Medication History for Hospital Settings: Better Data, Better Decisions. Tuesday, March 25, 2014 Pharmacy Town Hall Series

Transcription

1 Medication History for Hospital Settings: Better Data, Better Decisions Tuesday, March 25, 2014 Pharmacy Town Hall Series

2 Program Purpose The availability of comprehensive and accurate medication history is especially important in acute care settings. Gathering good medication history is essential for effective management of patient safety. More comprehensive data, electronically available through EHR systems can improve medication reconciliation across transitions of care. Attendees will learn: What can be done to leverage software and data services to improve patient safety How to efficiently access comprehensive electronic medication history in hospital and acute care settings The impact of implementing electronic medication history for medication reconciliation across health systems

3 Pre-test Questions Please utilize the open polling function on the bottom right of your screen to answer the pre-test questions. The poll will close in 5 minutes. The results will be displayed once the poll closes.

4 About NCPDP Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards Development Organization with over 1,600 members representing virtually every sector of the pharmacy services industry. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for e-prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. Our data products include dataq, a robust database of information on more than 76,000 pharmacies, and HCIdea, a database of continually updated information on more than 2.3 million prescribers. NCPDP's RxReconn is a legislative tracking product for real-time monitoring of pharmacy-related state and national legislative and regulatory activity.

5 About Surescripts Formed in 2001, Surescripts has evolved into the nation s most comprehensive clinical network. Surescripts connects pharmacies, payers, pharmacy benefit managers, physicians, hospitals, integrated delivery networks, health information exchanges and health technology firms to enable the efficient and secure exchange of health information. More than 500,000 prescribers, 600 EHR applications and 94% of community pharmacists are active on the Surescripts network. Guided by the principles of neutrality, transparency, physician and patient choice, open standards, collaboration and privacy, Surescripts provides information for routine, recurring and emergency care. Together with our network participants, Surescripts is committed to saving lives, improving efficiency and reducing the cost of health care for all. For more information, go to and follow us at twitter.com/surescripts.

6 About HIMSS HIMSS is a global, cause-based, not-for-profit organization focused on better health through information technology. HIMSS leads efforts to optimize health engagements and care outcomes using information technology. For more information, go to Vision Better health through information technology.

7 Today s Speaker Rachelle Shelly Spiro, RPh, FASCP Executive Director, Pharmacy Health Information Technology Collaborative Shelly Spiro is Executive Director of the Pharmacy HIT Collaborative (Collaborative). The Collaborative is an organization of the major national pharmacy associations and associate members focused on advocating and educating key stakeholders regarding the meaningful use of health IT and the inclusion of pharmacists within a technology-enabled integrated health care system. The goals of the Collaborative are to assure pharmacists services through health IT are accessible, can connect, and support national quality initiatives. Spiro is active in national pharmacy associations, standards development organizations (NCPDP, HL7 and X12) and is a leader in Pharmacy HIT. She is an American Society of Consultant Pharmacists (ASCP) Past President. She has authored several articles and is a national speaker on topics relating to various professional pharmacy, HIT systems and electronic prescribing.

8 Today s Speaker Ken Majkowski, Pharm.D Vice President, Product Support, Surescripts Ken has over 30 years of healthcare experience. Ken received Doctor of Pharmacy from the University of Minnesota. He has experience in E-Health, Managed Care, Transplant Services, Pharmacy Mail Services, Medical Devices and Drug Delivery Systems, Home Infusion Therapy and Hospital and Retail Pharmacy. At SureScripts, Ken has served as Director of Product Management and Director of Account Management and Vice President of Business Development and Vice President of Clinical Affairs and Product Strategy, Vice President of Strategy and Innovation and Vice President Business Management prior to moving into his present role. He also has 14 years of clinical pharmacy experience in retail, hospital and home care pharmacy.

9 Today s Speaker Lee Mork, MS, RPh, MBA Director of Ambulatory Pharmacy Services, Allina Health Lee Mork is Director of Ambulatory Pharmacy Services for Allina Health. In his role, he is responsible for the clinic's MTM program, Pharmacy and Therapeutics Committee, medication policies, pharmaceutical purchasing, medication storage and handling, a patient medication assistance program and e-prescribing prescription technologies for 72 primary care clinics. Before joining Allina Hospitals and Clinics, Lee had 15 years of experience in the Pharmaceutical industry and Prescription Benefit Management (PBM) industry. Lee received his Bachelor of Science in Pharmacy and Master of Science in Hospital Pharmacy from the University of Minnesota and received a Master of Business Administration from the University of St. Thomas.

