Reconciling Clinical Information > Selecting Imported or Current Problems/Allergies/Medications

Each record will display the item description, including custom allergy descriptions, status, last modified date and source. The width of the Imported and Current columns have been maximized to display as much information as possible for each record. However, in the event that the available information exceeds the width of the column, a message is displayed "..." at the end of the column to denote that there is more information than what is being displayed. Hovering with the mouse over such a record in any of the three columns will display the information for that column, respectively, in its entirety.

Any matching imported and existing records that share the same code or description are automatically associated. Associated items will display together on the same line.

NOTE: In some instances, the system may not import records for problems, home medications or allergies.

•One such instance is when the system is unable to determine the description of the record due to one of the following:

•The record has a nullflavor instead of a code (RxNorm, SNOMED, etc.).

•The record does not have a display name and the code does not have an associated description.

In these instances, a label will appear on the Clinical Information Reconciliation screen just below the "Select Options" filters. The label will be in bold red font and will read, "Please review the imported CCD. (#) (importing item) did not import." The label will indicate the number of problems, medications or allergies (depending on what is currently being reconciled) that were not imported and direct the user to review the imported CCD to resolve discrepancies.

•Also, the system will not import true duplicate records (i.e., records with a code that is a duplicate of another record's code and, in cases of importing medications, have the same dose) and these duplicate records will NOT be counted for the label. Conversely, medications with the same RxNorm code but different doses do not constitute true duplicate records and, therefore, will be imported individually.

For medications, the last modified date will be the date the medication was imported or the date it was modified after being imported. If a medication is from a previous visit on the same profile, the last modified date is the date the prescription was generated or the date the home medication was modified after pulling to the next visit.

Additionally, RxNorm identifiers will display. Medications with RxNorm identifiers that do not have active NDC numbers will use the NDC number with the most recent discontinue date when imported via Clinical Information Reconciliation. Furthermore, medications will display medication details including routes, frequencies and units being imported from a CCD. Imported medications will also import their respective start and stop dates if established.

Medications with a discontinued status will be imported directly into Prescription Entry as a historical record under the Include DC'd Medications filter.

NOTE: Imported frequencies, routes and units of medications are determined by cross-reference tables wherein frequencies (e.g., time period, units and event codes), NCIT codes and UCUM codes that populate a CCD may be associated with the hospital's Prescription Entry Frequency, Route and Unit tables respectively. Please see the Table Maintenance - Clinical User Guide for more information regarding the Clinical Information Reconciliation Frequency, Route and Unit Crosswalk tables.

NOTE: If a medication with an inactive NDC number is imported to Prescription Entry via Clinical Information Reconciliation, the system will display the prompt, "Failed to create rx for "medication name" from inactive NDC:"XXXXXXXXXX"; Please generate a new prescription."

Current allergies will display severity and reaction information. Imported allergies will only display severity and reaction information when there are accompanying severity and reaction SNOMED codes along with the imported CCD, otherwise those fields will be blank when imported. Imported allergies will also import their onset date if available.

When importing allergies that do not have RxNorm identifiers, the system will look for any SNOMED or NDFRT codes to identify the imported allergy.

For any imported home medications, problems and/or allergies, the source will be a label at the bottom of the imported item that states "Electronically imported from 'HOSPITAL NAME'". Sources for imported problems and allergies with more than 30 characters, and medications from a CCDA with more than 50 characters, will be truncated to a 30 and 50 character limit respectively. In addition, imported resolved problems will also import their resolved date.

NOTE: The source label that imports with medications from Clinical Information Reconciliation to Medication Reconciliation will carry forward to Prescription Entry when an imported home medication is continued on a discharge Medication Reconciliation which, in turn, will cause it to pull forward to the next visit. Furthermore, when selecting a Non-Formulary medication during a discharge Medication Reconciliation, the system will direct users to the Prescription Entry application with the new medication instead of a medication edit screen.

The Action Bar options will become available as listed items are selected:

•Associate Selected: Becomes available when one item from the Imported column and one item from the Current column are selected. Selecting this option moves the selected items to the same line on the screen.

•Remove Associations: Becomes available when an associated item is selected. Multiple associations may be selected by holding down the <Ctrl> key on the keyboard while selecting associated items with the mouse. Selecting this option removes any and all associations and returns the imported and current items to separate lines, with the current item being moved back to the bottom of the list. At any time an unassociated item is selected during multi-selection, the Remove Associations option will be disabled.

•Import New: Becomes available when an imported item or an associated item is selected. Selecting this option will indicate Import New in the Pending Action column.

•Keep Existing: Becomes available when a current item or an associated item is selected. Selecting this option will indicate "Keep Existing" in the Pending Action column. When Keep Existing is selected for existing home medications during a Clinical Information Reconciliation, they will retain their current status, confirmed or unconfirmed. Unconfirmed home medications must be confirmed within the Medication Reconciliation application. Please see the Medication Reconciliation User Guide for more information on this process.

•Remove: Becomes available when an imported or current item is selected. Selecting this option will indicate "Remove" in the Pending Action column. Upon reconciliation, if an item is removed from the patient, it does not disappear but is moved to the "Inactive" status.

•Postpone: Allows a clinical reconciliation to be delayed. When Clinical Information Reconciliation is triggered by way of accessing Allergies, Problem List or Medication Reconciliation due to imported data being present and Postpone is selected, users may bypass Clinical Information Reconciliation and access the respective application. The next time the postponed application is accessed on the patient's visit, Clinical Information Reconciliation will prompt again. When accessing Clinical Reconcile from Health Information Resource, Postpone allows users to skip the clinical reconciliation for a selected application and move on to the next clinical reconciliation screen when multi-selection is being used or return back to the main Clinical Information Reconciliation screen when only one application is selected.

•Review: Becomes available once all items have been addressed and have an action listed in the Pending Action column. When selected, this shows the user a summary list of the pending reconciliation.

Select items from the Imported and/or Current columns. Items may be selected by holding down the Ctrl key on the keyboard and selecting the corresponding imported and current items with the mouse or by choosing one of the "Select Options".

The "Select Options" filters are as follows:

•Select All Imported: Selects all items listed in the Imported Problems/Home Medications/Allergies column.

•Select All Current: Selects all items listed in the Current Problems/Home Medications/Allergies column.

The number of selected items will be reflected in the "Selected Rows" counter in the upper right corner of the screen just above the Pending Action column.

NOTE: If there is pending Clinical Information Reconciliation data for Home Medications and Clinical Information Reconciliation has been postponed, users will still be able to begin a discharge Medication Reconciliation. The system will display the prompt, Clinical Information Reconciliation for Medication Reconciliation has not been performed yet. Would you like to perform Clinical Information Reconciliation? Selecting Yes will access the Clinical Information Reconciliation application for the user to complete before performing a discharge Medication Reconciliation. Selecting No will allow the user to bypass Clinical Information Reconciliation and continue into the Medication Reconciliation application to complete the discharge Medication Reconciliation.