Implementing 30-day put up discharge remedy reconciliation utilizing FHIR

The aged and chronically sick sufferers are sometimes challenged with many medicine and complex dosing regimens, usually resulting in remedy errors. Remedy errors are one of the crucial frequent affected person security occasions. Greater than 40 {7c9b59ce8c19308b8d6c56ccee94517a6d60945b1b22ca4be0c0bc4efe82ee50} of remedy errors are believed to end result from insufficient reconciliation in handoffs throughout admission, switch, and discharge of sufferers. 

Whereas understanding and reconciling medicine after discharge from the hospital will be difficult, it’s a necessity for larger efficacy of care supply. There will be cases the place a affected person taking Glucophage earlier than admission after which prescribed Glycomet post-discharge is unaware that the 2 medicine are the identical and continues to take each till the affected person’s care supplier reconciles them. A major variety of emergency admissions are additionally traced again to inadequate reconciliation.

Remedy reconciliation is about figuring out probably the most correct record of at present prescribed medicines, together with the drug’s title, dosage, frequency and route. It may be a really time-consuming course of involving reviewing all medicines taken by the affected person, together with house drugs, OTC, natural dietary supplements and prescription drugs, and checking them for duplications, dosing errors, omissions and potential drug-drug interactions. 

Numerous high quality packages have mandated remedy reconciliation in any respect occasions of admission, discharge, switch, or throughout common affected person visits to the doctor.

High quality packages for monitoring remedy reconciliation 

The Joint Fee on Accreditation of Healthcare Organizations (JCAHO) has mandated reconciliation throughout every affected person encounter. Proof of remedy reconciliation achieved inside 30 days of discharge is a should for compliance with many regulatory reporting measures, together with HEDIS and MIPS MACRA. For value-based care, proof of 30-day remedy reconciliation is required to assert incentives towards the measure. The High quality Fee Program affords MIPS-eligible clinicians as much as 10 proportion factors towards the Advancing Care Data efficiency class rating for correct remedy reconciliation and establishing the “Selling Interoperability” measures. As part of the development actions, 15{7c9b59ce8c19308b8d6c56ccee94517a6d60945b1b22ca4be0c0bc4efe82ee50} of the ultimate rating can come from the development actions tracked for 90 days.

Figuring out prescribed medicines and reconciling them with HL7 FHIR

Whereas the intent of remedy reconciliation has all the time been there, the sooner days of the EHR had screens the place house drugs needed to be manually entered in a single column and painstakingly reconciled with the present medicines. Suppliers would put up a Class II CPT code on a declare to attest for reconciliation, normally not paid by the payer and written off by the supplier. Physicians confronted challenges in reporting for remedy reconciliation due to the cumbersome processes. 

The workflows surrounding remedy reconciliation are simpler to streamline with FHIR assets. The information artifacts are saved within the EHR when a doctor has evaluated and attested to reconciled medicine. This workflow has been specified by element by the HL7 Da Vinci project.

The HL7 Da Vinci Venture is a collaborative effort between payers, suppliers, expertise distributors and interoperability specialists to resolve real-world challenges by creating options that could be applied to handle particular use circumstances. Remedy reconciliation post-discharge is likely one of the use circumstances that this group has recognized as a excessive precedence one.

Information factors to report for remedy reconciliation and the corresponding FHIR assets

From an information trade standpoint, the supplier is the information producer, and the payer is the information client. As soon as the first care doctor or treating doctor is conscious that the affected person is inside a 30-day post-discharge window, they need to evaluation the entire affected person’s remedy lists – pre-admission, throughout admission and post-discharge – and reconcile them.

That is achieved by means of a display screen inside the EHR that gives all of the lists and permits the doctor to cancel, add, delete or make vital dosage changes on the prescription to reconcile the meds. As soon as that’s achieved, the doctor attests to having reconciled the drugs. The EHR assembles all of the FHIR assets used to streamline the entire workflows for remedy reconciliation and creates the Measure Report. 

The Measure Report is a specialised FHIR useful resource that helps manage and include the outcomes for calculating the measure. That is an efficient technique to harmonize and bundle all the data to calculate a high quality measure, sometimes the numerator, denominator, exclusions and inclusions, and the algorithm/calculation steps to generate the outcomes. For the tip consumer, it is a chance to take away implementation complexities and manage the data in a structured format. It simply helps organize the required assets or datasets already within the EHR and pull them collectively for reporting functions.

The first assets used for outlining a Measure are listed within the desk beneath. These are packages of data used to construct an algorithm and constructed as a Measure Report by the EHR system when the supplier attests to reconciliation.

Useful resource Kind



Gives details about the policyholder or beneficiary, payer group and the interval for which it’s legitimate.


Details about the encounter, the standing of the encounter.


Particulars and place data for a bodily place the place providers are supplied and assets and members could also be saved, discovered, contained or accommodated.

CQFM Measure Profile

Describes minimal expectations for outlining an digital Scientific High quality Measure (eCQM).

DEQM Measure Report

That is an organizer for the information trade for measures and measure reporting and offers particular person and abstract reviews.


Defines the core set of components and extensions for high quality guidelines and measures authors.


Defines the group the place the practitioner is working when testifying for a measure.

Affected person 

Profile of affected person for choice help/high quality metrics.


Representing the practitioner who carried out the measure or to which is testifying.


Defines the core set of components and extensions for high quality guidelines and measures authors.


This constructed report or the Measure Report is obtained by the FHIR server of the payer and validated. The payer system on validation shops the member’s data of their database.

Payer methods can select to retailer the information in FHIR or another proprietary format. The payer, who’s the aggregator of the reviews, can ship out particular person affected person reviews of reconciliation or abstract reviews to regulatory our bodies by sending REST API calls to the receiver of the data, which is normally the NCQA, CMS or any regulatory physique. Remedy reconciliation is a important security observe that helps remove conditions like duplication, dose errors and drug interactions. The first care doctor’s involvement is definitely important in finishing the reconciliation.

Dr. Joyoti Goswami is a principal marketing consultant at Damo Consulting, a development technique and digital transformation advisory agency that works with healthcare enterprises and world expertise firms. A doctor with diverse expertise in scientific observe, pharma consulting and healthcare data expertise, Goswami has labored with a number of EHRs, together with Allscripts, AthenaHealth, GE Perioperative and Nextgen.