10 An Industry, Regulatory and Policy Perspective: Why medication history is important Shelly Spiro, RPh, FASCP Executive Director Pharmacy HIT Collaborative

11 Medication history for reconciliation is a critical aspect of ensuring patient safety

12 Manual tracking of patient medication history is clearly inefficient

13 Medication Information Flow Share Collect Med History Medication Information Med Reconciliation Change Evaluate

14 Other Medication History Sources: Patient Engagement ephr Blue Button Plus Source: 9 Popular Personal Health Record Tools

15 The Joint Commission: Patient Safety, Medication Reconciliation National Patient Safety Goal #8 Joint Commission suspended medication reconciliation Medication reconciliation incorporated into National Patient Safety Goal # to July January Accredited organizations required to: Implement a process for obtaining complete medication list Document complete current med list Communicate complete med list to next provider (referred or transferred outside the accredited organization) Sources: Agency for Healthcare Research and Quality Patient Safety Network National Patient Safety Goal #3 (NPSG ): Reconciling Medication - Maintain and communicate accurate patient medication information Hospital Accreditation Program Obtain information on medications the patient is currently taking when he or she is admitted to the hospital or is seen in an outpatient setting. Provide patient (or family as needed) written information on medications the patient should be taking when he or she is discharged from the hospital or at the end of an outpatient encounter Examples: name, dose, route, frequency, purpose Hospital National Patient Safety Goals, effective Jan 1, 2014, pgs 5-6, accessed Feb 18,

16 Medication Reconciliation Guidance from APhA and ASHP ASHP Statement Hospital Pharmacist s Role in Medication Reconciliation Guidance Optimizing medication reconciliation during transition of care Copyright American Society Health-Systems Pharmacists, Inc. All rights reserved. improving_care_transitions.pdf

17 HL7 Pharmacist/Pharmacy Provider EHR Functional Profile Facilitates EHR systems capture of medication and clinical related data at the point of contact or point of care Specifies the functional requirements needed to support messaging among prescribers, pharmacist and pharmacy providers and other health care entities needing medication-related information Direct Care Essential now Manage Medication List Create and maintain patient-specific medication lists Source:

18 Meaningful Use Stage 2 October 2012 Eligible Hospital (EH) and Critical Access Hospital (CAH) Medication Reconciliation should be performed When receiving a patient from another setting of care When receiving a patient from another provider of care When you believe an encounter is relevant Core Measures 11 of 16 Source: E-Prescribing (erx) Generate and transmit permissible discharge prescriptions electronically Measure 5 of 6 Source:

19 Meaningful Use Stage 3 - Proposed Eligible Hospital (EH) and Critical Access Hospital (CAH) Medication history for adherence monitoring Connections to PBMs to retrieve external medication fill history for medication adherence monitoring

20 NCPDP SCRIPT STANDARD 10.6 Communication of prescription information Between prescriber and pharmacy Medication history information between entities electronically (not faxes/paper) NCPDP e-prescribing Fact Sheet - Medication History Pharmacy Prescriber/Hospital Entities (pharmacy, prescriber, hospital, intermediary, payer/health plan) Initiate med history request to prescriber Initiate med history request to pharmacy Request med history Request from another entity Initiate med history request to payer or other entity Initiate med history request to payer or other entity Provide med history Source: NCPDP Electronic Prescribing Fact Sheet, page 2-3, accessed Feb 18,

21 Real-time medication history for transitions of care Ken Majkowski, PharmD VP, Product Support Surescripts

22 Not having real-time, electronic medication history has adverse impact MORE THAN 40% of medication errors on average result from inadequate medication reconciliation¹ MORE THAN 770,000 people die or are injured annually from Adverse Drug Events (ADEs)² 23% of patients readmitted within 30 days of discharge had an ADE as either a primary or secondary diagnosis³ 1. Rozich JD, Howard RJ, Justeson JM, et al. Patient safety standardization as a mechanism to improve safety in health care. Jt. Comm J Qual Saf 2004: 30(1): Agency for Healthcare Research and Quality (AHRQ), Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs, Publication # Formulary Watch, Incidence of ADEs in patients readmitted within 30 days of discharge in a tertiary care teaching hospital, Dec. 1, 2007

