Highlights & Takeaways from the Three-Part Advanced Medication Reconciliation workshop

The Michigan Health Information Network Shared Services (MiHIN) prioritizes use cases where health information exchange (HIE) can have the most significant impact. In partnership with the Michigan Pharmacists Association, they identified optimizing medication safety and outcomes across the state as a top priority, leading to the development of a two-pronged technical framework to optimize medication use safety and outcomes across the state.

 The fragmented U.S. healthcare system, including incomplete medication reporting and lack of over-the-counter (OTC) and supplement identification, makes medication reconciliation challenging. By leveraging their robust infrastructure, HIEs are uniquely positioned to support and improve this process.

MiHIN convened diverse, multi-sector stakeholders across Michigan for a three-part series designed to understand the current, complex landscape of medication reconciliation and work to develop a solution through the Advanced Statewide Medication Reconciliation Workshop Series. Pharmacists, payers, and others within the healthcare ecosystem identified key challenges related to way medication reconciliation is currently handled:

• There is not a single source of truth for medication lists. Individual pharmacies see what prescriptions they receive and fill. Payers see the prescription for which claims are submitted. Hospitals sometimes apply formularies that revise medication lists. How do we get all the data into a single source of truth that can be relied upon?
• Medication lists change frequently, including during transitions of care, new diagnoses, long-term care admissions, and other instances. How are we going to deliver this to the point of care and integrate it into workflows?
• No one person or entity owns medication reconciliation; communication is siloed. A lack of clearly defined roles can cause overlaps or gaps. How do we create a policy or incentive framework that supports this effort?

With these in mind, the workshops shifted focus to potential pilot projects that could address the current barriers. Six projects were evaluated for strengths and weaknesses, and two emerged as the top pilots to explore.

• Utilize an existing, integrated infrastructure. Current legislation and policy are in place for the tracking of controlled substance prescriptions. Could this be expanded to include non-controlled substances to receive dispensation transactions?  
• Create a new MiHIN Active Care Service (ACRS) workflow. Every time a pharmacy dispenses a medication, a transaction flows into MiHIN, and ACRS is utilized to get that information to care team members.

MiHIN is grateful to all the participants who attended these workshops and shared their valuable insights, perspectives, and ideas on practical and accessible medication reconciliation. This collaborative feedback will be presented to the Michigan Health Information Technology Commission in May 2024.