Long Term Care ePrescribing Standards and MN LTC ePrescribing Pilot Study LTC HIT Summit Baltimore J

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Long Term Caree-Prescribing StandardsandMN LTC
e-Prescribing Pilot StudyLTC HIT
SummitBaltimore June 2006Michael Bordelon
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Quiz

• What is e-Prescribing?

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E-Prescribing Standards

• The great thing about standards is that there are
  so many of them to choose from.

NCPDP National Council for Prescription Drug
Plans HL7 Health Level 7 X12 ANSI EDI
Standards Body LOINC Codified Nomenclature for
Healthcare
Example Prior Authorization Standards are
developed at NCPDP and use an X12 Envelope with
HL7 attachments with LOINC codified content.
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NCPDP

• NCPDP National Council of Prescription Drug
  Programs
• Where e-Prescribing standards were developed
• Key Standards Developed
• SCRIPT
• Formulary Benefits and Eligibility
• Medication History
• Prior Authorization

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NCPDP LTC Work Group

• Started in March 2005
• Work Group 14 Task Groups
• EHR/HL7
• E-Prescribing
• Part D Transaction Support
• LTC Return Credit
• Billing Issues

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Mikes Soap Box

• Standards are only as good as the team developing
  them
• Standards are only
• Ideas when they are developed
• Concepts when they are balloted and voted for
• Tested when they are piloted
• Standards when the whole industry adopts them
• No one company can work alone to develop a
  standard It takes many smart people, time,
  money and a willingness to work together.

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LTC e-Prescribing Standards Team
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LTC e-Prescribing Standards Team
Contributors at the Conference
Shelly Spiro Sue Mitchell Zoe Bolton Jim
Hancock Gladys Wheeler Jennie Harvell Larry
Wolf Alan Winegar
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Current LTC Prescribing Process
Physician
Patient Allergies
Clarify and update order with physician
Order Update (Phone or fax)
Start
Decide on patient order
Patient Orders
Written order
Physician signs copy of the order
Faxed order
Verbal order
Physician writes order on Order Sheet
Signed copy of order
Copy of order (mail, on-site)
Nursing
Evaluate order, clarify if needed and file in
Patient Record
Evaluate order, clarify if needed
Updated Order Sheet
Patient Record
File Signed copy in Pt. Record
Patient Allergies
Resident Status (phone call, fax, on-site)
Notice updated Order Sheet, evaluate order and
clarify if needed
Write order on Physician Order Sheet
Write order on Physician Order Sheet and send
copy to physician
Order Sheet
Manage on-hand medications (Pt Meds, Stock and
Emergency Kit)
Patient MAR
Start
Resident Change in Condition New admission
Med
Check patient choice for pharmacy
Update the MAR
Administer and Chart
Med
Resolve Discrepancy
Receive and check medication (patient, med, doc)
Follow pharmacy-specific procedure including
after hours rules
Clarify and update order with nursing
Order Update (Phone or fax)
Order (phone, fax, pickup by driver, auto-fax
from SNF order management application)
Pharmacy
Order Question (phone or fax)
Patient Allergies
Consultant Pharmacist
Patient Orders
Receive new order
Resolve issues with order (clinical, payor, etc.)
Receive updated order
Drug Regimen Review or other Patient Status Review
Patient MAR
Med
MAR Update (optional)
Order Exception
Process order and dispense includes payor
verification and formulary compliance
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LTC ePrescribing Nuances

• Three way communication between
• Prescriber - Nurse Pharmacy
• Less dependent on physician adoption
• Nurse as an agent
• Nurse Practitioners and Physician Assistants
• Most orders have no end date or quantity
• Refill requests represent 80 of orders
• Renewals are different than in retail
• Need unique formulary and benefit information
• Part A, Part D, and Medicaid
• Little or no connected pharmacies

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LTC e-Rx To-Be Process Model
(NCPDP WG14 Process Work Product)
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LTC e-Rx To-Be Process Model
(NCPDP WG14 Process Work Product)
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LTC Prior Authorization Process Model
(NCPDP WG11 Process Work Product)
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The First LTC e-Rx DERF!!!