23 Electronic Medication History for hospitals enhances workflow efficiency Delivers real-time, electronic information to EHRs Provides a broader view of the patient s medication history Offers extensive access to both PBM claims and pharmacy fill data

24 Electronic Medication History for hospitals contains PBM medication claims for 250 million patient lives Pharmacy database of over 2 billion prescription records Name of drug Dosage Quantity dispensed Days supply Dispensing pharmacy Pharmacy phone number Prescription fill date Name of prescribing physician Prescribing physician phone number Pharmacy SIG data only

25 Transaction Workflow: Electronic Medication History for Hospitals Payer 1 Hospital Physician History Request HL7 ADT Uniquely Identify Member ID History Request NCPDP SCRIPT Format NCPDP Prescription History Request History Response NCPDP SCRIPT Payer 2 History Response HL7 ORU or RDS Aggregate Prescription History Responses Format HL7 Prescription History Response History Request NCPDP SCRIPT History Response NCPDP SCRIPT Pharmacy

26 Medication History for hospitals addresses most common pain points Common Hospital Issues 1 Patient readmissions Personnel shortages Financial challenges Patient safety and quality Governmental mandates Patient satisfaction Technology incompatibility Creating an accountable care organization Benefits of Medication History Improved medication reconciliation and management reduces patient readmissions* Resource-saving opportunities, ability to redeploy staff to other activities Reduced costs (ex. less ADEs, resource-savings, etc.) impact readmission Less transcription errors, Reduced chances of ADEs Addresses Meaningful Use & JCAHO criteria Increased quality of care Integration with existing EHR systems Quality metric improvement opportunities 1. Top Issues Confronting Hospitals: American College of Healthcare Executives: * Patient readmissions was not included in the study

27 Electronic Medication History improves medication reconciliation 30% improved completeness in medication history¹ 20 min. savings per patient medication reconciliation performed² Increased Identification of medications most likely to cause ADEs³ 4 Billion+ 1. Walsh, Andrew, Report from MediCenter Pilot Study, Health Monitory Systems, Study showed medication reconciliation performed with electronic medication history resulted in average 95% complete, compared to the 73% average completion when medication reconciliation is performed following best practices only, without the Surescripts service. 2. Walsh, Andrew, Report from MediCenter Pilot Study, Health Monitory Systems, To achieve the same level of accuracy as with using Surescripts Med History, the study showed approximately 20 minutes of additional nurse time would need to be spent with each patient, following up with call to family members, physicians and pharmacies. 3. Walsh, Andrew, Report from MediCenter Pilot Study, Health Monitoring Systems, Study demonstrated that using Medication History identified these drug types at rates greater than the average rates at which they are reported using the patient interview process only.

28 Electronic Medication History can reduce an estimated $1,600 per bed annually Cost of Time Cost of Inaccuracy $887M 1 Total value of time spent creating a base med history $421M Cost of preventable ADEs related to drug interactions 800k 2 Total US hospital staffed beds 800k 2 Total US hospital staffed beds $1,107 Average value of time spent creating a base med history per bed per year $526 Average cost of preventable ADEs related to drug interactions per bed per year Internal Surescripts analysis.

29 Helping ensure medications most likely to cause ADEs get reported CONTROLLED NARCOTICS 67% Up to 67% increased identification of significant medications 1 NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ANTIBIOTICS CENTRAL NERVOUS SYSTEM DRUGS 29% 50% 67% CARDIAC DRUGS 11% 1. Walsh, Andrew, Report from MediCenter Pilot Study, Health Monitoring Systems, Study demonstrated that using Medication History identified these drug types at rates greater than the average rates at which they are reported using the patient interview process only.

30 More accountable care with Medication History for hospitals Improve patient care by reducing the risk of ADEs Increase the quality and efficiency of medication reconciliation Support Meaningful Use and JCAHO objectives

31 Network scale is needed for comprehensive electronic medication history Better Data. Better Outcomes. 10+ YEARS LEADING SECURE HEALTH INFORMATION EXCHANGE 600+ EHR APPLICATIONS 6 BILLION TRANSACTIONS ANNUALLY

32 IDN Experience: Electronic Medication History in Hospitals Lee Mork, MS, RPh, MBA Director of Pharmacy Clinic Division Allina Health Please note: The opinions expressed by Lee Mork are his own and do not necessarily reflect the viewpoint of Allina Health. The mention of Allina Health, any organization name, product, or service in this discussion should not be construed as an endorsement by Mr. Mork, nor is the failure to include an organization name, product, or service to be construed as disapproval.

