Drug File Management for Drug File Management for Multidivisional Sites using EHRMultidivisional Sites using EHR

Brian K. Johnston DPhLieutenant, USPHS

Clinical Application CoordinatorChoctaw Nation Health Care Center

Talihina, Oklahoma

Objectives:

Multiple Divisional Drug File vs. One Division Drug File

Formulary Management and Drug File Maintenance

Communication System for Formulary and EHR Changes

Choctaw Nation Health System

145,000 ft² 37 Bed Hospital located in Talihina, OK

6 Satellite Health Clinics Mail Order/Refill Center (opening spring ’07) ~100 Physicians and Mid-Levels Multidivisional Database ran from Talihina’s

Servers (EHR distributed by Citrix)

Multidivisional Drug File

Pros:– Each Pharmacy maintains their own Drug File

(pro & con)– Custom Formularies based on Provider’s

preferences– Open Access for Pharmacist’s Product

Substitutions

Multidivisional Drug File (cont.)

Cons:– Physician Order Entry & EHR– Lots of Rx Editing– Renewing Orders in EHR– Outpatient Medications & Change “link” in

EHR– Maintenance/Design of EHR & Drug File

One Divisional Drug File (Filtered)

Pros:– Standardization of Products– Limited Access to Drug File– Ease of Menu/Quick Order Creation in EHR– Solves Renewal Problem with Multidivisional

Sites

One Divisional Drug File (cont.)

Cons:– Intense Formulary Management– May require an Acquisitioning Technician– Time require to convert all refills to single drug

file– 10-15% of Products Revolve– Rx Editing Required

Formulary Management

Managing Multiple NDC’s– Pharmacy Director determines Generic

substitutions– STOP McKesson’s product substitution– Small price changes DO NOT validate product

switching– Drug File may contain Duplicates, Not EHR

Drug File Maintenance

3 Pharmacists control Drug File

(Staff Pharmacist, Inpatient Director and CAC)

All P&T changes available 1st of following month

Constant design required

Formulary Communication System

P&T determines approved Product & Dosage Forms

Pharmacy Director in coordination with Providers sets the standard strengths available

Acquisitioning Tech sends approved products information to Drug File Guardians

Acquisitioning Tech distributes list of specific items to all facilities

Formulary Communication System (cont.)

Drug File Guardian creates products in RPMS & EHR

New Products available 1st of following month after P&T meeting

All “tweaks” for products are emailed to Drug File Guardians

EHR Design/Development

Standardized View for Providers in EHR “Global” Picture of Patient’s Records Copying of Main Menus in EHR Updating a sub-menu places items in all

divisions P&T Restrictions/Messages instantly seen

by all facilities Citrix Portal Access

???Questions???

bkjohnston@cnhsa.com