Long Term Care ePrescribing Standards Pilot Study Michael Bordelon

1
Long Term Caree-Prescribing StandardsPilot
StudyMichael Bordelon

• The wonderful thing about standards is that there
  are so many of them

2
Purpose of e-Prescribing Pilot Study

• To study the effects of the
• electronic prescribing standards
• in Long-term Care on
• cost, quality and safety.

3
Pilot Projects

• ASCP CMS NPRM comments
• 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.
• Pilot development began Jan 2006
• Final results due no later than 1-31-07
• Only one LTC pilot was granted funds
• Michael Bordelon is the Principle Investigator

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

5
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
6
LTC ePrescribing Nuances

• Three way communication between
• Prescriber - Nurse - Pharmacy
• Most orders have no end date or quantity
• Refill requests represent 80 of orders
• Renewals are different than in retail
• Need formulary and benefit information
• Part A, Part D, and Medicaid
• Need electronic prior authorization
• Little or no connected pharmacies

7
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

8
Goals of Pilot Research Study

• Functional Do the standards work? These outcomes
  are related to answering the core evaluation
  questions.
• Financial Do the standards yield cost benefits?
  These are related to costs in processing and
  refilling prescriptions, data entry,
  non-formulary prescribing, and prior
  authorization processing.
• Quality Do the standards improve quality of
  care? These are related to reducing transcription
  errors, right-drug right-time errors,
  before-and-after measures of 9 or more
  medications, and contraindication overrides.
• Safety Do the standards improve patient safety?
  These are related to identifying, tracking, and
  reducing drug allergies, adverse drug
  interactions, and therapeutic duplications.

9
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

10
Facility Characteristics
11
Participants
12
Flow of Information
13
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

14
Challenges and Concerns

• Timeframe to implement software and
  infrastructure
• Breadth of payer participation 30-40 Coverage
• Non-random and small facility and patient
  population
• Low Prior Authorization payer support

15
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