louis cheung, clinical systems application pharmacist, peninsula health - exploring what is needed...
DESCRIPTION
Louis Cheung delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems. For more information, please visit http://www.healthcareconferences.com.au/emed14TRANSCRIPT
System Interface Between Two Vendors: Cerner Powerchart with
CSC iPharmacy
Louis Cheung, Peninsula Health
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Peninsula Health - background
Major public health care provider serving metro and rural areas on Victoria’s Mornington Peninsula (catchment area of approx. 850 sq. kms)
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Peninsula Health - background
Measure 2011-2012
Staff (EFT) Medical 373
Nursing 1517
Allied Health 328
Other 1168
Total 3386
Structure Facilities Acute (incl. Maternity), Sub-
acute (incl. residential care),
Mental Health and Community
Health
Beds 878 (Acute -527, Mental Health
– 74, Rehabilitation, Aged and
Palliative Care – 277)
Theatres 8
Throughput Admissions(Overnight/Day) 75,345
Community Occasions of Care 235,467
Babies Born 2675
Emergency Visits 79,311
Operations 15,121
Development of e-MR at Peninsula Health – Background/Timelines
2007 2002 October
2009 June
2011
June 2012 August
2013 Oct 2014
Investigated other
clinical solutions.
Business case
developed
Orion implementation: e-
results viewing, Dis Summ,
Dis meds &e-prescribing
(sub-acute)
Announced as Lead
Agency (with Austin
Health) to implement
HealthSMART Clinicals
using Cerner First Go-Live of
Stage 1, Phase A
Final Go-Live
of Stage 1,
Phase A
First Go-Live
of Stage 1,
Phase B Final Go-Live
of Stage 1
Phase B
Proposed
EDIS Go-Live
November
2011
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Clinical system at Peninsula Health – 2013
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Cerner
Millenium
iPM
Synapse
Dorevitch
Radiology
PAS
Pathology
Pharmacy iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Why interface?
Marianne Lisby, Lars Peter Nielsen, and Jan Mainz. Errors in the medication process: frequency, type, and potential clinical consequences
Int J Qual Health Care (2005) 17 (1): 15-22
Dispensing
Inventory Control
Purchasing
PBS Claim
Reports
Prescribe in Cerner Powerchart
Clinical review & product assignment in
Cerner’s PharmNet e-Rx (inpatient &
discharge)
De
cisi
on
su
pp
ort
iPharmacy X
Integration between two vendors
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
ACK
Medication Process Workflow
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Boy accepts dare…
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
"The Simpsons Movie" Copyright © Fox Network
Boy loses control of his skateboard…
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
"The Simpsons Movie" Copyright © Fox Network
On admission
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Bart’s details are entered into iPM
• Weight and allergies are documented
• Pathology and radiology tests are ordered
Document home medication and Admission medication reconciliation
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Home medications are documented electronically
• Home medications are reconciled on admission and inpatient medications charted on the same screen
Clinical ordering
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Inpatient medications are ordered
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Inpatient eRx
• Cerner Powerchart will differentiate between imprest and non-imprest items
• Only verified items will send an eRx message
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Discern report to replace inpatient eRx
• PH has developed a discern analytics report + Excel macro to filter all non-imprest orders regardless of verification status
Doctor rounds
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Discharge reconciliation
• Home and inpatient medications are electronically converted and reconciled in Cerner Powerchart
iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
Refill
• These discharge orders appear in PharmNet Retail ready to be ‘refilled’
• Select a dispensing pharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
• Pick the product off the shelf then select that product in the PharmNet product window
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
• Check that the order (quantity, SIG) is OK to be sent to iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
• Repeat for other eRx orders
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• Open iPharmacy 5.7.1002 build 6 or later version
• Click on Dispensing > e-Rx orders
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• Search for patient UR and select appropriate eRx orders
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• Check that the orders are OK to be dispensed and click ‘Process’
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• iPharmacy will do a patient entitlement and financial values check
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Records of dispensing in Powerchart
• Right click the discharge prescription order in Powerchart > click ‘Order Info’ > History tab
Difference between inpatient and discharge eRx
Data Inpatient Discharge
Application Med Manager Retail
Product Automatic Manual
Verification/Refill Automatic Manual
SIG translation No Yes
Quantity Automatic (system) Automatic (doctor)
Other Cartfill reports
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Pilot wards for discharge eRx: ED, ESSU, ESW
Build Design
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
e-Chinese Whispers
Cerner PharmNet
CSC iPharmacy
HSS IE
PH IE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Testing, testing and more testing…
Devil is in the details
Prescriber
• Name, alias, PBS prescriber #
Patient
• Name, Medicare, concession, address, etc
Order details
• Product, Order ID, dispense ID, SIG, quantity, UOM
PBS data
• PBS restriction, streamline, authority codes, reg 24
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Where’s Wally?
