will show last / most frequently used SIG/Dose.

    That is a lot of work to prescribe a medication.

    This is the same "Entire Drug Database approach" you are trying on the Web Prescription applet.

    Synapse needs to codify meds with RxTerms but also be the fastest prescribing EMR.
    This approach won't accomplish both goals.

    Prescribing Screens in Synapse:


    What are the plans with all of this stuff ?
    FDA, NZ, RxN, RxT, RxCUI, E-Rx, Drug Interactions, Reconcile Medications, Inactivate Allergies,

    If people wanted the fastest codified drug prescribing applet of all time, I'd be happy to design one if that is what people want.
  5. Graham

    Graham Developer Staff Member

  6. Jason

    Jason Developer / Handyman Staff Member

    Previous Instructions looks good.


    This is Recent SIG is effective:

    Attached Files:

  7. Graham

    Graham Developer Staff Member

    Yes, I could do that ... preselect the blank food table. I didn't though as it confuses people where the focus is at the time.
  8. Graham

    Graham Developer Staff Member

    The issue I'm having is that we seem to use a number of medications for which there is no RxCUI. Presumably these drugs are not marketed in the USA.
    These include:

    Naprosyn EC 750 mg
    Aspirin EC 100 mg
    Folic Acid 5 mg

    So, I'm not sure what to do about these drugs.
    In the meantime, I'm creating shortcuts for these drugs.

    PS: emailed the RxNorm people asking them why some other drug forms seem to be missing.
  9. Jason

    Jason Developer / Handyman Staff Member

    No 100mg ECASA. Health Canada Drug Search

    Can it be optional ? If not clicked, then no warning ? That's the best answer for me. Unless it's mandatory for medication codification it should be made optional.
  10. Graham

    Graham Developer Staff Member

    Yes, I know that these drugs are available in Canada, as they are in NZ, but they're not in the USA. And since I'm using the RxCUI .. that is the problem.
  11. Graham

    Graham Developer Staff Member

    Using Aliases for RxTerms names ... the rxcui-aliases.r file is in the same directory as your favorites.r file ie. the dropbox directory if specified.
  12. Jason

    Jason Developer / Handyman Staff Member

    Excellent idea. I think that Humira Pen should appear as a selectable item from the RXNorm results - maybe not as a replacement of Humira (Injectable) but in addition to.

    Medications RX needs for Synapse:
    (1) Fastest
    (2) Codified

    Seems like (2) is possible.
    The most popular feature for doctor's would be (1).

    What's the plan for speed ?
  13. Jason

    Jason Developer / Handyman Staff Member

    I just re-read this:

    First Post
    Seems similar to my priorities:
    So what is the speed plan ?
    Medications is the most useful part of a good EMR.
    A great EMR requires a Prescribing Applet to be superior in speed.

    What can we do to speed it up ?
  14. Jason

    Jason Developer / Handyman Staff Member

    Do you use this alot ?
    Will this just encourage non-codified drug RXing ?

    Attached Files:

  15. Graham

    Graham Developer Staff Member

    The quickest way to speed up is to put them all into favourites. So, the idea would be to search on favourites automatically before it goes to rxterms.

    The other thing is for non-rxterms to allow mouse prescribing.
  16. Jerry

    Jerry Administrator Staff Member

    I find favorites pretty quick, and you can modify the dose and sig of a favorite for a particular patient on the fly, so you don't have to make a fav for every little sig nuance for a particular drug. But, some accoutrements could be added, such as filtering favs by diagnosis. Just click on a diagnosis and all your favs come up for that diagnosis, and they can be selected with a single click. Make it so you can hold the Ctrl key down as you left click on multiple selections, just like you would select multiple files in Windows Explorer.
  17. Graham

    Graham Developer Staff Member

    You could be right. I don't use favourites enough .. and I can use RxTerms to create the favourite too.

    I shall try it.
  18. Jason

    Jason Developer / Handyman Staff Member

    Exactly how I feel.
    I don't want to use the popup, it is slow. 90% of the time I shouldn't need it. Maybe more.

    hopefully this happens so rarely, this isn't a big issue.

    Yes, but the modified dose wouldn't be RXCUI codified then.

    This could work. I usually know what drug I want but I think lots of people would be impressed by this feature.

    This would fulfil the multiple drug selection plan you devised previously.

    I'm glad you both felt favo(u)rites was the key ... as it is !
    Why use a database that you pick a drug out of 100,000 drugs, when you only prescribe 50-100, and 90% of the time you only prescribe 35-60 !
    I'm not sure any EMR has exploited this important fact, but we should.
  19. Jason

    Jason Developer / Handyman Staff Member

    Other issues with the "database method" of drug selecting:
    - IV drugs come up, obviously those will fail the 90/10 rule for outpatient doctors ... they shouldn't even show up !

    The 90/10 rule as applied to prescribing means it should be Super Fast to prescribe these.
    Graham, you nurse need to enter these drugs easily.
    I'm not sure other EMRs have made sure that the "Top Drugs" are the most accessible / convenient drugs to prescribe.

    However, at the end of the day, the most important thing would be make a great Favourites list.
    An ounce of prevention is worth a pound of cure here.

    Maybe we could pre-populate lists with the most popular drugs, and the synapse user could get rid of the ones they don't prescribe.

    Maybe I could share my list with other synapse users ?

    New users could be briefed how to get their staff to make the Medication Favorites List.

    The Favorites List also needs to be improved.
  20. Jason

    Jason Developer / Handyman Staff Member

    I think there should be options for more than 1 shortcut. Flexibility is important. How my nurse might remember how to pull up the drug might be different than how I will remember it.

    I prescribe everything generically, some doctors might want / need brand drugs and even multiple brands.

    I think the lists could be tweaked even more .... based on age and weight !

    When I type: Amox
    for a 2 year old ... why even list amoxicillin 500mg 1 tab po tid ? This age group cant swallow pills ... only list the syrups.

    I'm sure the pediatricians would like to see the Favorites display differently based on age / weight.

    Graham ...... is there a way to search through all your drugs (in REMR.FDB) you've RX'd in the past ? and Make your own Top 100 ?

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