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CC BY 4.0 · Appl Clin Inform 2025; 16(04): 1136-1145
DOI: 10.1055/a-2599-4135
Research Article

Framework for Improving Patient Safety: Reference Model for FHIR-Enabled, Patient-Centric Home Medication List Management and Medication Reconciliation

Noah D. Bastola
1   Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
James E. Tcheng
2   Department of Medicine, Duke University, Durham, North Carolina, United States
,
David M. Schlossman
3   Department of Health Services Administration, University of Alabama at Birmingham, United States
,
John R. Windle
1   Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
› Author Affiliations
Funding This research was conducted through investigator-supported funding at University of Nebraska College of Medicine, Omaha, Nebraska, United States.
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Abstract

Background

The Health Level 7 (HL7) Electronic Health Record Workgroup identified home medication list reconciliation as a prime opportunity to improve patient safety and reduce clinician burden. We developed a platform-neutral, Fast Healthcare Interoperability Resources (FHIR)-enabled reference model and demonstration wireframe to articulate the concepts of an interoperable, patient-centric home medication list management ecosystem.

Methods

Four principal artifacts describe the reference model: (1) a conceptual (high-level) model, (2) a data architecture (detailed) model including representations of the interactions among actors, workflows, data, and functionality, (3) a functionality (style) guide describing expected system behaviors, and (4) a high-fidelity, end-to-end wireframe. The wireframe was constructed using JavaScript, Bootstrap Studio, and FHIR to maximize code modularity, device compatibility, and interoperability.

Results

The conceptual and architecture models capture the complex interplay of actors and data occurring among healthcare providers, information systems, and patients, positioning the patient at the center of home medication list management. The style guide reflects functionality requirements. The wireframe demonstrates the use of FHIR for data interoperability while representing patient and clinician interactions that reduce burden. The wireframe accesses standardized data elements via FHIR calls to an EHR sandbox and integrates RxNorm content to improve usability and associated medication metadata. Finally, the wireframe generates a FHIR patient-reconciled medication list data package and printable lists that can be shared with the clinician to facilitate outpatient medication reconciliation.

Conclusion

This proof-of-concept highlights the potential of FHIR to facilitate patient-facing medication list management and provides a reference framework for developers.

Keywords

medication reconciliation - health information interoperability - patient-generated health data - health information exchange - electronic health records

Protection of Human and Animal Subjects

Humans and/or animal subjects were not included in the project. Investigational Review Board review was not required for this project.


Note

This manuscript was presented, in part, at the May 2024 AMIA Clinical Informatics Conference.


Supplementary Material



Publication History

Received: 22 November 2024

Accepted: 29 April 2025

Article published online:
19 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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