IMPROVING MEDICATION RECONCILIATION WITH STANDARDS

Transcription

1 Presented by NCPDP and HIMSS for the Pharmacy Informatics Community IMPROVING MEDICATION RECONCILIATION WITH STANDARDS December 13, 2012 Keith Shuster, Manager, Acute Pharmacy Services, Norwalk Hospital Rick Sage, Sr. Vice President, Pharmacy Services, Emdeon

2 Today s Speakers Keith Shuster, R.Ph, M.B.A., has over 25 years of clinical and management experience. As Manager of acute care pharmacy services at Norwalk Hospital, Keith is currently responsible for pharmacy operations. Norwalk Hospital is a 328 bed community teaching hospital located in lower Fairfield county Connecticut. The pharmacy department is staffed 24/7 by 11 pharmacist, 4 clinical specialists, and 12 technicians. The inpatient pharmacy follows a centralized distribution model including robotic dispensing, medication carousel, and bar code ready inventory. The Hospital staff maintains at least 98% computerized prescriber order entry and 90% bedside barcode compliance rates. Rick Sage has over 25 years experience in the pharmacy industry. As Sr. Vice President of Pharmacy Services for Emdeon, Rick Sage directs the company s pharmacy initiatives with a focus on developing programs, standards and partnerships to improve patient outcomes and reduce healthcare costs. Building the IT infrastructure to support Emdeon Clinical Exchange erx Network has been a priority of Rick s for the last eight years.

3 Agenda/Objectives Discuss medication management trends today by exploring progress and barriers that have been identified. Explore new trends and available resources on the medication reconciliation process. Explain current standards and regulatory requirements in place today including: Meaningful Use, Joint Commission Patient Safety Goals and available NCPDP resources. 3

4 Medication Reconciliation A process for documenting a complete list of the patient s current medications upon admission to the organization AND compare/reconcile the medications the organization provides, upon... A complete list of the patient s medications is communicated to the next provider of service A Joint Commission National Patient Safety Goal 4

5 National Patient Safety Goal*: Medication Reconciliation Objective Maintain and communicate accurate patient medication information Elements of Performance Compare the medication information the patient brought to the organization, with the medications ordered for the patient by the organization, in order to identify and resolve discrepancies Provide the patient with written information on the medications the patient should be taking at the end of the episode of care Explain the importance of managing medication information to the patient at the end of the episode of care Spotlights critical risk points Admission, transfers, and discharge 5 *Reference: Joint Commission

6 Hospital Drivers Hospitals are now financially penalized for readmissions Ineffective medication reconciliation upon hospital admission: Up to 50% of medication errors Up to 20% of future Adverse Drug Events (ADEs) More than one-third of patients had at least one discrepancy in one study According to the AHRQ, unintended medication discrepancies occur in 14% of patients upon discharge Medication Reconciliation is a Joint Commission Accreditation requirement for hospitals 6 Sources: American Academy of Pediatrics, Journal of General Internal Medicine, AHRQ

7 Automation and Medication Reconciliation Automated medication reconciliation can help accomplish NPSG requirements by: 7 Reducing manual and redundant processes needed to achieve NPSG accreditation Increasing accuracy, thereby decreasing unintentional medication discrepancies Improving the accuracy associated with assessments for medication appropriateness Increasing the speed by which valuable medication reconciliation information is delivered

8 Keys to medication reconciliation Accurate/Timely medication history Complete medication history Medication name, dose, frequency All medications from all sources (cash, OTC etc.) Discussion with patient/family Process for admission, transfer, and discharge What not to take upon discharge 8

9 Medication Reconciliation Trends Paper solution Retrospective comparison upon admission Hospital vendor solutions 9

10 Latest Trend - Automation Pharmacy prescription data Pharmacy Benefits Management (PBM s) Data Interfaced to hospital systems Nurse documents as medication history Prescriber can document a medication as history OR convert to inpatient order Pharmacist discharge phone calls and Medical home 10

11 Barriers 11 PBM look up dependent on accurate/matching name and DOB Some 3 rd party insurers do not participate Staff role confusion Nurse, physician, and/or pharmacy personnel Timely arrival, data gathering, and exchange of information Trusting the information Automation automatic

12 12 Key Drivers

13 Evolution of HIT 25 Years Now 13

14 Recent Drivers MEDICAL HOME / ACOs INTEROPERABILITY MEANINGFUL USE HITECH ARRA 14

15 Convergence Administrative Connect Capture Normalize Share Analyze & Report Clinical 15

16 16 Meaningful Use

17 Critically important to 81% of surveyed providers * *Source: HEALTHCARE INSIGHTS 2012: SMALL PRACTICE RESULTS, EMDEON,

18 But only 42% have already fully implemented an EMR * *Source: HEALTHCARE INSIGHTS 2012: SMALL PRACTICE RESULTS, EMDEON,

19 Closer Look at Stage 2: Electronic Exchange* 19 Stage 2 focuses on actual use cases of electronic information exchange: Stage 2 requires that a provider send a summary of care record for more than 50% of transitions of care and referrals The rule also requires that a provider electronically transmit a summary of care for more than 10% of transitions of care and referrals At least one summary of care document sent electronically to recipient with different EHR vendor or to CMS test EHR *HIMSS 2012 presentation by Robert Anthony