• What the heck is a DERF?
• Why did we do it?
• Synchronization of Patient IDs across CPOE, LTC
  and Rx systems
• Timestamp tracking for key LTC events like
  validation and delivery
• Minutes on timestamps
• Unit/Room/Bed Locators
• Prior Authorization Status Code (For
  informational purposes at the pharmacy)
• Do not fill flag
• Discontinue status on CANRX message
• Increasing number of provider loops
• Status Introduced in March, Comments in May, Now
  it goes to Ballot

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What are we doing now?

• Pilot Support
• DEA Testimony for e-Rx with Controlled Substances
• Refill Transaction

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Get Involved In Helping Set LTC e-Prescribing
and EHR Standards

• NCPDP LTC Work Group 14
• E-Rx call every Wednesday
• HL7/NCPDP LTC EHR Workgroup
• EHR call every other Friday
• Meeting Calendar at www.ncpdpwg14.org

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E-Prescribing StandardsPilot Study
Special Thanks for Support and Sponsorship
from CMS Centers for Medicare and Medicaid
Services and AHRQ Agency for Healthcare
Research and Quality
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Purpose of e-Prescribing Pilot Study

• To study the effects of the
• electronic prescribing standards
• in Long-term Care on
• cost, quality and safety
• and
• Validate that the e-prescribing
• Standards work in a LTC Setting.

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Pilot Projects

• ASCP CMS NPRM Comments in 2005
• Including LTC providers in these pilots projects
  will help define the industrys unique needs and
  work to promote adoption of e-Prescribing in this
  setting.
• Five pilots in total were funded
• Only one LTC pilot was granted funds
• Pilot development began Jan 2006
• Final results due no later than 1-31-07

Source Comments on e-Prescribing NPMR, American
Society of Consultant Pharmacist, April 4, 2005,
available at http//www.ascp.com/MedicareRx/epres
cribing.
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LTC e-Rx Pilot Study Abstract

• Electronic Prescribing is new to Long term Care
• 1.5 Million Residents in 17,000 Facilities
• The study includes two geographically diverse
  treatments facilities (BHS) and two comparison
  facilities (non BHS)
• Three phase implementation and study
• Participants were chosen for demonstrated thought
  leadership in the areas of LTC technology
  adoption and electronic prescribing standards
  development

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Study Hypothesis - Benefits

• Significantly Reduces Nursing Time Spent on Order
  Management
• Can Help Control Part A and Part D Drug Costs
• Decreases Dependency on Consulting Pharmacists
• Eliminates Faxing
• Eliminates Legibility Errors
• Reduces delay related to DUR and Payment Issues
• Accurate Medication Administration Records
• Streamlines Workload for Prescribers and Nurses
• Reduces Billing Rejections at Pharmacy
• Increases Patient Safety

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Goals of Pilot Research Study

• Functional Do the standards work?
• Financial Do the standards yield cost benefits?
• Quality Do the standards improve quality of
  care?
• Safety Do the standards improve patient safety?

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Design of the Research Study

• An interrupted multiple treatment time series
  design with non-equivalent no-treatment
  comparison group.
• Baseline Study at Facilities and Pharmacy
• Phased incremental study at Facilities and
  Pharmacy

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Facility Characteristics
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Participants
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Flow of Information
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2006 Phased Implementation

• Baseline Study
• Q1 Q2
• Phase I (June Start)
• SCRIPT New and Cancel
• Formulary Benefits
• Patient Safety
• RNA Refill Tool Demonstration
• Phase II in Q3-Q4
• SCRIPT Fill Status and Change
• Prior Authorization
• Report Finding End of Q4

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2006 Phased Implementation
GO LIVE IS JUNE 26!!!

• Baseline Study
• Q1 Q2
• Phase I (June Start)
• SCRIPT New and Cancel
• Formulary Benefits
• Patient Safety
• RNA Refill Tool Demonstration
• Phase II in Q3-Q4
• SCRIPT Fill Status and Change
• Prior Authorization
• Report Finding End of Q4

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Challenges and Concerns

• Almost no existing technology infrastructure
• Aggressive timeframe for implementation and Study
• Breadth of payer participation 30-40 Coverage
• Non-random and small facility and patient
  population
• Low Prior Authorization payer support
• DEA support needed for e-Rx with controlled
  substances