Module 2 Discussion: Initial Post
The Faxed Medication List: Why Interoperability Is a Patient Safety Issue
When a patient on my medical unit is discharged to a skilled nursing facility, the medication list leaves our electronic health record as a printed or faxed discharge summary. A nurse at the facility then retypes each medication into a different system. The two records do not talk to each other, and every retyped line is a chance for error. Research confirms the risk: in a study of 199 admissions from a hospital to skilled nursing facilities, at least one medication discrepancy occurred in 71 percent of admissions, and disagreement between the discharge summary and the transfer form accounted for most of them (Tjia et al., 2009).
This is an interoperability problem, and it has several layers. Lehne et al. (2019) describe interoperability in levels: foundational, the ability to transmit data from one system to another; structural, a shared format so the receiving system can parse the data into fields; semantic, shared meaning, so that both systems understand a coded term the same way; and organizational, the policies, trust, and workflows that let exchange happen in practice. A fax achieves only a crude form of the first level. A PDF sent electronically still requires a human to read and retype it.
Standards address the structural level. HL7's Consolidated Clinical Document Architecture defines a structured summary of care document, and the newer Fast Healthcare Interoperability Resources standard, FHIR, breaks health data into discrete resources, such as a medication request or an allergy, that can be exchanged through modern web interfaces (Bender & Sartipi, 2013). With FHIR, a facility's system could retrieve the patient's current medication list directly as structured data.
Terminologies address the semantic level. Structure alone is not enough if one system calls a drug "metoprolol succ ER 25" and another expects a different string. RxNorm provides standard codes for clinical drugs, LOINC for laboratory tests and observations, and SNOMED CT for clinical findings and problems. When a medication travels with its RxNorm code, the receiving system knows exactly what drug, strength, and form it is, without a nurse guessing from an abbreviation.
The organizational level may be the hardest. Our hospital and the local facilities use different vendors, and no agreement exists for direct exchange, so the fax persists. As a nurse leader, I would push for participation in a regional health information exchange and for a shared reconciliation process at transfer, with the receiving nurse able to view the structured list rather than a scanned page.
Has anyone worked where discharge medication lists transfer electronically to post-acute facilities? What made it work?
References
Bender, D., & Sartipi, K. (2013). HL7 FHIR: An agile and RESTful approach to healthcare information exchange. In Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems (pp. 326-331). IEEE. https://doi.org/10.1109/CBMS.2013.6627810
Lehne, M., Sass, J., Essenwanger, A., Schepers, J., & Thun, S. (2019). Why digital medicine depends on interoperability. npj Digital Medicine, 2, Article 79. https://doi.org/10.1038/s41746-019-0158-1
Tjia, J., Bonner, A., Briesacher, B. A., McGee, S., Terrill, E., & Miller, K. (2009). Medication discrepancies upon hospital to skilled nursing facility transitions. Journal of General Internal Medicine, 24(5), 630-635. https://doi.org/10.1007/s11606-009-0948-2
How this N 537 Module 2 example is structured
N537 Module 2 typically covers standards, terminologies and interoperability as a discussion. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example grounds the topic in one workflow, uses a levels framework to organize the discussion, explains structural standards and terminologies with correct examples and ends with an organizational step and a question for peers.
N537 Module 2 questions, answered
What does N537 Module 2 usually ask for?
The module typically covers health data standards, terminologies and interoperability, often through a discussion asking you to apply them to a problem in your practice. Aspen does not publish module deliverables, so your classroom's instructions govern.
What is the difference between structural and semantic interoperability?
Structural interoperability means data are exchanged in a shared format that systems can parse into fields. Semantic interoperability means both systems understand the meaning of the data the same way, usually through standard terminologies.
Which terminologies apply to medications, labs and problems?
RxNorm for clinical drugs, LOINC for laboratory tests and observations, and SNOMED CT for clinical findings, problems and procedures.
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