K-TRACS KANSAS TRACKING AND REPORTING OF CONTROLLED SUBSTANCES Using Direct Messaging to send Unsolicited Reports MITRE/Cerner/C4UH/K-TRACS Pilot Christina Morris, JD Assistant Director, Disciplinary Counsel & PMP Program Director Kansas State Board of Pharmacy 800 SW Jackson, Ste. 1414 Topeka, KS 66612 P: 785.296.8717 F: 785.296.8420 Christina.morris@pharmacy.ks.gov
Opportunity The State of Kansas is statutorily tasked with sending out Person of Interest (POI) alerts to prescribers and dispensers of patients who meet a state determined threshold for controlled meds abuse. The use of K-TRACS alerts in Kansas is considerably hampered by the extensive labor and costs required for manual letter processing and delivery. As such, alerts are currently sent only quarterly, which is highly sub-optimal from a patient care standpoint. Additionally, current only send alert letter and not patient profile due to security concerns via due to the delivery method of postal mail. Secure clinical messaging delivery would alleviate this concern and allow us to include patient profiles.
Use Case/Solution The tools provided by Cerner, including Health Information Service Provider (HISP) capability and online Electronic Health Record (EHR) system with integrated Direct inbox, will be used to drastically improve the availability of K- TRACS alerts at the point of care and the amount of information a provider receives. Cerner will leverage an existing client base to generate a set of pilot participants. This pilot addresses the use of Direct messaging to deliver unsolicited K-TRACS alert reports to ambulatory clinic providers in Kansas for patients over the defined threshold 4 prescribers/1 or more pharmacies/in 30 days(4/1/30). (Usual KS threshold is 5prescribers AND 5 dispensers in a quarter OR 10 prescribers/1+ dispensers OR 10 dispensers/1+ prescriber in a quarter)
Alert Dissemination Process K-TRACS 1 2 3 Kansas PDMP PDF/HC App or other solution Cerner Direct (Secure E-mail) Providers with Cerner EHRs who have prescribed to a given patient (Kansas or Missouri)
What is Direct - Simplified Think of Direct as Electricity or Phone Lines Phone lines needed before your phone works Electricity needed for your toaster/radio to work Simply a secure transportation vehicle Allows separate organizations to securely and reliably exchange sensitive information No custom or expensive interfaces required Given an address, just like an email address (drbob@direct.ahospital.org) Uses for Direct? It s not just email Start with any workflow that involves fax/phone/paper Ad Hoc communication, Referrals, Results Delivery, Unsolicited Reporting No limit to uses, be creative Kansas Board of Pharmacy
Sample Screenshot from Cerner Direct-Outbound
Sample Screenshot from EMR-Inbound
Scope of Pilot: Lawrence Memorial Hospital Lawrence Memorial Hospital 173 bed community hospital 18 clinics across Lawrence and Douglas County 161 physicians (employed, hospitalist and affiliates) Potential to send KTRACS alert to all physicians at all LMH locations across Lawrence and Douglas county Site Visit Interview Team Dr. Sabrina Pruett, ED Director Jane Maskus, CIO Patrick Parker, Director of Pharmacy Travis Ptacek, Director Information Systems (Ambulatory) Michael Williams, Directory Information Systems (Inpatient)
Scope of Pilot: Heartland Health (Missouri) Integrated Health Delivery System that includes: Heartland Regional Medical Center 392 bed level 1 trauma center 38 clinics across NW Missouri and North Kansas City 354 physicians (employed, hospitalist and affiliates) Potential to send KTRACS alert to all physicians at all Heartland locations across Lawrence and Douglas county Site Visit Interview Team Dr. Joe Boyce: Chief Medical Information Officer Thomas Medsker: Enterprise Solution Specialist Brennan Lehmann: Director of Information Systems Mike Dittemore : Lewis and Clark Information Exchange
Scope of Pilot: LaFene Health LaFene Health Clinic Student Health Clinic located on the campus of Kansas State University Multiple in-house services include laboratory, pharmacy, radiology, women s clinic, physical therapy, nutrition clinic and primary care 9 staff practitioners for primary care including MDs, PAs, etc. Additional clinical staff (pharmacy, rad techs, etc.) Highly integrated clinical teams, preliminary medical home model Site Visit Interview Team Dr. Megan Mudrick (Primary Care) Dr. Robert Tackett (Medical Director) Mark Brown-Barnett, R.PH (Pharmacy Director) Shecky Davis (Director of Administration) Julie Gibbs, MPH (Health Promotion) Robin Millington (Administration) Clinic
Total Scope: By the Numbers 2 Hospitals, 565 beds in total 59 clinics across Kansas and Missouri 531 total physicians available to be reached by pilot ***High-level map of Providers in Pilot across KS/MO. Not indicative of all facilities represented by Heartland and LMH.
