Using Social Knowledge Networking (SKN) Technology To Enable Meaningful Use of EHR Technology

Medication errors are a major contributor to adverse patient outcomes and increased healthcare costs. Under the Federal “Meaningful Use” program, medication reconciliation is mandated. Medication reconciliation is the process of creating a complete list of a patient’s current medications by comparing the medications the patient is actually taking to the medication list in the electronic health record (EHR), reconciling the two lists, and updating the list in the EHR. This process significantly reduces the risk of medication errors during care transitions, improves patient safety, and reduces healthcare costs. Despite the Federal policy impetus toward medication reconciliation, hospital adherence has lagged due to low physician engagement stemming from lack of consensus about who is responsible for managing a patient’s medication list.

This pilot project implemented EHR MedRec and Social Knowledge Networking (SKN) systems at Augusta University Health System to help progress from limited use of a medication reconciliation to becoming compliant with Meaningful Use. “EHR MedRec” is a technology that allows providers to complete the medication reconciliation process in the EHR. SKN technology was used to enable communication between clinical staff during the medication reconciliation process. The project was implemented in two phases. In the development phase, an existing SKN system was enhanced to promote medication reconciliation, and then integrated into the EHR. The enhancement included: 1) tools to report issues related to EHR MedRec, 2) an online platform for moderated discussion of issues, 3) learning sessions, and 4) periodic email updates. Next, in the pilot phase, the feasibility of using the enhanced SKN system in EHR workflow was assessed in outpatient and inpatient settings.

The specific aims are of this project were as follows:

• To examine user engagement in the SKN system through SKN user surveys and SKN usage analytics. 
• To examine preliminary associations between SKN use and EHR Meaningful Use. 

Fifty SKN users, including physicians, nurses, and pharmacists, participated in discussions about their experience using the system. Interprofessional knowledge exchange progressed across the following stages: 1) identifying problems related to EHR MedRec, 2) problem solving, 3) learning the system, and 4) identifying best practices. These stages produced a culture of change that laid a foundation for improvement in medication reconciliation and meaningful use. Moderators were identified as critical for identifying best practices in the literature and promoting collective learning among providers. Furthermore, provider champions made important contributions to solving the EHR MedRec-related problems that were reported in the SKN and corroborating the best practices shared by the administrators. These findings suggest that healthcare managers must make a conscious effort to link practices to outcomes in order to increase physician engagement in medication reconciliation. The project team concluded that a SKN system may be valuable for enabling implementation of other complex innovations in healthcare.