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So You Think You Can Prescribe? (Electronically) Andrew Premvardhan & Rachel Hiatt, Product Analysts April 2015

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2015 General Electric Company All rights reserved. The results expressed in this document may not be applicable to a particular site or installation and individual results may vary. This document and its contents are provided to you for informational purposes only and do not constitute a representation, warranty or performance guarantee. GE disclaims liability for any loss, which may arise from reliance on or use of information, contained in this document. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE. DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GES DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE. GE, the GE Monogram, Centricity, and imagination at work are trademarks of General Electric Company. All other product names and logos are trademarks or registered trademarks of their respective companies. General Electric Company, by and through its GE Healthcare division. All other product names and logos are trademarks or registered trademarks of their respective companies. 2

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Todays Agenda Electronic Prescribing of Controlled Substances (EPCS) Overview Regulatory and All that Jazz Modern Design Hip Hop through Prescriptions Demo Q&A 3

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EPCS in Centricity Practice Solution 12.2 / Centricity EMR 9.10 Includes Support for Electronic Prescribing of Controlled Substances (EPCS) 12.1 / 9.9 Fixes and Enhancements New Family History/Social History Form Simplified Installation LA tracking to May/June Initially Targeting Customers in NY State NYS eRx Mandate Postponed to 3/27/16 GA in Q3 to Full Installed Base

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Regulatory and All that Jazz

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6 The ruling time signature (Regulatory requirements) Selecting the music (Setting up for ePrescribing)

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The Ruling Time Signature: Regulatory 7

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8 In 2011, the #1 source of nonmedical use of prescription painkillers was a single doctor. 1 1. Source: ONDCP National Survey on Drug Use and Health 2011, pg. 29: https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/nsduhresults2011.pdf https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/nsduhresults2011.pdf

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The Ruling Time Signature: Regulatory 9 Increasing legislation to combat drug abuse Source: CDC Vital Signs http://www.cdc.gov/vitalsigns/opioid-prescribing/infographic.html#infographic2http://www.cdc.gov/vitalsigns/opioid-prescribing/infographic.html#infographic2

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Selecting the Music: Setting up for ePrescribing 10

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11 PRESCRIBE TRANSMIT DISPENSE COMPLETED eRx DELIVERED eRx ORDER ENCRYPTED AUTHENTICATE FIPS PUB 140-2 COMPARE HASH AUTHENTICATION MGMT AUTHENTICATION MGMT FIPS PUB 180-3 FIPS PUB 186-3 NIST 800-63-1 NIST 800-76-1 NIST 800-53 REPORTS INCIDENT RECORDS SIGN Descriptions of Future Functionality reflect current product direction, are for informational purposes only and do not constitute a commitment to provide specific functionality. Timing and availability remain at GEs discretion and are subject to change and applicable regulatory clearance.

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Selecting the Music: EPCS Requirements Identity Proofing Institutional or Individual Identity Proofing Credentialing Two-Factor Using Fingerprint or Token with Password Access Control Configure and Approve Access in the EMR Auditing Audit Trail of All Activities AUTHENICATION MANAGEMENT

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Two Types of Identity Proofing and Credentialing Institutional Identity Proofing [The DEA] allows institutional practitioners, which are themselves DEA registrants, to conduct the identity proofing for any individual practitioner whom the institutional practitioner is granting access to issue prescriptions using the institutions electronic prescribing application. Individual Identify Proofing For individual practitioners in private practice (i.e., those practitioners not seeking access to an institutional practitioners applications), DEA will use existing certification authorities (CAs) and similar credential service providers (CSPs) that have been approved by a Federal authority. AUTHENICATION MANAGEMENT

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Institutional Credentialing Verifies practitioners are licensed and allowed to prescribe controlled substances Medical Credentialing Office Creates a list of practitioners that are allowed to electronically prescribe controlled substances Creates a list of users that can approve EPCS access in the EMR Information Technology Synchronizes Imprivata Confirm ID with AD accounts of practitioners Verifies photo IDs of practitioners match those on the list from the credentialing office Issues two-factor credentials to practitioners and supervises enrollment of credentials in Imprivata Confirm ID Imprivata Confirm ID creates records of IDs verified and issuance of credentials Enrollment Supervisors EPCS Sets EPCS access for practitioners in EMR that has been certified for EPCS EMR Administrator EMR Administrators must be a different entity/group than the Medical Credentialing Office EPCS Access Approvers Approves EPCS access for practitioners in the EMR (does not require two factor authentication) Approvers must be a different group than the EMR Admins (DEA registrants not required) AUTHENICATION MANAGEMENT

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Individual Credentialing EPCS Sets EPCS access for practitioners in EMR that has been certified for EPCS EMR Administrator EMR Administrators must be a different entity/group than the Credential Service Provider EPCS Access Approvers Approves EPCS access for practitioners in the EMR using Imprivata Confirm ID two factor authentication Approvers must be a different group than the EMR Admins (DEA registrants required) Imprivata Confirm ID performs NIST Level 3 identity-proofing of practitioners using social security number, date of birth and credit card information Credential Service Provider Imprivata Confirm ID registers and issues tokens to practitioners via two channels Practitioners can optionally self-enroll fingerprints with Imprivata Confirm ID Imprivata Confirm ID automatically creates records of issuance of credentials Information Technology Synchronizes Imprivata Confirm ID with AD accounts of practitioners AD accounts must include the full legal name of practitioners and valid e-mail addresses AUTHENICATION MANAGEMENT

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Implementation Action Items List of practitioners who will require EPCS (AD group(s)) Credentials that will be issued (fingerprint vs. token) List of enrollment supervisors for institutional identity proofing List of EMR EPCS access approvers for individual identity proofing List of users who will Enroll users in the EMR List of users who will Approve users in the EMR Credentialing Team verifies approval checklist Identify Reviewer for EPCS Reports Identify eRx Administrator AUTHENICATION MANAGEMENT

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Authentication Regulations Application uses an authentication protocol that uses two of the following three factors: Something the practitioner knows Something the practitioner has Something the practitioner is Fingerprint readers and tokens (compliant with FIPS and NIST standards ) tokens must be separate from the computer used for prescription biometric must be co-located or built in to the computer used for prescription Application allows a practitioner to sign multiple prescriptions for a single patient Only prescribing practitioner is allowed to sign Surescripts Requirement Prescriber vendors shall display a summary screen in order to allow the prescriber to review the prescription and ensure that it contains the correct information before it is sent to the pharmacy. 17

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Modern Design

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Designing the steps (Designing for the users) Finding the right partners (Partnering for usability)

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Modern Design: Research, Design, Test, Repeat Formative Usability Round 1 Jul-Aug 2014 Three focused workflows 17 participants Design Review & Revision Round 1 May-Jun 2014 Reviews with clinical specialists Patient Safety design evaluation Design Revision Round 2 Sept 2014 Usability analysis Design simplification Regulatory Review Jul-Aug 2014 Surescripts review Requirements analysis

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Modern Design: Prototype 1: May-Aug 2014

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Modern Design: Key Observations Focal point for medication management Data organization is critical for processing information Providers need maximum space to see all medications

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Modern Design: Evolved Design Remove extra Outgoing ePrescriptions list Make medication-disease connections obvious Make pharmacy changes simple Improve visibility of chart information without compromising prescription real estate

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Hip-Hop Through Prescriptions

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Dancing with the legends Prescribing legend drugs electronically Dancing with control Prescribing controlled substances electronically

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Demo

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Questions?