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117 Pharmacy ReEngineering PRE Update

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Title: 117 Pharmacy ReEngineering PRE Update


1
117 Pharmacy Re-Engineering (PRE) Update
  • Eric Williamson (Project Manager)
  • Lina Bertuzis (Lead Functional Analyst)

2
Project Update
  • Eric Williamson

3
Project Update - Releases
  • PRE V.0.5 pre-release
  • Pharmacy Data Management patch allowing
    preparation time for overall v.0.5 implementation
  • PRE V.0.5
  • Enhanced order checks using COTS drug database

4
Project Update - Schedule
  • Pre-release (completion dates)
  • Stage III/Site testing (mid August 2008)
  • National release (early September 2008)
  • V.0.5 on track (completion dates)
  • Coding (September 2008)
  • Stage I testing (January 2009)
  • Stage II testing (late March 2009)
  • Stage III/Site testing (late May 2009)
  • Complete to EPS (mid June 2009)
  • National release (July 2009)

5
Project Update - Testing
  • Testing Process (4 Stages)
  • Stage I Internal (Team) Testing
  • Stage II Testing Services
  • Stage III Production Site Testing
  • Stage IV Final Review and Approval

6
Project Update - Issues
  • Major Issues and Risks
  • Equipment Acquisition and Deployment
  • Testing Preparation and Execution
  • Technical and Business Process Documentation

7
PRE V.0.5 Pre-Release
  • Lina Bertuzis

8
Background Information
  • Preparation Work Needed for PRE V. 0.5
  • To implement Enhanced Order Checking
  • Improve existing order checks
  • Drug-Drug Interactions
  • Duplicate Therapy (Class)
  • Add Dosing Checks
  • Interfacing with First DataBank (FDB) database
    and APIs
  • Mapping required between VistA and FDB
  • File review and setup activities

9
Why A Pre-Release
  • Mapping Activities (VistA to FDB)
  • Drug Connection
  • GCNSEQNo in VA Product File
  • Local Medication Routes
  • Dose Units
  • File Review and Setup
  • Local Possible Dosages
  • Administration Schedule and Medication
    Instruction frequency
  • Identify PreMix Solutions

10
Pre-Release Patch Installation
  • New Files
  • Standard Medication Routes (51.23)
  • Dose Unit (51.24)
  • New Fields
  • Drug File (50) Local Possible Dosage multiple
    (904)
  • Numeric Dose (5)
  • Dose Unit (4)
  • Dosage Form File (50.606)
  • Exclude From Dosage Checks (11)

11
Pre-Release Patch Installation (cont.)
  • New Fields (continued)
  • Medication Routes file (51.2)
  • Standard Medication Route (10)
  • Standard Med Route Change Log (7)
  • Activity Date and Time (.01)
  • Person making change (1)
  • Old Value (2)
  • New Value (3)
  • IV Solution file (52.7)
  • PreMix (18)

12
Pre-Release Patch Installation (cont.)
  • Menu Changes
  • Enhanced Order Checks Setup Menu (New)
  • Pharmacy Data Management Menu (Restructuring)

13
Enhanced Order Checks Setup Menu
14
Pre-Release Patch Installation (cont.)
  • Post Init
  • Initiate NTRT population of VUIDs for Standard
    Medication Route file
  • Auto mapping of local Medication Routes file to
    Standard
  • Auto population of numeric dose and dose unit for
    Local Possible Dosages
  • MailMan message upon completion

15
Medication Route Mapping
16
Standard Medication Route
  • Standard Medication Route file (51.23)
  • Created by Standards and Terminology Service
    (STS)
  • Mapped to FDB dose route table by STS
  • Approved by Pharmacy Benefits Management (PBM)
  • Facilitate mapping of local medication route to
    FDB

17
Standard Medication Route (contd)
  • Initially exported as a Pharmacy Data Management
    (PDM) file
  • No local editing allowed
  • Updates via New Term Rapid
  • Turnaround (NTRT)
  • Change Requests
  • Via VistA option (temporary)
  • NTRT Website (permanent)
  • Available with PRE V. 0.5 release

18
Change Requests
  • Request Change to Standard Medication
  • Routes File option
  • Request additions and/or modifications to
    standard medication route
  • Request Information submitted
  • Medication route to be added/modified
  • Example of medication administered by route
  • References/reason for request
  • Sent to VHA OI SDD HDS NTRT Outlook mail group
    and requestor on VistA account
  • To be reviewed by established committee

