Transcript Slide 1

Pharmacy Benefits Management
Clinical Informatics and Pharmacy Re-engineering
Strategic Initiatives
Lynn C. Sanders, Pharm D.
Associate Chief Consultant
PBM Clinical Informatics/Pharmacy Re-engineering
Who Are We?
Lynn Sanders – PBM Associate Chief Consultant for Clinical
Informatics/Pharmacy Re-engineering
– Adelaide Quansah
• LuAnne Barron – Program Manager – Pharmacy Re-engineering
– Amy Colon – Clinical Analyst
– Mike Martinko – Clinical Analyst
– Al Havens – Clinical Analyst
• Robert Silverman – Program Manager – Clinical Informatics and Education
and Training
– Program Specialist – Education and Training (Vacant)
– Pharmacy Informatics Field Advisory Task Force
– Tom Fagan – Education and Training
• Don Lees – Program Manager – Pharmacy Enterprise Product System and
National Drug File Management
– Deborah Coulter – Program Specialist
– Todd Schippers – Program Specialist
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Top Priorities
• Re-engineering and Enhancement of Pharmacy
Information System to improve patient safety,
efficiency, and care to Veterans
• Provide communications and support to VAMC
pharmacies with informatics and analytics
information, problem resolution, and education
and training.
• Represent PBM as the business owner in
relationships within VA (VA IT and VHA Health
Information Offices) and nationally.
• iEHR Pharmacy Solution
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PBM Clinical Informatics
Relationship with the Field
ASHP Definition of Pharmacy Informatics
• A pharmacy informaticist is a dedicated specialist
involved in the computerization and automation of
the medication use process.
• Pharmacy Informatics is the use of integration of
data, information, knowledge, technology, and
automation in the medication use process for the
purpose of improving health outcomes.
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What’s a Pharmacy Informaticist/ADPAC
Directive
Requirements for minimum local IT system access
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VistA menus
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FileMan files required by the Pharmacy Informaticist and
VistA access required of any service ADPAC but not specific
to pharmacy.
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Any VistA Security Keys that are required to access VistA
options required by this directive.
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VA Pharmacy Informaticist
• Responsibilities
– Implementation/ monitoring/reporting of/for VistA and
VistA interfaced systems
– Maintenance and support of pharmacy automated
dispensing and storage systems
– Subject Matter and Knowledge Experts for Pharmacy
Information Systems
– Testing VistA Software for Pharmacy (patches)
– Communicating with local IT staff
– Communicating with PBM Clinical Informatics/PRE staff
– Reporting system defects (remedy) and patient safety
concerns to VA IT.
– Participating in training and education
The Pharmaceutical Care Team
3/22/2011
Management
Informaticist
Best Care
Any Where
Clinicians
Practice
Operations
PBM Pharmacy Informatics Advisory Task Force
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Automation Technology
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Systems and Parameters
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Technician Training Modules
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Frequently Asked Questions
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Education and Training
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Inventory Management
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Technician Forum
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Pharmacist Training Modules
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Prime Vendor Group
Marian Daum (Coatesville),
Jennifer Howard (San Diego)
Esther Song (Palo Alto), Anders
Westanmo (Minneapolis), Cynthia
Mansfield (Detroit)
Amy Bieryla (Coatesville), LeeAnn
Gadbaw (Fayetteville NC)
Naeem Mian (VISN 3), Janet Graham
(Louisville)
Shawn Toy (Tucson), Thomas Fagan
(Richmond), Silverman, Robert (PBM)
Don Lees (PBM Hines), Georgia
Stefanidis (Brooklyn VAMC)
Richard Wilson (Coatesville), Christina
Andrade (Cheyenne)
Daphen Shum (Perry Point), Phillip
Coggins (Richmond)
Kathy Walker (Coatesville), Dionne
Roney (Charleston)
Pharmacy Software Development Workgroups
• These are established when a development project is
initiated. Participants are volunteers from VAMC
Pharmacies. Included below are some of our
workgroups
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Inpatient Medications
Pharmacy Legacy Enhancements
Bar Code Medications
Pharmacy Re-engineering (multiple)
Women’s Health Initiative –Teratogenic Drugs
DEA Electronic Prescribing of Controlled Substance
PBM CLINICAL INFORMATICS
RELATIONSHIP WITH OTHER
INFORMATION TECHNOLOGY
PROGRAM OFFICES
VHA Internal Realignment (2011)
Office of Health Informatics/Office of Informatics and
Analytics
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VHA Under Secretary for Health (USH) identified alignment of the organization
around a vision of excellence and reduction of unwarranted variation as priorities
The “Managing Data Workgroup”, one of 6 workgroups guiding the VHA
realignment, identified the need to:
– Create synergies in health informatics, with the Veteran and the clinician in
mind
– Create authoritative, accessible, and coordinated approaches to data
management, performance measurement, data analysis, and reporting for
clinicians and managers
– Improve data quality, information governance, and informatics patient safety
The new Office of Informatics and Analytics (OIA) combined assets that had been
dispersed across the organization.
