medication reconsiliation pharmacy informatics townhall december2012
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7/27/2019 Medication Reconsiliation Pharmacy Informatics TownHall December2012
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Presented by NCPDP and HIMSS for the Pharmacy Informatics Community
IMPROVING MEDICATIONRECONCILIATION WITH STANDARDS
Rick Sage, Sr. Vice President,Pharmacy Services, Emdeon
December 13, 2012
Keith Shuster, Manager, Acute
Pharmacy Services, Norwalk
Hospital
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Todays 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 centralizeddistribution 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 thecompanys 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 Ricks for the last
eight years.
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Agenda/Objectives
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Discuss medication management trends today
by exploring progress and barriers that have
been identified.
Explore new trends and available resources onthe medication reconciliation process.
Explain current standards and regulatory
requirements in place today including:
Meaningful Use, Joint Commission PatientSafety Goals and available NCPDP resources.
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A process for documenting a complete list of the
patients current medications upon admission to the
organization AND compare/reconcile the
medications the organization provides, upon...
A complete list of the patients medications is
communicated to the next provider of service
A Joint Commission National Patient Safety Goal
Medication Reconciliation
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Objective
Maintain and communicate accurate patient medicationinformation
Elements of Performance
Compare the medication information the patient brought to the
organization, with the medications ordered for the patient by theorganization,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
National Patient Safety Goal*: Medication Reconciliation
*Reference: Joint Commission
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Hospital Drivers
Hospitals are now financially penalized forreadmissions
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
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Automated medication reconciliation can help
accomplish NPSG.06.03.01 requirements by:
Reducing manual and redundant processes needed to
achieve NPSG accreditation
Increasing accuracy, thereby decreasing unintentional
medication discrepancies
Improving the accuracy associated with assessments formedication appropriateness
Increasing the speed by which valuable medication
reconciliation information is delivered
Automation and Medication Reconciliation
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Accurate/Timely medication history
Complete medication history
Medication name, dose, frequency
All medications from all sources (cash, OTCetc.)
Discussion with patient/family
Process for admission, transfer, and discharge
What not to take upon discharge
Keys to medication reconciliation
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Paper solution
Retrospective comparison upon admission
Hospital vendor solutions
Medication Reconciliation Trends
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Pharmacy prescription data
Pharmacy Benefits Management (PBMs)
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
Latest Trend - Automation
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PBM look up dependent onaccurate/matching name and DOB
Some 3rd party insurers do not participate
Staff role confusion Nurse, physician, and/or pharmacy
personnel
Timely arrival, data gathering, and exchangeof information
Trusting the information
Automation automatic
Barriers
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Key Drivers
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Evolution of HIT
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25 Years Now
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Recent Drivers
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ARRA
HITECH
MEANINGFUL USE
INTEROPERABILITY
MEDICAL HOME / ACOs
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Convergence
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Administrative
Clinical
Connect Capture Normalize ShareAnalyze &
Report
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Meaningful Use
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Critically important to
81% of surveyedproviders*
*Source: HEALTHCARE INSIGHTS 2012: SMALL PRACTICE RESULTS, EMDEON, 2012.
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But only 42% have
already fullyimplemented an EMR*
*Source: HEALTHCARE INSIGHTS 2012: SMALL PRACTICE RESULTS, EMDEON, 2012.