MSH|^~\&|CERNERPHARM|FH|PHIE|FH|20140307191711||ORM^O01|Q77776745T80839191|P|2.3.1
PID|1||0000000^^^FH^MR~~ERROR^^^AUSHIC^PEN~~30026770712^^^AUSHIC^MC||Dummy^Fred^John^^^^CURRENT~Dummy^Fred^Tester^^^^A||19210101000000|M||8|Kkljklk.^3 Frankston-Dandenong Rd^Frankston^VIC^3199^Australia^4~10 Olive St^^Overseas^VIC^8888^Overseas^3~Po Box 25 Bruce Stre^^Mentone^VIC^3194^Australia^2||(097)870-9999^PRN^PH||8179|5|2011||||||||0|||||N
PV1|1|PBS Outpatient Invoice|E2220^F020^F020^2220^^Bed170^2220|6|||^^^^^^^^^^^^BUILD_ERROR||||||||||PH00129^HEWITT^Helen^^^Dr.^^^^^^^External Identifier~R173^HEWITT^Helen^^^Dr.^^^2220^^^^ORGANIZATION DOCTOR~0584286A^HEWITT^Helen^^^Dr.^^^2220^^^^Provider Num|E|6583907^^^2220|NON PBS||Y|||||||||||||||||2220||C|||20130920080000|20130920152255
ORC|NW|185227631^HNAM_ORDERID|15072268^DISPENSEID|15072270^HNAM_RUNID|NW||^^D1^20140307000000^20150307235959^CD:7159890^^Take 6 mL FOUR times a day||20140307191710||^CHEUNG^LOUIS|PH00090^PH00090 PH00090 Katherine BRISTOW^0874363~~|CD:18579840^^^CD:9572758^^Pha193^2220||20140307191710|NW|CD:28549375
RXO|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^Stocca|1||^bottle(s)|CD:318203^|||E2220^F020|||1||0||||15072268
RXR|^Oral
RXE|^^D1^20140307000000^20150307235959^CD:7159890^^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle T6 ELIXIR QID #1|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^AMT-TPP^22589011000036109^paracetamol 240 mg/5 mL elixir 200 mL^AMT-MPP|1||mls^mL|CD:318203|^T6 ELIXIR QID~^Take 6 mL FOUR times a day~^Take 6 mL FOUR times a day||Y|1|mls^mL|0|PH00090^BRISTOW^Katherine^^^Dr.^^^^^^^External Identifier~0874363^BRISTOW^Katherine^^^Dr.^^^AUSHIC^^^^PRES~SS10^BRISTOW^Katherine^^^Dr.^^^2220^^^^ORGANIZATION DOCTOR~2049737X^BRISTOW^Katherine^^^Dr.^^^2220^^^^Provider Num|PH04471^Cheung^Louis^^^^^^^^^^External Identifier|33723628-||00|20140307000000|||~^PBS~~OPDRX^Outpatient Pharmacy
RXR|^Oral|||MED
RXC|B|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^AMT-TPP^22589011000036109^paracetamol 240 mg/5 mL elixir 200 mL^AMT-MPP|1|mls^mL|1
OBX|1||1770E^N||||||||
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Aligning the databases
• 1,200 doctors mapped and cross-checked.
