Overview of Technology Approaches of Medication Management in LongTerm Care

1
Overview of Technology Approaches of Medication
Management in Long-Term Care

• Rachelle Shelly Spiro, RPh, FASCP
• President, Spiro Consulting

2
Overview

• LTC Electronic Health Record (EHR) Standards
• e-Prescribing and eMAR
• LTC e-Prescribing standards and pilots
• Summary

3
HHS-ASPE Study to Access Business Case for LTC HIT

• Types 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

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/d
altcp/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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LTC EHR Standards

• 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

6
CCHIT LTC Roadmap
Source http//www.ahima.org/infocenter/whitepaper
s/documents/Public_Comment_Expanding_CCHIT_Certifi
cation_Roadmap_20070202.pdf
Proposed for August 2009
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e-Prescribing and eMARs

• 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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eMAR Standards

• Pharmacy versus facility driven
• Integration
• Hardware and software
• Further standards of eMAR and inventory
  management is needed
• REMOTE DISPENSING

Covered in next presentation
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Reduction 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 Medicines 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

Source http//www.iom.edu/Object.File/Master/35/9
43/medication20errors20new.pdf
10
Grantee/Contractor Project Titles for
e-Prescribing AHRQ Pilot Project
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Purpose of LTC e-Prescribing Pilot

• 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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e-Prescribing in the LTC Setting

• 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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Summary

• LTC industry is working on EHR-S standards
• LTC 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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Thank you

• Shelly Spiro
• President, Spiro Consulting
• 1200 First Street, Suite 1632
• Alexandria, VA 22314
• 703-599-5051
• www.spiroconsulting.net