Title: Overview of Technology Approaches of Medication Management in LongTerm Care
1Overview of Technology Approaches of Medication
Management in Long-Term Care
- Rachelle Shelly Spiro, RPh, FASCP
- President, Spiro Consulting
2Overview
- LTC Electronic Health Record (EHR) Standards
- e-Prescribing and eMAR
- LTC e-Prescribing standards and pilots
- Summary
3HHS-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
4Source 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
5LTC 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
6CCHIT LTC Roadmap
Source http//www.ahima.org/infocenter/whitepaper
s/documents/Public_Comment_Expanding_CCHIT_Certifi
cation_Roadmap_20070202.pdf
Proposed for August 2009
7e-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
8eMAR Standards
- Pharmacy versus facility driven
- Integration
- Hardware and software
- Further standards of eMAR and inventory
management is needed - REMOTE DISPENSING
Covered in next presentation
9Reduction 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
10Grantee/Contractor Project Titles for
e-Prescribing AHRQ Pilot Project
11Purpose 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
12e-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
13Summary
- 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
14Thank you
- Shelly Spiro
- President, Spiro Consulting
- 1200 First Street, Suite 1632
- Alexandria, VA 22314
- 703-599-5051
- www.spiroconsulting.net