Medication reconciliation

Switch on medication reconciliation

Medication reconciliation is an organization-level switch that changes one rule: every permanent change to a patient’s medication list needs a clinician’s sign-off. With it off, Hero EMR behaves exactly as it always has — patients and staff edit the list directly, and nothing is marked for review. With it on, those same edits become proposals, the encounter’s Medications section becomes a reconciliation workspace, and every row in the chart carries a review state you can read at a glance.

1. Open the setting. Go to Admin > Patient Portal Configuration and stay on the Features tab. Scroll to the Medication reconciliation group, below the history features.
2. Flip Enable medication reconciliation. It ships off. The pill on the right reads Disabled or Enabled; the blurb underneath spells out what changes — “Patient and staff edits become proposals for clinician review, the encounter Medications section becomes a full reconciliation workspace, and visit types can require a pre-visit medication check in the portal.”
3. Read the IMPACTED SURFACES line before you save. It lists everywhere the switch reaches: the encounter completion Medications section, the chart review Medications tab, the portal Medications tab, and pre-visit tasks for visit types that require a medication check.
4. Save, and expect a short lag for signed-in patients. The dialog footer says it plainly: existing patient sessions pick up saved features on their next reload or organization switch. Your own EMR surfaces change immediately.

Once it’s on, every medication carries one of four review states. You’ll see these as badges in the encounter workspace and in the chart’s Medications tab, alongside the usual Active / Discontinued status pill — they are two different things: status is what the prescription is doing, review state is how well the care team has vouched for it.

Ask the patient to review their list before the visit

The most useful reconciliation happens before the patient sits down. Any visit type can require a pre-visit medication check: the portal adds a required task to the patient’s checklist, they either confirm the list or report what’s changed, and you arrive at the encounter with their answer already waiting.

1. Turn it on per visit type. Open Schedule > Scheduling Settings > Visit Config, expand the visit type, and check Require pre-visit medication check (patient portal) in the Options column. It sits with the other pre-visit options and only does anything while the organization switch from 20.1 is on.
2. Choose the visit types that deserve it. Annual physicals, new-patient consultations, and med-management follow-ups earn it; a quick nurse visit or a procedure-only slot usually doesn’t. Every required task is one more thing between the patient and their appointment — see Visit types for the rest of that panel.
3. Let the portal do the asking. Before a qualifying visit, the patient’s portal home shows “You have 1 task before your next visit”, and Review your medications appears under ACTION ITEMS flagged REQUIRED with a Review button. It also counts toward the PRE-VISIT CHECKLIST progress bar next to it, so a patient clearing their checklist clears this too.
4. The patient answers one question. The Review your medications modal asks “Are these all the medications you currently take, exactly as written?” over their current list, with two ways out: Yes, this list is correct or Something’s changed.

Proposals: what patients and staff can and can’t change

With reconciliation on, patients and non-prescribing staff can still say everything they could before — they just can’t enact it. Editing a medication’s details, stopping one, or reporting that it isn’t being taken all create a proposal. The live list does not move until a clinician approves it.

1. Report a change from the portal. Something’s changed puts the modal in change mode: every row grows an Update and an I stopped this button, and a dashed + Add a medication you take sits at the bottom. A row the patient touches highlights amber and reads back what they said — e.g. “You reported you stopped this: Stopped after finishing the course” — with an Undo. Nothing is sent until Send updates for review.
2. Read the safety copy the patient reads. The modal footer is explicit: “This is a report to your care team — it does not change your prescriptions. A clinician reviews every change you report. If you are thinking about stopping a medication, please contact the clinic before you stop.” That sentence is doing real work — it’s why a portal-side stop is safe to offer at all.
3. Watch the chip afterwards. Back in the portal’s Profile > Medications tab, the affected medication carries a blue Stop request pending review chip and the line “A medication change is waiting for your care team to review before a refill can be requested.” Request refill is disabled for that medication until the proposal is decided.
4. Know what staff see. Non-prescribing staff get the same actions from the chart with Propose… wording instead of the direct verbs. Their edits queue for review exactly like a patient’s.

Reconcile during the encounter

With reconciliation on, the encounter’s Medications section stops being a discontinue checklist and becomes the reconciliation workspace. It stacks in one column: anything pending review at the top, then New Medications From This Encounter (read-only), then Current Medications — the list you are actually vouching for. When anything on the list still needs a first review, an amber banner at the top counts it — “1 medication to reconcile — review the list, then finalize below.” — and the same count rides the collapsed section header (“1 to reconcile”) and the footer’s Meds chip, so an unreconciled list is visible before the section is even opened.