The Office of Health Information (OHI) continued its role in defining and
monitoring the health business requirements for VHA’s health delivery system.
The new organizational structure was approved in March, 2011.
Pharmacy Benefits Management
Clinical Informatics/Pharmacy Re-engineering Program Office
Business Owner Relationship and Communication Model
January 2011
VISN
Pharmacy
Executives
PCS/PBM
CLINICAL
INFORMATICS/
Pharmacy
Re-engineering
Program
VAMC Pharmacy
Chiefs/
Pharmacy
Informaticists/
ADPACs
Health
Informatics
Organizations/
Program Offices
Internal and
External to VA
Facility CHIOs
VAMC Medical
Center
Director/COS/AD
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Incorrect Outpatient Prescription Last Fill Date after Date of Death marked
“Entered in Error”
Distribution Date: August 16, 2011
Notice Number PBM-2011-03
SUBJECT:
Incorrect Outpatient Prescription Last Fill Date after Date of Death marked
“Entered in Error”
APPLICATIONS AFFECTED:
Outpatient Pharmacy v7.0
ATTENTION:
Pharmacy Chiefs
Pharmacy ADPACS
Pharmacy Outpatient Supervisors
Please share this Notice with Outpatient Pharmacy staff at your facility.
Pharmacy Reengineering Update
The Pharmacy Reengineering (PRE) Project
• The Pharmacy Reengineering project seeks to replace
all VistA Pharmacy applications with a system that
provides interoperable, safe, and efficient pharmacy
information technology to support VA’s strategic plans
for transformation in the 21st Century.
• PRE will replace current pharmacy software through
the use of new technology, reengineering, and
integration of commercial products. These are
required to meet current and future workload,
technology, and patient safety requirements for VA and
Indian Health Services. The potential benefits offered
by this program contain eight primary functions,
deployed in a phased approach for planned completion
by 2014.
Pharmacy Reengineered System
Order Check Data Flow
Pharmacy Reengineering Project
Plan FY 11/12/13
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Increment 1 – PRE Foundational Enhancement –
Complete
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Increment 2 – Pharmacy Enterprise Customization System
(PECS) – National Only
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Increment 3 – Medication Order Check Healthcare Application
(MOCHA v1.0 - Non-Dosing)
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Increment 4 – Medication Order Check Healthcare Application
(MOCHA v2.0 - Dosing)
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Increment 5 – Pharmacy Enterprise Customization System
Enhancements - National
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Increment 6 – Enhanced Order Checks – Issue Resolution
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Increment 7 – Data Migration of the NDF Management System
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Increment 8 – Pharmacy Product System National
What is MOCHA?
Medication Order Check Healthcare Application
• MOCHA is the first increment of Pharmacy
Reengineering to be released to VAMCs and
will provide enhanced non-dosing MOCHA 1
and dosing MOCHA 2 order checks utilizing
data from the commercial database First
DataBank, and customization using PECS, the
VA Pharmacy Enterprise Customization
System.