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Closer Look at Stage 2: Electronic Exchange*
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 EHR19 *HIMSS 2012 presentation by Robert Anthony
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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 CAHs
inpatient or emergency department
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*Page 175 of MU Stage 2 final rule
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Key Considerations
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Hospital/Acute Care
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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: 136.1 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: http://www.cdc.gov/nchs/fastats/hospital.htm
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Requires Additional Data & Collaboration
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Many medications are used for multiple conditions; all diagnoses not readilyavailable
Patients use multiple physicians
Primary Care Providers (PCPs) often do not have time to work with clinicalpharmacists 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 establishedmedication therapy
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Patient Authorization (HIPAA)
Patient authorizes to their
provider/physician or healthcare
provider either verbally or written, to
access any medical data, including
medication history
The requesting provider is responsible
to ensure that any request for
medication history information is madefor an authorized purpose, as defined by
HIPAA (meaning for, continuity of care,
avoidance of medication errors and
other treatment)24
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Supporting Standards
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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 andcash claims stored on pharmacy systems including OTC if submitted asa prescription
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A Real-Time Solution
Endpoints obtain pharmacy-sourced medication historythrough a single real-time inquiry accessed via anePrescribing application or web portal
Identifies a unique patient using person-matchingalgorithms based on several criteria including patient firstand 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 otherlegal requirements from the results
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Medication History Request/Response
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Entity
Entity
Medication History RequestMessage - RXHREQ
Medication History ResponseMessage - RXHRES
1. Requesting entity supplies enough information to uniquely identifypatient.
2. Prescriptions returned in the order of the most recent date filledfirst.
3. Requesting entity must evaluate the Patient Consent for accuratereporting.
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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
Providers application sends a flag in the medication history
request indicating that the provider has obtained theappropriate consent
The lack of consent will return a rejected response
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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 andHL7 based on the HL7 Clinical Document Architecture (CDA)
Generates Medication Action Plan and Medication List
May be used by pharmacists to conduct MTM medication reviewsanytime 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 tointegrate the active medication list and care plan into EHR
DERF approved during August 2012 WG10 meeting; Task Groupreconciling HL7 ballot comments; final ANSI approved versionexpected to be published May 2013
Key Contacts See Resource section
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Putting it All Together
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Name:Arthur DoeDOB: 01/01/1940Gender: Male
Notes:Has a primary care physician Sees 2-3 specialists per year Is on maintenance medications for
- Hypertension- Diabetes
Our Patient
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?
PCP
Specialist
Hospital
Pharmacy
Lab
Payer
101010001011
110011
101010001011110011
101010001011
110011
101010001011
110011
101010001011
110011
101010001011110011
Payer
Problems
Allergies
Active Medications
Results
Medicare 999999999BBCBST Z999999999
DiabetesHypertensionHyperlcholesterolemia
SulfaPenicillin
Metformin 500 MGLisinopril 10 MGLipitor 20 MG
HbA1c 6.2%Triglycerides 302 mg/dLTotal Cholest. 240 mg/dLHDL 70 mg/dLLDL 135 mg/dL
Arthurs data is
siloed on information islands.
Care is less coordinated.Quality is reduced.Payment and delivery are less efficient.
How do we bring it together?
HIEVisualized
Health InformationExchange
Patient Centric
Interoperable
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Medication Reconciliation (MR)
Improving Care
Transitions: Optimizing
Medication
Reconciliation: March2012
http://www.ashp.org
/DocLibrary/Policy/P
atientSafety/Optimizing-Med-
Reconciliation.aspx
CDA Release 2 Medication Therapy Management
http://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspxhttp://www.ashp.org/DocLibrary/Policy/PatientSafety/Optimizing-Med-Reconciliation.aspx -
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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 Spirowith Pharmacy e-HIT Collaborative,
shelly@pharmacyhit.org
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mailto:sthompson@ncpdp.orgmailto:shelly@pharmacyhit.orgmailto:shelly@pharmacyhit.orgmailto:sthompson@ncpdp.org -
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Thank You!
Rick Sage
SrVP, Pharmacy Services
Emdeon
817-887-0282rsage@emdeon.com
Keith Shuster
Manager of Acute Care
Pharmacy Services
Norwalk Hospital
Keith.Shuster@Norwalkhealth.org
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mailto:rsage@emdeon.commailto:Keith.Shuster@Norwalkhealth.orgmailto:Keith.Shuster@Norwalkhealth.orgmailto:rsage@emdeon.com
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