1. Clear Pending review first. The header carries a count. Each proposal card shows the medication and strength, a chip naming the request (Stop requested, for instance), who proposed it and when — “Emily Rodriguez (patient) · Aug 8, 4:08 AM” — and their reason in quotes. Approve applies the change to the live list; Reject asks for a short reason and leaves the list untouched. Both are recorded against your name.
2. Heed a stale-proposal warning. If the medication changed after the proposal was made, you’ll be warned before the approval goes through. Read the current row before you confirm — approving a stale proposal means acting on a picture that has since moved.
3. Work the current list. Every row shows name, strength, its badge, and the sig, with three actions: Edit for dose or sig corrections, Not taking to record non-adherence, and Stop to discontinue. Add medication at the top of the section adds something the patient reports. Clinician actions here are immediate — there is no proposal step for you — and each one marks that medication Reviewed.
4. Use Not taking for adherence, not for stopping. The dialog is headed Patient is not taking this medication with the medication and strength beneath it, an optional Details box, and a Record button. It stamps the row Patient reports not taking and leaves the prescription alone — whether it should also be discontinued is a separate decision, made with Stop.
5. Treat AI stop suggestions as suggestions. Medications Hero EMR proposes stopping from your note surface here as suggestions, exactly as they do in med management. Nothing stops unless you act on it.

Finalize the reconciliation, then sign

Working the individual rows isn’t the same as declaring the list correct. Finalize reconciliation is the attestation: it stamps every medication currently displayed as Reviewed and records who finalized it, when, and against which encounter.

1. Decide every pending proposal first. Finalizing is blocked while anything sits in Pending review. Approve or reject each one — there is no “finalize around” an undecided proposal.
2. Use the fast path when nothing has changed. With no proposals outstanding, Reviewed — no changes sits next to Finalize reconciliation. It’s the honest one-click answer for the common case: you went through the list with the patient and it was already right.
3. Read the footer for the current state. Before a first pass it reads “This list has never been reconciled.” Afterwards it turns green — “Reconciled by Sarah Johnson · Aug 8, 4:15 AM” — and the button retires: a finalized, unchanged list has nothing left to confirm. If the list moves again during the visit — a new medication, an edit, a fresh proposal — Finalize reconciliation returns for another pass. A toast confirms “Medication reconciliation finalized”.
4. Re-review if the list moved under you. If the list changed while you were reviewing — a refill posted, a colleague acted, the patient sent a new proposal — the server declines the finalize and asks you to re-review. Refresh what you’re looking at and finalize again; don’t retry blindly.
5. Sign the note. If proposals are still pending, or a required reconciliation is unfinalized, Sign & Close Visit raises Medication changes awaiting review — “1 proposed medication change has not been reviewed. You can sign now and review them later, or handle them in the Medications section first.” It is non-blocking: Review medications jumps you to the section, Sign anyway signs.

Keep the list current from the chart — and see who did what

Reconciliation doesn’t only live inside an encounter. The chart’s Medications tab gains a reconciliation header, review badges on every row, and a right-click menu that puts the same actions one gesture away — so a nurse taking a phone call or a physician reviewing a chart between visits can keep the list honest without opening a note.

1. Read the header first. A Last reconciled … by … strip sits above Active Medications. If it’s missing, this list has never been reconciled — a fine thing to fix at the next visit.
2. Scan the badges. Each row shows its status pill (Active, Discontinued) plus its review state (Reviewed, Not reconciled, Unverified, Change pending), and an amber Patient reports not taking chip where adherence has been recorded. Discontinued rows keep their review badge in Medication History too.
3. Act from the row. Right-click a medication in either table — or its bar in the Medication Timeline chart, or the ··· button on the row — for Quick edit…, Mark not taking…, Discontinue… (which asks for a reason), Mark reviewed, and View history. The menu header repeats the medication and sig so you know what you’re acting on, and its footer shows the attribution, e.g. “Reviewed by Sarah Johnson”.
4. Expect Propose… if you’re not a prescriber. Non-prescribing staff see the same menu with proposal wording. The action still gets recorded — it just queues for a clinician instead of applying.
5. Open View history for the audit trail. The History dialog lists every event on that medication as a timeline — creation, edits, reconciliations, proposals, and the approve/reject decisions — each with a description and a timestamp. Who proposed, who reviewed, and who finalized are all in here.