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071 - Hardy

Pharmacy Technology BriefTRICARE Conference

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071 - Hardy

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    1. 071 - Hardy

    2. Pharmacy Technology Brief TRICARE Conference – January 2005

    3. 3

    4. 4 Military Health System Weekly Statistics 18,086 Admissions 1,460,000 Outpatient Visits 1,990,000 Prescriptions 2,013 Births 2,000,000 Claims Processed 382,725 Dental Procedures

    5. 5 Overview Consolidated Mail Outpatient Pharmacy (CMOP) Enterprise-wide Refill Request Processing and Appointment Reminder System CHDR Web Based Pharmacy Benefit Tool ePrescribing CHCS II/Pharmacy Commercial-Off-The-Shelf (RxCOTS)

    6. CMOP Update In brief…

    7. 7 CMOP Overview

    8. Overview

    9. 9 Prior to DoD contract award DoD Medical Treatment Facilities (MTF) utilized several different automated pharmacy refill request and appointment reminder systems throughout the Military Health System (MHS) with varying levels of functionality since the early 1990s. TRICARE Management Activity (TMA) initiated an effort to standardize these systems through the procurement of an enterprise wide contract for an automated pharmacy refill request and appointment reminder system. DoD contract award Tri-Service technical evaluation panel convened and selected AudioCARE Systems Refill Request Processing and Appointment Reminders for the Enterprise Background DoD, TMA awarded AudioCARETM Systems of Malvern, PA a contract for a automated pharmacy communication and appointment reminder system. AudioCARE Systems is a 15 year old company which was first deployed in the VA in 1989, then in 1995 in the NavyDoD, TMA awarded AudioCARETM Systems of Malvern, PA a contract for a automated pharmacy communication and appointment reminder system. AudioCARE Systems is a 15 year old company which was first deployed in the VA in 1989, then in 1995 in the Navy

    10. 10 AudioCARE System (ACS) Based in Malvern, PA Contract awarded 24 Nov 03. Contract protest/stop work: Dec 03 Contract resolution/start work: Mar 04 Prior to contract award Installed in 89 DoD sites with varying levels of functionality First AudioCARE system installed January 1996 (Goodfellow AFB) Currently at nearly all VAs ~153 sites Currently over 100 systems installed in 98 DoD sites

    11. 11 Installation of 35 new systems (8 Army, 8 Navy, 19 Air Force) and upgrading existing systems. On-site training for new systems (2-3 days). In FY 2005, license renewal / maintenance. Modules AudioREFILL – Prescription refills via telephone WebREFILL – Prescription refills via Web AudioRxMINDER – Rx pick-up reminders via telephone (DRX) AudioOFFLINE – Process phone-in Rx refills (CHCS/network unavailable) AudioRxORDER – New Rx and refill processing (CHCS/network unavailable) AudioCOMMUNICATOR – Automated messages AudioREMINDER – Appointment reminders via telephone TOL Integration – Rx refills and appointment reminders CMOP Functionality – Installed for future use NOTE: Sites responsible for renewal of licenses/contracts for any modules not included in the DoD Enterprise Wide contract.

    12. 12 Implementation period MAY 2004 – AUG 2005 Focus Expiring contracts Problems No system Upgrade Modules/Hardware Coordinating efforts with Pharmacy, Patient Appointing, and CIO representatives from each Service (Tri-Service Working Group). Implementation Plan and Strategy

    13. 13 Working Group Members Pharmacy Functionality: Maj James Czarzasty (Air Force); phone: (703) 681-6184; email: James.Czarzasty@pentagon.af.mil MAJ Travis Watson (Army); phone: (202) 782-0363; email: Travis.Watson@na.amedd.army.mil LT Randy Anderson (Navy); phone: (301) 319-1290; email: randyanderson@us.med.navy.mil Patient Appointing Functionality: CAPT Christine Boltz (Navy); phone: (202) 762-3147; email: CBoltz@us.med.navy.mil COL Christie A. Smith (Army); phone: (210) 221-7055; email: Christie.Smith@amedd.army.mil Mr. David Corey (Air Force); phone: (703) 681-6191; email: David.Corey@pentagon.af.mil IM/IT (CIO) Service: Maj James Czarzasty (Air Force); phone: (703) 681-6184; email: James.Czarzasty@pentagon.af.mil MAJ Patrick Shannon (Army); phone: 703-681-3423; email: patrick.shannon@us.army.mil LT Randy Anderson (Navy); phone: (301) 319-1290; email: randyanderson@us.med.navy.mil

    14. Overview

    15. 15 CHDR Pharmacy Prototype CDR – Clinical Data Repository – DoD HDR – Health Data Repository – VA C/HDR Pharmacy Prototype Initial effort within the CHDR framework to achieve interoperability Demo exchange of patient information for the purposes of proactively providing interoperable/computable pharmacy clinical decision support to patients from both Departments Allergies Prescription fills (info only vs. order portability)

    16. 16 CHDR Pharmacy Prototype Architecture

    17. Overview

    18. 18 Estimated 98,000 patients die each year through preventable medical errors Processes to detect & reduce medical errors hampered by lack of integrated technology and decision support applications Key published documents JAMA, 1998 –”physicians should never again write a prescription” Institute for Safe Medication Practice, 2000 – “need to respond to medication errors by eliminating written prescriptions” State of the Industry Handwritten Rxs remain the norm rather than the exception Approximately 5-18% of clinicians create Rxs electronically Call for universal electronic prescribing remains loud & strong ePrescribing Exploration Background

