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Consulting

Overview of Technology Overview of Technology Approaches of Medication Approaches of Medication Management in Long-Management in Long-Term CareTerm Care

Rachelle “Shelly” Spiro, RPh, FASCPPresident, Spiro Consulting

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LTC Electronic Health Record (EHR) Standards

e-Prescribing and eMARLTC e-Prescribing standards and pilotsSummary

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OverviewOverview

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HHS-ASPE Study to Access HHS-ASPE Study to Access Business Case for LTC HITBusiness Case for LTC HITTypes 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

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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/daltcp/reports/2006/BCfinal.pdf

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Source: 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

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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

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LTC EHR StandardsLTC EHR Standards

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CCHIT LTC RoadmapCCHIT LTC Roadmap

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CCHIT Roadmap for Expansion of Certification

Feb 2, 2007 Expansio

n Area

Jan-Jun2007

July-Dec2007

2008 2009 2010

Care Settings

Long Term Care

Furtherdiscussio

ns

BeginDevelopme

nt-------

Launch?

TBD

Launch

TBD

Proposed for August 2009

Source: http://www.ahima.org/infocenter/whitepapers/documents/Public_Comment_Expanding_CCHIT_Certification_Roadmap_20070202.pdf

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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

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e-Prescribing and eMARse-Prescribing and eMARs

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Pharmacy versus facility drivenIntegrationHardware and softwareFurther standards of eMAR and inventory

management is neededREMOTE DISPENSING*

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eMAR StandardseMAR Standards

*Covered in next presentation

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Reduction in Adverse Drug EventsReduction 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 Medicine’s 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

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Source: http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf

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Grantee/Contractor Project Titles Grantee/Contractor Project Titles for for e-Prescribing AHRQ Pilot Projecte-Prescribing AHRQ Pilot Project

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Organization Name

Project Name

Achieve Healthcare Information Technologies, LP

LTC E-prescribing Standards Pilot Site Study

Brigham and Women’s Hospital

Electronic Prescribing Using a Community Utility: The e-Prescribing Gateway

Ohio KePRO A Practice-Based Pilot Site Test of Emerging E-prescribing Standards

RAND Corporation Test of Medicare’s Initial Electronic Prescribing Standards in the New Jersey E-prescribing Action Coalition

SureScripts, LLC Maximizing the Effectiveness of E-prescribing Between Physicians and Community Pharmacies

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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

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Purpose of LTC e-Prescribing PilotPurpose of LTC e-Prescribing Pilot

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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

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e-Prescribing in the LTC Settinge-Prescribing in the LTC Setting

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LTC industry is working on EHR-S standardsLTC 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

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SummarySummary

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Consulting

Thank youThank you

Shelly Spiro

President, Spiro Consulting

1200 First Street, Suite 1632

Alexandria, VA 22314

703-599-5051

www.spiroconsulting.net

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