Project Artifacts: Full Service HISP (RA, CA, HISP) During the course of this State of Kansas Pilot Project, Cerner performed the role of a Full Service HISP. This means that Cerner took on the responsibility of: RA (Registration Authority) RAs collect and verify identity information from Direct exchange Subscribers using procedures that implement the identity validation policies. The RA creates CSRs for submission to a CA. RA entities must utilize identity validation policies defined in the relevant certificate policy. CA (Certificate Authority) A Certification Authority is an entity that signs certificate signing requests (CSRs) and issues public key X.509 certificates to Direct exchange organizational or individual Subscribers. A CA must create a Certification Practices Statement that is conformant to the policies. HISP (Health Information Service Provider) The term HISP (Health Information Service Provider) describes an outsourced email service provider that follows Direct Project standards and represents the mechanism used to provision users with a universal, Direct email address. The HISP provides its users with an infrastructure that can manage message encryption, the circles of trust as to who can be communicated with, and the incorporation of appropriate policies and procedures necessary to ensure a level of confidence in provisioning members on the network appropriate to healthcare.
KS PDMP Project - Work Plan Prerequisite Configuration Launch Go-Live Onboarding Strategy Kick Off Meetings Identity Verification Access to Demonstration Environment Organization Validation Organization Creation Domain Set-up DNS Set-up Domain Testing Administrator Establishment Knowledge Transfer Sessions Creation of Direct Addresses Run Secure PDF Creator Direct Inbox Go-Live Message Center Go- Live Run KTRACS Alerts End-to-End Messages Turn Over to Support Secure PDF Creation Configuration Maintenance Mode
Quarterly Threshold Letter Statistics Quarter Number of Patients Most Pharmacies Most Physicians 1Q 2011 227 26 27 2Q 2011 233 24 26 3Q 2011 209 25 25 4Q 2011 181 31 31 1Q 2012 171 29 35 2Q 2012 166 19 26 3Q 2012 162 21 36 4Q 2012 152 23 36 1st Qtr 2011 2nd Qtr 2011 3rd Qtr 2011 4th Quarter 1st Qtr 2012 2nd Qtr 2012 3rd Qtr 2012 4th Qtr 2012 Jan-Mar 2011 Apr-June 2011 July-Sept 2011 Oct-Dec 2011 Jan-Mar 2012 Apr-June 2012 Jul-Sept 2012 Oct-Dec 2012 Threshold Patients 227 233 209 181 171 166 162 152 # Pharmacies Receiving Letter 411 400 367 347 380 340 346 335 # Prescribers Receiving Letter 1058 1206 997 920 996 927 935 872 Total Threshold Letters Sent 1469 1606 1364 1267 1376 1267 1281 1207
Next Steps K-TRACS Specific: Meet with KS Board of Pharmacy to discuss interest in continuing the pilot Meeting with K-TRACS and Lawrence Memorial Hospital to evaluate new project. (New project is EMR query directly to K- TRACS) Integration project in tandem with Lewis and Clark Information Exchange Work with KS Board of Pharmacy to educate KS stakeholders on this project, the use case and the go-forward potential
Questions? Christina Morris, JD Assistant Director, Disciplinary Counsel & PMP Program Director Kansas Board of Pharmacy 800 SW Jackson, Rm 1414 Topeka, KS 66612 P: 785-296-8717 christina.morris@pharmacy.ks.gov