Post on 11-Jan-2016
Spiro
Consulting
Overview of Technology Overview of Technology Approaches of Medication Approaches of Medication Management in Long-Management in Long-Term CareTerm Care
Rachelle “Shelly” Spiro, RPh, FASCPPresident, Spiro Consulting
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LTC Electronic Health Record (EHR) Standards
e-Prescribing and eMARLTC e-Prescribing standards and pilotsSummary
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OverviewOverview
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HHS-ASPE Study to Access HHS-ASPE Study to Access Business Case for LTC HITBusiness Case for LTC HITTypes of Health Information Technology (HIT)
applications and functionalities in Post Acute Care (PAC) and Long-Term Care (LTC)
Based on stakeholder description and technical expert panel (TEP) input
Exhibit A-1 summarizes the types of HIT applications, functionalities, and the applicable PAC/LTC setting in which the applications are used
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Source: U.S. Department of Health and Human Service (HHS) Assistant Secretary for Planning and Evaluation (ASPE) Office of Disability, Aging and Long-Term Care Policy EVALUATION DESIGN OF THE BUSINESS CASE OF HEALTH INFORMATION TECHNOLOGY IN LONG-TERM CARE http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf
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Source: U.S. Department of Health and Human Service Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy EVALUATION DESIGN OF THE BUSINESS CASE OF HEALTH INFORMATION TECHNOLOGY IN LONG-TERM CARE http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf
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E-prescribing◦CMS-AHRQ LTC e-prescribing pilot◦Modifications to NCPDP SCRIPT standard
HL7 Continuity of Care Document (CCD)◦Standard for the exchange of clinical documents◦Replaces MDS
HL7 EHR System (EHR-S) Functional Model◦The standard for the functions needed in an EHR-
S
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LTC EHR StandardsLTC EHR Standards
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CCHIT LTC RoadmapCCHIT LTC Roadmap
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CCHIT Roadmap for Expansion of Certification
Feb 2, 2007 Expansio
n Area
Jan-Jun2007
July-Dec2007
2008 2009 2010
Care Settings
Long Term Care
Furtherdiscussio
ns
BeginDevelopme
nt-------
Launch?
TBD
Launch
TBD
Proposed for August 2009
Source: http://www.ahima.org/infocenter/whitepapers/documents/Public_Comment_Expanding_CCHIT_Certification_Roadmap_20070202.pdf
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e-Prescribing◦Prescription order entry◦Bar code scanner for re-supply◦Web connections◦NCPDP Script◦HL7
Electronic Medication Administration Records (eMARs)◦Proprietary or HL7◦System at a minimum include the “Five Rights”
Right Resident Right Medication Right Dosage Right Route Right Time
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e-Prescribing and eMARse-Prescribing and eMARs
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Pharmacy versus facility drivenIntegrationHardware and softwareFurther standards of eMAR and inventory
management is neededREMOTE DISPENSING*
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eMAR StandardseMAR Standards
*Covered in next presentation
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Reduction in Adverse Drug EventsReduction in Adverse Drug Events
Theoretically an integrated eMAR and EHR would help reduce adverse drug events (ADE) and medication errors
July 2006 the Institute of Medicine’s report on “Preventing Medication Errors” concluded that of the 1.6 million nursing home population in the U.S., 800,000 preventable ADEs could occur each year
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Source: http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf
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Grantee/Contractor Project Titles Grantee/Contractor Project Titles for for e-Prescribing AHRQ Pilot Projecte-Prescribing AHRQ Pilot Project
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Organization Name
Project Name
Achieve Healthcare Information Technologies, LP
LTC E-prescribing Standards Pilot Site Study
Brigham and Women’s Hospital
Electronic Prescribing Using a Community Utility: The e-Prescribing Gateway
Ohio KePRO A Practice-Based Pilot Site Test of Emerging E-prescribing Standards
RAND Corporation Test of Medicare’s Initial Electronic Prescribing Standards in the New Jersey E-prescribing Action Coalition
SureScripts, LLC Maximizing the Effectiveness of E-prescribing Between Physicians and Community Pharmacies
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To study the effects of the electronic prescribing standards in long-term care on cost, quality and safety
Validate that the e-Prescribing and electronic Prior Authorization standards work in a LTC setting
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Purpose of LTC e-Prescribing PilotPurpose of LTC e-Prescribing Pilot
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Three way communication: prescriber, nurse, pharmacy
Resident is not a patient◦SCRIPT adjustments for unit/room/bed, resident, facility
information Medications are delivered
◦Communicate admission and discharge information to the pharmacy (new census message)
Medication “chart” orders are open-ended ◦Orders need to be cancelled or discontinued
Facility needs to know the medication was actually dispensed
Resupply requests represent 80% of LTC orders ◦Resupply message
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e-Prescribing in the LTC Settinge-Prescribing in the LTC Setting
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LTC industry is working on EHR-S standardsLTC setting e-Prescribing can be supported
with some technical modifications to the standards
Additional research should be done on electronic prior authorization (e-PA)
Further standards of eMAR and inventory management is needed
These efforts are ways the industry is improving medication safety in the LTC setting
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SummarySummary
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Consulting
Thank youThank you
Shelly Spiro
President, Spiro Consulting
1200 First Street, Suite 1632
Alexandria, VA 22314
703-599-5051
www.spiroconsulting.net
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