20 Closer Look at Stage 2: Med Reconciliation* Core requirement for Stage 2: Eligible Professional (EP), Eligible Hospital (EH) or Critical Access Hospital (CAH) must perform medication reconciliation for more than 50 percent of transitions in care To an eligible professional Admission to an eligible hospital or CAH s inpatient or emergency department 20 *Page 175 of MU Stage 2 final rule

21 21 Key Considerations

22 Hospital/Acute Care Hospital inpatient care Number of discharges annually: 36.1 million Average length of stay in days: 4.9 Hospital outpatient department care Number of annual outpatient department visits: 96.1 million Hospital emergency department care Number of annual emergency department visits: million Number of emergency department visits resulting in hospital admission: 17.1 million Number of emergency department visits resulting in admission to critical care unit: 2.2 million This results in approximately 268 million medication reconciliations annually Source: 22

23 Requires Additional Data & Collaboration Many medications are used for multiple conditions; all diagnoses not readily available Patients use multiple physicians Primary Care Providers (PCPs) often do not have time to work with clinical pharmacists to reconcile medications Patients use multiple pharmacies or pay cash, creating lack of visibility Patients may not remember what they are taking Lack of awareness of medications in patient home Disparate health systems make data sharing difficult Hospital and emergency events create frequent misalignments in established medication therapy 23

24 Patient Authorization (HIPAA) Patient authorizes to their provider/physician or healthcare provider either verbally or written, to access any medical data, including medication history 24 The requesting provider is responsible to ensure that any request for medication history information is made for an authorized purpose, as defined by HIPAA (meaning for, continuity of care, avoidance of medication errors and other treatment)

25 25 Supporting Standards

26 NCPDP SCRIPT Medication History Overview Real-time exchange between prescribing systems, pharmacy systems, payer/processor systems, or other entities involved in healthcare Populates medication history on prescriber and pharmacy systems Medication history information delivered in the NCPDP 8.1 SCRIPT XML format Request message = RXHREQ Response message = RXHRES Will be supported with the NCPDP 10.6 SCRIPT XML format Accessible via existing eprescribing workflows Can include third party claims submitted to payers/processors and cash claims stored on pharmacy systems including OTC if submitted as a prescription 26

27 A Real-Time Solution Endpoints obtain pharmacy-sourced medication history through a single real-time inquiry accessed via an eprescribing application or web portal Identifies a unique patient using person-matching algorithms based on several criteria including patient first and last name, gender, date of birth and zip code Applies edits and rules to eliminate duplicate records & limit time period in which history is searched Filters to remove any drugs based on state and/or other legal requirements from the results 27

28 Entity Entity Medication History Request/Response Medication History Request Message - RXHREQ Medication History Response Message - RXHRES 1. Requesting entity supplies enough information to uniquely identify patient. 2. Prescriptions returned in the order of the most recent date filled first. 3. Requesting entity must evaluate the Patient Consent for accurate reporting. 28

29 Medication History Patient Consent Patient Consent flag required as part of obtaining successful medication history Consent is the responsibility of each healthcare provider Pharmacy receives consent prior to submitting claim to payer/pbm Provider receives consent prior to requesting medication history Provider s application sends a flag in the medication history request indicating that the provider has obtained the appropriate consent The lack of consent will return a rejected response 29

30 Comprehensive Medication Reviews Required by Medicare once per year starting January 1, 2013 Supported by CDA Release 2 Medication Therapy Management (MTM) Part D Implementation Guide that is a joint Release between NCPDP and HL7 based on the HL7 Clinical Document Architecture (CDA) Generates Medication Action Plan and Medication List May be used by pharmacists to conduct MTM medication reviews anytime and can include non-prescription medications Designed to help eligible providers (EPs) and eligible hospitals (EHs) meet MU medication reconciliation requirements Uses RxNorm and specific MTM SNOMED CT codes for EP and EH to integrate the active medication list and care plan into EHR DERF approved during August 2012 WG10 meeting; Task Group reconciling HL7 ballot comments; final ANSI approved version expected to be published May Key Contacts See Resource section

31 31 Putting it All Together

32 Our Patient Name: Arthur Doe DOB: 01/01/1940 Gender: Male Notes: Has a primary care physician Sees 2-3 specialists per year Is on maintenance medications for - Hypertension - Diabetes

33 HIE Visualized Specialist Arthur s data is siloed on information islands. Care is less coordinated. Quality is reduced. Payment and delivery are less efficient. PCP Hospital How do we bring it together? Payer Medicare B BCBST Z Problems Diabetes Hypertension Hyperlcholesterolemia? Health Information Exchange Patient Centric Interoperable Pharmacy Allergies Sulfa Penicillin Active Medications Metformin 500 MG Lisinopril 10 MG Lipitor 20 MG Results HbA1c 6.2% Triglycerides 302 mg/dl Total Cholest. 240 mg/dl HDL 70 mg/dl LDL 135 mg/dl Payer Lab

34 Medication Reconciliation (MR) Improving Care Transitions: Optimizing Medication Reconciliation: March /DocLibrary/Policy/P atientsafety/optimizi ng-med- Reconciliation.aspx

35 CDA Release 2 Medication Therapy Management (MTM) Part D IG Information on the MTM CDA can be obtained from Sue Thompson with NCPDP, sthompson@ncpdp.org Interested pilot participants should contact Shelly Spiro with Pharmacy e-hit Collaborative, shelly@pharmacyhit.org 35

36 Thank You! Rick Sage SrVP, Pharmacy Services Emdeon Keith Shuster Manager of Acute Care Pharmacy Services Norwalk Hospital 36