19
Request Change To Standard Med Route
20
Request Change To Standard Med Route
21
Req Change To Standard Med Route
22
Mapping Local to Standard
  • Mapping Local to Standard Med Routes
  • New STANDARD MEDICATION ROUTE field (10) in
    MEDICATION ROUTES file (51.2)
  • Only required for local Medication Routes marked
    for ALL PACKAGES
  • Map to ACTIVE Standard Medication Route
  • No changes to Order Entry selection lists

23
Mapping Local to Standard (contd)
  • Options for mapping
  • Find Unmapped Local Medication Routes
  • Map Local Medication Route to Standard
  • Medication Route File Enter/Edit

24
Mapping Local to Standard (contd)
  • All three options
  • Allow for mapping of a local medication route
    marked for All Packages to an active standard
    route
  • FDB route is displayed when selecting an active
    standard medication route
  • User can bypass route without mapping

25
Find Unmapped Local Med Routes
  • Find Unmapped Local Medication Routes
  • Loops through every unmapped local medication
    route and presents each route to user for mapping
  • Redisplays the mapping after mapping
  • At completion or if the user to exit loop,
    the software rechecks status of mapping
  • Displays status of mapping to user

26
Find Unmapped Local Med Routes
27
Find Unmapped Local Med Routes
28
Find Unmapped Local Med Routes
29
Mapping Local to Standard (contd)
  • Next two options also
  • Display mapping for a route already mapped
  • Allow remapping
  • Redisplay the mapping after remapping
  • If no mapping occurs, warning message displayed

30
Map Local Medication Route
  • Map Local Medication Route to Standard
  • Allows individual selection of a local medication
    route marked for ALL PACKAGES
  • Only used for mapping to a standard route

31
Map Local Med Route to Standard
32
Medication Route File Enter/Edit
  • If a local medication route is not marked for ALL
    PACKAGES user will not be asked to map to
    standard
  • Allows deletion of mapping

33
Dosage Form File Enter/Edit
  • Modified to not allow entry of a new Medication
    Route
  • Will still be able to associate existing local
    medication route with a Dosage Form

34
Mapping Local to Standard
  • Mapping Reports
  • Medication Route Mapping Report
  • Medication Route Mapping History Report

35
Medication Route Mapping Report
  • Allows printing of all local medication routes or
    unmapped local medication routes
  • Only displays local medication routes marked for
    ALL PACKAGES
  • Report Display Information
  • Local Medication Route
  • Outpatient Expansion for Local Medication Route

36
Medication Route Mapping Report
  • Report Display Information (cont)
  • Standard Medication Route
  • FDB Route
  • Totals for local medication routes and/or
    unmapped local medication routes
  • Alphabetical display
  • 132 column format
  • Output to screen or printer

37
Medication Route Mapping Report
38
Medication Route Mapping Report
39
Medication Route Mapping Report
40
Medication Route Mapping Report
41
Medication Route Mapping Report
42
Med Route Mapping History Report
  • Medication Route Mapping History Report
  • Tracks mapping changes between local medication
    routes and standard medication routes
  • Allows printing for all local medication routes
    with mapping changes or a single local medication
    route
  • Can specify timeframe

43
Med Route Mapping History Report
  • Output to screen or printer
  • Report Display Information
  • Local Medication Route
  • Date/Time change occurred
  • User who made mapping change
  • Old Value
  • New Value

44
Med Route Mapping History Report
45
Med Route Mapping History Report
46
Med Route Mapping History Report
47
Med Route Mapping History Report
48
Dose Unit Mapping
49
New VistA Dose Unit File
  • Dose Unit File (51.24)
  • New VistA file
  • Mapped to FDB dose unit table
  • Facilitate mapping of local possible dosage unit
    to FDB
  • Being analyzed by STS for standardization (for
    PRE V. 1.0)
  • No local editing allowed
  • Exported as PDM file
  • Updates via PDM patch
  • Change Requests
  • Via VistA option

50
Change Requests
  • Request Change to Dose Unit Option
  • Request additions and/or modifications to dose
    unit
  • Request Information submitted
  • Dose Unit to be added/modified
  • References/reason for request
  • Sent to VA OIT VHIT PS DOSE UNIT REQ Outlook mail
    group and requestor on VistA account
  • To be reviewed by established committee

51
Request Change to Dose Unit Option
52
Request Change to Dose Unit Option
53
Dosage Form File (50.606)
  • New field added to exclude dosage form from
    dosage checks
  • Initial data population with Pre-Release patch
  • To be managed by NDF manager nationally
  • Future data updates via NDF data update patches

54
Local Possible Dosages
  • Two new fields added to DRUG file (50) within
    LOCAL POSSIBLE DOSAGES multiple (904)
  • UNITS - points to New Dose Unit File
  • NUMERIC DOSE - numeric representation of dosage
    based on unit defined