MOCHA 2
Drug Dosing Order Checks
 MOCHA v2.0 Incremental Delivery
 Increment A - Maximum Single Dose Check Warning
 Increment B - Daily Dose Range Check Warning
 Increment C - Daily Dose Range Check Complex
 Increment D - TBD
What Does PRE Bring to VA Medical
Centers
• Maintenance, Support, and Standardization
– Moving from local software systems to enterprise software
systems benefits VAMCs by providing improved
maintenance, support, and standardization of pharmacy
informatics software.
– Maintenance and updating is provided by First Databank,
PBM, and VA IT.
• Customization:
– PRE uses a COTS product for its clinical decision support
data, and the Pharmacy Enterprise Customization System
(PECS) allows VA to modify order check codes (significant,
and critical) and will allow for non-COTS data under PRE.
Safety:
• It is proven that the functionality of the PRE project directly
and immediately impacts the care of Veterans. An increase in
clinical support tools, along with improvements to the content
of drug file data at the enterprise and VA Medical Center
levels will significantly prevent the negative and costly impact
of patient harm from ADE’s. As a result of the beta test
implementation of MOCHA v1.0 and v2.0, at a typical VA
Medical Center in 2010, the yearly rate of reported ADE’s preand post-installation were reduced by 56%.
MOCHA Impact on Workflow
• Workflow:
• Reports from five facilities using PRE MOCHA v1.0
indicate that targeted order check pop-up alerts have
decreased by 32%, improving the quality of clinical
decision support information while reducing
potential provider and pharmacist pop-up alert
desensitization.
NDF Update
• Clinical Effect of Drug: Set product specific time
limits on order checks against expired or recently
discontinued medication orders
• Exclude products from order checks when there
is no match to FDB.
• Auto-Create Default Possible Dosages
– Stops the auto-creation of a possible dosage.
– More specific, the ability to modify default for an
individual product
PECS Enhancements
• Version 2.0- Fixes database issues but will not
be released (May 2011)
• Version 2.1– Upgrades GUI interface
– Creation of easy order check GUI
– December 2011 (TBD)
Pharmacy Product System National
(PPSN)
• New name for PEPS National
• PPS-National will partially replace NDF Management
(NDFMS) system
• PPS-Local will not be addressed in this upgrade
• Data elements from local will be maintained in the
system, but will not be used.
• PPSN will update NDFMS. Patch will be released to
sites as before.
• PPSN will incorporate FDB data and FSS data.
• User Acceptance testing December of 2011
• Release October 2012 (TBD)
How Do We Get Things Done –
The Current Information Technology
Approach
It starts with your question, your
concern, your problem, or your idea.
2011 Software Enhancements
• Did you know that Pharmacy Benefits
Management Clinical Informatics Program
Office and the associated Medical Center
Pharmacy Informatics specialists worked with
the Office of Information and Technology to
deliver 86 VistA Patches, and 36 National Drug
File Update Patches? Many of these were a
result of New Service Requests or problems
reported by VA medical center staff through
Remedy.
Pharmacy Legacy Enhancements (PLE)
• Pharmacy Legacy Enhancements – the
program in charge of software development
to modify VistA software.
• PLE is subject to the same PMAS rules as other
projects, so everything is delivered in
‘Increments’.
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Pharmacy Legacy Enhancements
• Non-Verified/Pending Orders
– Categorize STAT and ASAP orders to bring them to the top of
the list.
• OPAI Functionality Enhancement
– Allow sites with multiple vendors Automated Dispensing
Devices to set up rules by which VistA will know what
product is in which machine, and route the prescription to
that machine.
• Med Routes Selection Enhancement
Functionality to resolve a patient safety risk of an order being
placed with a med route that is appropriate for the dosage
form (such as INJ, SOLN) but not for the specific medication
route (as in a medication that should never be given via the
EPIDURAL route).
