Medical Administration Record

OpenEMR Development Inpatient Development
8

Medical Administration Record

Exploratory Roadmap

What is a Medical Administration Record?

A Medical Administration Record (aka “MAR”) provides a record for all medications for a patient at a given encounter (think a hospital visit). It is often considered the official medication documentation for a patient, and nurses use it as the “gold standard” when deciding if a patient is able to receive a medication. Medications include scheduled, as needed (PRN), discontinued, as well as one-off prescriptions.

Basic Data Points of a MAR

  • Patient ID (Name, DOB)
  • Medication name
  • Dosage
  • Route
  • Date and time
  • Site of administration
  • 2nd provider witness
  • 2nd provider signature
  • Adverse reaction
  • Pre-administration assessment
  • Follow up assessment

Integration Points

  • Administration section to enable/disable MAR and set simple settings as well as possibly complex rules
    • This includes a dedicated section to manage a virtual pharmacy (i.e. valid medications that can be ordered)
  • Encounter hook to provide link
  • Dedicated table-based view of medications
  • New form to add a medication to the MAR
  • New form to witness/sign/administer medication
  • Potential alert hooks that trigger overdue medications
  • Basic interaction checker (Alert for Allergies)

Potential Development Routes

  1. Create OpenEMR\MAR namespace
  2. Investigate routes to administration
  3. Evaluate usage of event-driven functions
  4. Sketch out full data entity
    • This is likely going to be split into OpenEMR\MAR and OpenEMR\Medication where a MAR object represents a collection of Medications (decoupling the MAR from medications)

Personal Opinion

I think the iniital steps of any project like this is to layout the entities involved. Before we can begin thinking about UI or event triggers or databases we must know what data we are actually engaging with. I suggest we do this by collarborating on a document mapping out what the objects are in plain-text before trying to abstract them into any type of codable language interfaces. I have experience on the front-end of inpatient MARs – I use them in my clinical work and have a strong understanding of what a nurse would see/use on an everyday basis (at least for in patient). Nurses (at least in the US) provide the BULK of care involving the actual administration of medications.