55
Local Possible Dosages
  • Population of two new fields
  • Will not be done for
  • Supply items
  • Drug associated with a dosage form excluded from
    dosing checks
  • Auto population
  • During post init based on established business
    rules

56
Options for Population
  • Find Unmapped Local Possible Dosages
  • Map Local Possible Dosages
  • Drug Enter/Edit
  • Enter/Edit Dosages

57
Options for Population (contd)
  • All four options
  • Allow for editing of the Numeric Dose and Dose
    Unit fields for a local possible dosage
  • Exclude the following drugs
  • Marked as a supply item
  • Associated with a Dosage Form excluded from
    dosage checks
  • Has no local possible dosages defined

58
Options for Population (contd)
  • System displays to user
  • Drug name
  • Strength and unit (if data exists)
  • Local possible Dosage
  • Numeric Dose and Dose Unit (if data exists)
  • If strength of Drug does not match VA Product
    strength, a warning is displayed to the user and
    respective strengths displayed
  • User can bypass prompts without entering data

59
Options for Population (contd)
  • New options also
  • Redisplay entered/modified data
  • If user will be asked if they want to continue

60
Find Unmapped Dosages
  • Find Unmapped Local Possible Dosages
  • Loops through drugs that have local possible
    dosages eligible for dosage checks that do not
    have either Numeric Dose or Units entered
  • Excludes the following additional drugs
  • Inactive
  • Not matched to NDF
  • At completion or if the user to exit loop,
    the software rechecks status of data population

61
Find Unmapped Dosages (contd)
62
Find Unmapped Dosages (contd)
63
Find Unmapped Dosages (contd)
64
Map Local Possible Dosages
  • Allows selection of an individual drug
  • Displays warning message for excluded drugs
  • No local possible dosages defined
  • Supply item
  • Associated with dosage form excluded from dosage
    checks
  • Displays warning message and/or information, but
    allows population of fields for drugs that are
  • Inactive
  • Not matched to NDF

65
Map Local Possible Dosages
66
Map Local Possible Dosages
67
Drug Enter/Edit
  • Modified to allow editing of the Numeric Dose and
    Dose Unit fields when
  • Entering/Editing a new drug
  • Matching a drug to NDF
  • Rematching a drug to NDF
  • Fields not shown for editing if drug
  • Supply Item
  • Associated with Dosage Form excluded from dosage
    checks

68
Enter/Edit Dosages
  • Modified to allow editing of the Numeric Dose and
    Dose Unit fields
  • Fields not shown for editing if drug
  • Supply Item
  • Associated with Dosage Form excluded from dosage
    checks

69
Reports
  • Strength Mismatch Report
  • Review Dosages Report
  • Local Possible Dosages Report

70
Strength Mismatch Report
  • Displays dosage information
  • For DRUG file (50) entries that have a different
    strength than what the VA product match has
  • Information Displayed
  • Local drug IEN
  • Drug Name
  • Inactive Date
  • Strength and Units
  • Application Package Use
  • Possible Dosage Fields (Dispense Units Per Dose,
    Dose, Package, Outpatient Expansion)
  • Local Possible Dosage Fields (Local Possible
    Dosage, Package, Numeric Dose, Dose Unit)
  • Strength mismatch warning and strength comparisons

71
Strength Mismatch Report
72
Strength Mismatch Report
73
Review Dosages Report
  • Modified to displayed Numeric Dose and Dose Unit
    fields for a Local Possible Dosage
  • If strength of Drug does not match VA Product
    strength, a warning is displayed to the user and
    respective strengths displayed

74
Local Possible Dosages Report
  • Allows printing of all drugs with local possible
    dosages eligible for dosage checks or for drugs
    with just missing data in the Numeric Dose and
    Dose Unit fields
  • Excludes drugs that are
  • Supply Items
  • Associated with Dosage Form excluded from dosage
    checks
  • Inactivated
  • Not matched to NDF

75
Local Possible Dosages Report
  • 132 column format
  • Information displayed
  • IEN of local drug
  • Drug Name
  • Strength and Units
  • Application Package Use
  • Local Possible Dosage data (Local possible
    dosage, Package, Numeric Dose, Dose Unit)
  • Strength mismatch warning and information

76
Local Possible Dosages Report
77
Local Possible Dosages Report
78
Frequency Review
79
Administration Schedule Frequency
  • Administration Schedule File Report
  • Allows for printing of all Administration
    Schedules or those without a frequency
  • Only those schedules that have a PSJ in the
    package prefix will be included
  • 80 or 132 column format

80
Administration Schedule Frequency
  • Display Information
  • Administration Schedule
  • Standard administration times
  • Outpatient Expansion
  • Other Language Expansion
  • Ward(s)
  • Ward(s) Administration Times
  • Schedule Type
  • Frequency (in Minutes)

