Implementing 30-day put up discharge remedy reconciliation utilizing FHIR

The aged and chronically ailing sufferers are sometimes challenged with many medication and complex dosing regimens, typically resulting in remedy errors. Medicine errors are one of the vital widespread affected person security occasions. Greater than 40 % of remedy errors are believed to end result from insufficient reconciliation in handoffs throughout admission, switch, and discharge of sufferers. 

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

Medicine reconciliation is about figuring out essentially the most correct checklist of presently 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 residence medicines, OTC, natural dietary supplements and prescription medicines, and checking them for duplications, dosing errors, omissions and potential drug-drug interactions. 

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

High quality applications 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 completed 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 Cost 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 advance actions, 15% of the ultimate rating can come from the advance actions tracked for 90 days.

Figuring out prescribed medicines and reconciling them with HL7 FHIR

Whereas the intent of remedy reconciliation has at all times been there, the sooner days of the EHR had screens the place residence medicines 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 medication. This workflow has been specified by element by the HL7 Da Vinci project.

The HL7 Da Vinci Mission 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 deal with particular use instances. Medicine reconciliation post-discharge is without doubt one of the use instances that this group has recognized as a excessive precedence one.

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

From a knowledge trade standpoint, the supplier is the information producer, and the payer is the information shopper. 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 evaluate all the affected person’s remedy lists – pre-admission, throughout admission and post-discharge – and reconcile them.

That is completed by a display screen throughout the EHR that gives all of the lists and permits the doctor to cancel, add, delete or make obligatory dosage changes on the prescription to reconcile the meds. As soon as that’s completed, the doctor attests to having reconciled the medicines. 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 set up and include the outcomes for calculating the measure. That is an efficient methodology to harmonize and bundle all the data to calculate a top 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 set up the data in a structured format. It simply helps prepare the mandatory 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



Offers 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 individuals could also be saved, discovered, contained or accommodated.

CQFM Measure Profile

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

DEQM Measure Report

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


Defines the core set of parts 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 determination assist/high quality metrics.


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


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


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

Payer programs can select to retailer the information in FHIR or every other proprietary format. The payer, who’s the aggregator of the stories, can ship out particular person affected person stories of reconciliation or abstract stories 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. Medicine reconciliation is a vital security observe that helps eradicate conditions like duplication, dose errors and drug interactions. The first care doctor’s involvement is certainly important in finishing the reconciliation.

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