– Name, unique ID and prescriber #
– Currently 1,400 doctors mapped
– IT provisioning send doctor codes to pharmacy
• iPM (PAS) feeds patient information into both Cerner applications and iPharmacy
– no mapping required between Cerner & iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Aligning the databases
• Using the Trade Product Pack (TPP) code,
– 3,200 formulary items mapped and cross-checked
• Generic, brand, strength, form and pack size
– 3,200 product unit of measure (UOM) cross-checked and discrepancies addressed
– 5,600 item formulary statuses mapped
– Review every 3 - 6 months
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Aligning the databases
• 3,200 drug imprest locations mapped
– Only non-imprest items are sent through the inpatient eRx
• 40 inpatient wards mapped
– Outpatient wards not currently using Powerchart
• PBS codes
– Various salts (e.g. clopidogrel)
– Dispersible vs. non-dispersible (e.g. omeprazole)
– Various pack sizes (e.g. Slow-K vs. Span K)
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Building/translating the SIG
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dosage Form
Verb Quantity per dose
Unit of measure
Route Frequency
Tablet Take x Tablet -
Capsule Take x Capsule -
Inhaler Inhale x Puff -
Liquid Take x mL by metric measure
-
Eye Drops Instill x Drop [route]
Patch Apply x Patch To the skin
• Example of SIG translations
Lessons Learnt
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Issues
• Problems on both sides of the fence
• PharmNet Retail
– unable to check PBS codes
– not suitable for PBS claiming
– Reg 24 and PRN not immediately obvious
– SIG does not always generate
• ‘Zz’, SIG = [dose][route][freq][duration][PRN][spec inx]
• iPharmacy issues
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
iPharmacy issues
Date Issue
16/08/13 When Editing a dispensing written by a doctor processed via e-Rx, it only allows us to choose a
16/08/13 Doctor prescribed Clopidogrel-DRLA with PBS code 5436D. In e-Rx pharmacist changed product to Pla
7/03/13 Want to be able to tick the 'Own Supply' tickbox from the e-Rx orders screen
5/07/12 Want to be able to alter the number of repeats from the e-Rx orders screen
19/03/12 The Total Qty being displayed in the Rx Details window is incorrect for orders passed from the
1/10/12 Cannot get the 'Team' field in the e-Rx screen to populate with the Prescriber's Team in i
28/05/12 The e-Rx module is unable to dispense an item not listed in the PBS/RPBS list but has been approved
10/05/12 In the e-Rx interface for Cerner, the Script Classification matches the first word in i.Pharmacy.
8/05/12 When the TPP from the ORM message does not automatically assign a product in the eRx window and
14/02/12 The "On Imprest" 'Action' default in the e-Rx window needs to consider the 'Check Imprest' value
14/02/12 Patient Price and PBS Claim Price are appearing as 0
19/01/12 Placer Filler number (Dispense_ID from Cerner) according to specs supposed to populate dspn_order_id
18/06/13 When dispensing a script from eRx functionality for a patient with GOLD card and SN card, it is rej
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Issues
• Initial testing shows increased time taken to dispense
– Due to iPharmacy issues
• Doctors don’t always get the quantity right
– Direct information to iPharmacy
• SIG is not always correct
– E.g. Spiriva inhalation capsules
• iPharmacy (Stocca) will reject messages
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Lessons Learnt
• Novel approach
– Process could be more streamline
– Preferable if eRx order could be dispensed straight from the eRx window
– Potential full roll-out across network if successful
• Testing, testing, testing…
• Vlookups will be your best friend
• Development/maintenance is a full-time job
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Thank you