81
Administration Schedule File Report
82
Administration Schedule File Report
83
Medication Instruction Frequency
  • Medication Instruction File Report
  • Allows for printing of all Medication
    Instructions or those without a frequency
  • 80 or 132 column format
  • Information Displayed
  • Name
  • Synonym
  • Expansion
  • Other Language Expansion
  • Plural
  • Intended Use
  • Frequency (In Minutes)

84
Medication Instruction File Report
85
Medication Instruction File Report
86
Identify PreMixes

87
Identify PreMix Solutions
  • Flag IV solutions as PreMixes
  • Identify for order check inclusion
  • Option modifications/adds
  • Added PreMix field for editing in
  • Drug Enter/Edit
  • Primary Solution file
  • Mark PreMix solution (new)
  • IV Solution Report (new)

88
Mark PreMix Solution
  • Allow marking of IV Solution as a Premix
  • Fields presented for Editing
  • Print Name
  • Print Name 2
  • Generic Drug
  • Volume
  • Inactivation Date
  • Used in IV Fluid Order Entry
  • PreMix

89
Mark PreMix Solution
90
IV Solution Report
  • Option to print all IV Solutions or those only
    marked as PreMixes
  • Display Information
  • Print Name
  • Print Name 2
  • Volume
  • Synonyms
  • Generic Drug
  • Pharmacy Orderable Item
  • Inactivation Date
  • Used in IV Fluid Order Entry
  • Premix Flag

91
IV Solution Report
92
IV Solution Report
93
PRE V.0.5 Enhanced Order Checks
  • Whats coming

94
Enhanced Order Checks
  • Build a HeV component to utilize services
    provided by a commercial drug database to support
    Legacy VistA order check changes
  • Create/Modify APIs in M environment to support
    order check enhancements

95
Order Checks Data Flow
96
Enhance Existing Order Checks
  • Drug-Drug Interactions
  • Short description of drug interaction clinical
    effects
  • Detailed professional drug interaction monograph
    (optional)
  • Display Changes
  • Enter/Edit Local Drug Interaction Edit Drug
    Interaction Severity options no longer available
  • Request Changes to Enhanced Order Checks Database
    option

97
Enhance Existing Order Checks
  • Duplicate Therapy (Class)
  • Utilize FDBs Enhanced Therapeutic Classification
    (ETC) System
  • Allows for multiple classes per drug
  • Each therapeutic class assigned Duplication
    Allowance
  • No longer processed in pairs
  • Display changes

98
Enhance Existing Order Checks
  • Duplicate Drug
  • Display changes
  • Removed from Inpatient Medications
  • Allergy/ADR
  • Provide consistent displays between Outpatient
    Pharmacy Inpatient Medications
  • Allow user to take action after display for
    Inpatient Medications application

99
New Order Checks
  • Dosing Order Checks
  • Single Maximum Dosage Check
  • Daily Dose Range Check
  • General Dosing Information for a Drug
  • Incorporate dosing checks in Outpatient Pharmacy
    verification options
  • New intervention types to accommodate dosing
    checks

100
New Order Checks
  • CPRS Order Checks
  • Incorporate in Pharmacy backdoor
  • Aminoglycoside Ordered
  • Glucophage Lab Results
  • Dangerous Meds for Patient gt64

101
Enhanced Order Checks Plus…
  • Allow user to take action after order check
    display for Inpatient Medications (PSI-07-080)
  • Order Check Display Sequence Changes
  • Consistency between Outpatient Pharmacy
    Inpatient Medication (PSI-07-080)
  • Display changes between Remote and Local Order
    Checks for consistency
  • Ability to perform order checks on PreMix
    solutions (PSI-06-012)

102
Enhanced Order Checks Plus…
  • Error Handling
  • Messages at system, drug and order level when
    order checks cannot be performed
  • Priority message when FDB link is down
  • Provide option to check connectivity to FDB
    database
  • Placing Intervention Menu hidden action on
    additional ListMan order screens

103
Enhanced Order Checks Plus…
  • Identify Recently Discontinued/Expired Orders
  • Identify D/C and Hold Action on Profile
  • User notifications for Standard Medication Route
    and Dose Unit file changes

104
Customization
  • GUI Application for Customization
  • Ability to customize FDB standard reference
    tables used in enhanced order checks
  • Provide facility users access to request custom
    changes and to view information
  • Ability to accept/process custom requests
  • Provide designated users ability to review and
    then to approve/reject customization requests
  • Ability to manage queries and reports
  • Provide method via FTP to update local/regional
    instances of FDB standard and custom tables

105
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