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 reconciliation is on, every medication carries one of four review states. You’ll see them as badges in the encounter workspace and in the chart’s Medications tab, next to the group the row sits in (Needs review, Current, Past and so on). They are two different things. The group says whether the patient is taking the medication now. The review state says how well the care team has vouched for it.

Automatically close prescriptions that ran out

The same Features tab has a second medication switch, just below reconciliation: Automatically close prescriptions that ran out and were not renewed. It works whether or not reconciliation is on. A prescription whose supply and refills are used up leaves the current count and moves to Needs review on the day it runs out (see What counts as current). This switch decides what happens if nobody acts on it.

1. It is on by default. Every practice starts with the pill reading Enabled and a 30-day grace period. Once a prescription has been out for that many days without a renewal, Hero closes it with the reason “Course ended, not renewed” and it moves to Past. Hero checks once an hour, and the days are counted on your practice’s calendar. It closes only prescriptions Hero sent and can time with confidence. It never touches an as-needed prescription, one with a later fill scheduled or an open refill request, one that is on hold or waiting on another review, or one a clinician recently confirmed with Still taking.
2. Change the grace period, or turn it off. Enter Grace period (days), a whole number from 7 to 180. To keep every ran-out prescription in Needs review instead, click the pill so it reads Disabled. Ran-out prescriptions then wait there until someone clicks Renew, Still taking or Stopped.
3. Save. Save keeps the switch and the grace period together with your other feature settings. It stays disabled while the grace period is outside 7–180 (“Enter a whole number of days from 7 to 180.”).

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. The list shows each medication’s full name with its release type, and it includes medications waiting in your Needs review group, marked Refill needed (the prescription ran out) or Your care team is reviewing. If the list changes while the patient is answering, the portal asks them to look again: “Your medication list was just updated. Please review the refreshed list and try again.”

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 wraps the reconciliation workspace around the same medication list every other surface shows (see the encounter’s Medications section and the chart’s Medications tab). There is no separate reconciliation list. From top to bottom, the section shows:

• an amber banner while anything still needs a first review, for example “2 medications to reconcile — review the list, then finalize below.”;
• Pending review, holding proposals from patients and staff;
• the list itself, with Add medication in its toolbar, then Prescribing today, Needs review, Current, Scheduled, On hold and Past, with a review badge on every row;
• the finalize bar (see Finalize & sign).

The same count appears on the collapsed section header (“2 to reconcile”) and on the footer’s Meds chip (“(2 to reconcile)”), 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 list. Needs review rows carry the buttons that fit their reason: Renew, Still taking, Stopped, Specify, Merge or Mark reviewed (see the Medications tab). Other rows carry Stop, which opens Discontinue medication and applies straight away, with the offer to cancel the prescription at the pharmacy when one is still live there. The ··· button (or a right-click) holds Quick edit… for dose or directions, Mark not taking…, Discontinue…, Mark reviewed and View history. Add medication in the toolbar adds something the patient reports. Clinician actions here are immediate, with no proposal step for you. Edits, stops, not-taking reports and additions mark that medication Reviewed.
4. Use Mark 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. The row moves to Needs review with the line Patient reports not taking and the date, and it leaves the current count. The prescription itself is not stopped. Decide that separately with Stopped, or use Still taking if the patient has restarted.
5. Treat AI stop suggestions as suggestions. When Hero reads a stop in your note, the row shows a Suggested stop chip and a Suggested stop: line with the reason, plus Discontinue and Dismiss. Nothing stops unless you click Discontinue. This is the one place suggestions differ from an organization without reconciliation, where they arrive queued to stop at sign (see the encounter’s Medications section).

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 exactly what the list shows above Past as Reviewed: every medication in Needs review, Current, Scheduled and On hold. It also 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 only when nothing has changed. Reviewed — no changes sits next to Finalize reconciliation when no proposals are outstanding, the list hasn’t been finalized in this visit, and you haven’t changed anything during this review. It’s the honest one-click answer for the common case: you went through the list with the patient and it was already right. Any change you make here takes it away. That includes Still taking, Specify, Merge, Mark reviewed, an edit, a stop, a not-taking report and an added medication. Then use Finalize reconciliation.
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. Finalize checks that the list is still exactly what you are looking at. It may have changed since the page loaded: a prescription was sent or ran out, a fill posted, a colleague acted, or the patient sent a new proposal. Then Hero declines with “The medication list just changed” and asks you to “Review the refreshed list, then finalize again.” The list refreshes on its own. Look it over, then finalize again rather than retrying 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. With it on, the chart’s Medications tab adds a reconciliation header and review badges on every row. Staff also get the Propose… versions of the row menu, so a nurse taking a phone call or a physician reviewing a chart between visits can keep the list honest without opening a note. Prescribers have the row menu in every organization, with or without reconciliation (see the Medications tab).

1. Read the header first. A Last reconciled … by … strip sits above the medication list. On a list nobody has reconciled yet it reads “This medication list has never been reconciled.”, which is a fine thing to fix at the next visit. When proposals are waiting, a blue N changes pending review chip sits beside it.
2. Scan the badges. Each row carries its review state (Reviewed, Not reconciled, Unverified, Change pending) next to its other chips, in whatever group it sits. A medication the patient reports not taking sits in Needs review with the line Patient reports not taking. Rows in Past keep their review badge too.
3. Act from the row. Right-click a medication in the list — 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.