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FDA Med Guide
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Increment #1 Provided updates to the National Drug File Management System which allow data entry of the URL for each available Medication Guide. Delivered as planned. National Release 5/6/10.
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Increment #2 Provide Enhancements to NDF to provide the ability to display Medication Guide On-Demand. Provide enhancements to Outpatient Pharmacy to display Medication Guide On-Demand. Created a Centralized
repository within CMOP to store the FDA Medication Guides. Loaded the FDA Medication Guides to the CMOP central repository to support the display on-demand features within NDF and Outpatient Pharmacy. National
Release 4/20/11
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Increment #3 Enhancements will support Automatic Printing of the FDA Medication Guides when a prescription is being filled. This increment had hardware requirements, therefore the project team requested the technical
analysis review (TAR) to assist in addressing proper hardware requirements to ensure performance requirements were met with minimal impact to network traffic. National Release TBD
Electronic Prescriptions for Controlled
Substances - DEA EPCS
The project by which we will electronically prescribe C-II
through C-V medications through CPRS and meet DEA rules
issued 6/1/2010
• Project status
– Requirements Elaboration Document (RED) are complete
– VA has requested a waiver of the Interim Final Rule
– Blog: Rob Silverman is posting project updates and Q&A
on a new blog at:
http://vaww.infoshare.va.gov/sites/vapharmacyinformatics/
BLOG/DEA_EPCS/default.aspx
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Women’s Health Initiative -Teratogenic Drugs
 Documenting and displaying pregnancy/lactation status
information
 Identifying teratogenicity of medications as well as lactation
medications that are harmful to breast fed infants
 Provide additional information for medications during the
order entry process
 Provide order checks, reminders, and alerts
 Provide order check information to Pharmacy/Radiology
packages to include pregnancy/lactation status information
 Provide reporting functionality for all prescribed
teratogenic/lactation orderable items
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Software Testing: Pharmacy and Information Technology
Partnership (Sample)
Test Site
POC & Title
System
Size
Production
Date Install
Release Sign
Off Date
Oklahoma VA
Medical Center
Oklahoma City,
Oklahoma
Pharmacy,
ADPAC
IT -
Large
02/22/2011
03/09/2011
VA New Jersey
Healthcare
System
East Orange, New
Jersey
Director
Pharmacy
Informatics
Large /
Integrated
02/24/2011
03/11/2011
VA Puget Sound
Healthcare
System
Tacoma,
Washington
Pharmacist
Large /
Integrated
03/02/2011
03/11/2011
Large
02/18/2011
03/11/2011
Durham VA
Medical Center
Durham, North
Carolina
IT –
IT –
Pharmacy
ADPAC
IT –
Pharmacy Informatics Education
and Training Initiatives
• Significant turnover in pharmacy informaticist
positions
• Current and future releases of major program
enhancements, e.g., MOCHA
• Health Informatics Initiative (hi2) addressing
the collective competency of the informatics
workforce
Pharmacy Informatics Education
and Training Initiatives
• Current training modalities
– Real-time LiveMeetings
– Recorded content on
SharePoint sites
– PowerPoint presentations
– Annual conferences (Hi,
everybody!)
– Frequently Asked
Questions / Knowledge
Experts
• Proposed additional
opportunities
– Interactive webinars
– Face-to-face training
independent of
conferences
• Stay tuned for the
workgroup report…
iEHR Pharmacy Scope
• Provide the ability for a joint DoD/VA pharmacy system to enable
pharmaceutical services (e.g., process medication orders and
prescriptions) without any degradation to existing functionality.
• Align joint business processes and requirements for:
o Inpatient Pharmacy (order fulfillment only)
o Outpatient Pharmacy (order fulfillment only)
o Inventory Management
• All orders received by the joint DoD/VA pharmacy system will be
available enterprise wide for medication therapy management.
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iEHR Pharmacy Request for
Information
• RFI posted on November 30, 2011
• RFI responses due on January 2, 2011
• Received nine responses
iEHR Next Steps
• Review RFI Responses
• Request for Proposal
Questions