33 Allina Health 12 Hospital IDN with 24,000 employees and 5,000 physicians Using e-prescribing, formulary and benefit and medication history for outpatient clinics and acute hospital care settings (Surescripts) o Started medication history for hospitals in 2011

34 The desired capabilities and needs of hospitals was assessed Desired Results Better process Situation Nursing staff had difficulty correctly adding medications to the patient list at time of admission Improved efficiency A quicker and more accurate way to identify medications missing from the patient s list was needed More complete history The clinics wanted to be able to see the medications that patients were actually getting filled in pharmacies

35 Made the case for electronic medication history for hospital use PRESENTED THE CASE: better, more efficient medication reconciliation was possible with the addition of comprehensive electronic medication history within our computer systems Supported state regulatory requirements DEMONSTRATED CLINICAL BENEFITS to management and providers o We could see the patient s blood pressure was up because they were not filling their hypertension medication This would not have been a timely, diagnostic finding with manual collection methods of reconciling medication history no need to call the pharmacy Management was impressed with how the display automatically shows which meds are not found on the current list and are easily added.

36 Tips for successful roll out of electronic medication history across IDN hospitals Recognize technology installs are big projects, utilize EMR vendor materials Implementation requires a project manager, a core team and an executive steering committee Roll out to all sites with educational tip sheets and support material Configure it to run automatically at patient admission

37 Allina experience of staff and patients using medication history with Hospital EHR Patients are amazed that we are able to see the medications they have been filling or not filling at their pharmacy During medication reconciliation process, reviews need to incorporate dispense history in work flows Can quickly add medications to the patient s records with a click of button that brings the medication into the patients EMR medication list Easy to use when matches with the patient s prescription payer Remind staff that medication dispense history is available - need to promote it more for staff to use it Better data in, with a more efficient process to directly add medications from the data feed when not found on the existing medication list

38 Allina experience: How electronic medication history for hospitals performed Performs well - showing medication/strength, date of fill, and filled quantity Most patients are found by data matching elements o Patient situations occur where no match is found or minor change in demographics results in lack of match Limited outages with hospital medication history service

39 Allina experience: Defining medication reconciliation improved our approach Three Step Medication Reconciliation Process* 1. Collection: Patient Interview and Medication List 2. List Clarification Clarify omissions Remove discontinued meds Assess appropriateness Select correct product from Excellian medication list 3. Reconciliation: MUST be performed by physician *Adapted from the IHI definition by the Allina Health Medication Reconciliation Steering Committee

40 Allina experience: Medication reconciliation process improved Pharmacist are increasingly more involved in medication list collection as step 1 in the medication reconciliation process. They use the EMR patient s record, patient interview, the medication dispense history and may call the patients pharmacy. Process has improved for staff, allowing easy addition of medications the patient is taking o o We receive the fill date, medication name, strength and quantity Without having to retype the information mistakes are avoided.

41 Allina experience: Medication history s impact on clinical services, outcomes, patient safety Improved Medication Reconciliation better data makes on-going medication addition decisions easier Clinical quality outcomes improved to detect non-adherence o Example: no fills on diabetes meds Patient safety improved by knowing medication use history when patient is incapacitated o Example: opioid use in patient overdose situation

42 Summary: Electronic Medication History for Hospitals Value Gain Improves patient safety More efficient Supports health quality standards Better Data. Better Care. Reduces risk of adverse drug effects Medication Reconciliation process is more comprehensive and quicker Meaningful Use JCAHO (Joint Commission)

43 Post-test Questions Please utilize the open polling function on the bottom right of your screen to answer the post-test question. The poll will close in 5 minutes. The results will be displayed once the poll closes.

44 Q & A

45 Save the Date Future Town Hall Thursday, April 10, 2014, 11:00am CT/12:00pm ET The New Standard for Electronic Prior Authorization Register Today!

46 Slide & Recording Information Please visit to download the slide deck and access the recording of this session.