    19. 19 ePrescribing Exploration Background DoD drafted electronic prescribing (eRx) white paper Documents the “as is prescribing process” and the “to be eRx” process for both direct care (MTFs) & non-direct (managed care support contractor) environments Over 98% of RXs ordered by direct care/MTF providers are electronic (CHCS/CHCSII) ALL Rxs ordered by non-MTF providers are handwritten & given to patient FY05 Congressionally-directed Protected Health Information Initiative (PHII) is aimed at enhancing patient care delivery, patient safety, & protection of patient information PHII will focus on concept exploration, requirement definition, and a pilot demonstration of the “to be eRx” in the non-direct care environment

    20. 20 DoD MHS Prescription Processing Key Features of “As Is ” Over 98% of Rxs ordered by direct care/MTF providers are electronically entered into CHCS or CHCSII Some are still handwritten Eligibility checked before provider sees patient through DEERS Clinical screening completed locally (CHCS) and globally (PDTS) Warning alerts received before patient leaves provider ALL Rxs ordered by non-direct care providers are handwritten & given to patient Rxs manually transcribed into pharmacy system (CHCS host, TMOP computers or retail drugstore system) Local drug-drug and drug-allergy checks performed Rx data transmitted to PDTS for global clinical screening PDTS performs eligibility check via DEERS for TMOP & TRRx Provider receives warning alerts from pharmacy after patient leaves office

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    23. 23 ePrescribing-Next Steps Formalize project partners Identify non-direct care providers that produce high MHS beneficiary Rx volumes Finalize functional requirements & scope of pilot demonstration Identify technology solutions that leverage existing MHS architecture & applications

    24. Overview

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    30. CHCS II/RxCOTS Overview

    31. 31 Migration Overview CHCS I – CHCS II

    32. 32 CHCS II/RxCOTS Current and Future Capabilities — Pharmacy Trends Enterprise pharmacy functionality Clinician ? Pharmacy Provider ? Patient Inpatient Provider Order Entry Functionality Barcode to Bedside Barcode matching of medication to patient Automated Medication Administration Record Expand drug alerts Drug-organ Immunization-allergy

    33. 33 CHCS II/RxCOTS Current and Future Capabilities — Pharmacy Trends Drug alerts in the battlefield Automated presentation of therapeutic alternatives Depleted supplies Non-availability of 1st choice Alternatives based on indication and cost Standardization - One Enterprise Drug File Centrally managed updates to drug file Increases cost effectiveness Uniformity across the Military Health System 3rd Party Collections – Increased claims integrity

    34. 34 Integrated Inventory Package (POS Tracking, Ordering, Reporting and Auditing) Information-only Orders Identify potential drug interactions without creating a fillable order Register non-prescribed drugs in patient’s profile (Herbal meds) Industry Standard Interfaces In-patient / Out-patient Robotics Refill System Clinical Information System Migration of PDTS Capabilities Operational Benefits

    35. 35 Interfacing Overview Benefits of Using Commercial Software and Standards

    37. 37 Current PDTS Architecture Enterprise-Wide Drug Screening

    38. 38 Future PDTS Architecture Enterprise-Wide Drug Screening

    39. 39 One Pharmacy Data Set for Direct Care

    40. 40 Bundled COTS Services Benefits Adoption and incorporation of industry “best practices” into system upgrades Full life-cycle maintenance Fixed life-cycle pricing Supported by DoD Pharmacy Board of Advisors

    41. 41 IPS Two-phased Approach Approved by ASD (HA) Sept 1998 Phase I - Pharmacy Data Transaction Service (PDTS) Directed by NDAA FY 2000 Based on commercial standards Fully implemented as of 25 June 2001 Phase II – RxCOTS Strategic IM/IT Solution, fully integrated within MHS Completes fulfillment of GAO and Congressional directives Solves ongoing long term inventory/logistics deficiencies identified by DoD IG

    42. 42 Pharmacy COTS Interoperability Test TMA initiated program to find suitable RxCOTS product to replace/enhance existing CHCS legacy pharmacy module (1999) TMA selected BDM Information Systems’ Pharmacy System (now GEMS IT) for “fly-off” against CHCS Pharmacy module and Proof of Concept (POC) with CHCS II through a full and open competition (1999) BDM product tested against CHCS Pharmacy module; BDM determined superior to CHCS Pharmacy module (1999-2000) Integic, CHCS II integrator, began integration testing with CHCS II and BDM product (June 2000) Proof of Concept successfully completed (September 2003)

    43. 43 Current Pharmacy COTS Acquisition Funding and contracting through CHCS II Program - Clinical Information Technology Program Office (CITPO) RFP Developed: Dec 2002 – Nov 2003 RxCOTS RFP (full & open competition) released:12 Nov 03 RxCOTS solicitation period closed: 26 January 04 Pre-award protest submitted: May 04 Protest denied by GAO: July 04 Contract Awarded: General Electric Medical Systems Information Technologies, Inc (22 October 04) Readiness - Immunization tracking; real time clinical info Readiness - Immunization tracking; real time clinical info

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    47. 47 Contact Information LCDR David Hardy Phone: 703-681-0064 x3651 DSN: 761-0064 Fax: 703-681-1242 E-Mail: David.Hardy@tma.osd.mil LT Mathew Garber Phone: 703-681-0064 x3651 DSN: 761-0064 Fax: 703-681-1242 E-Mail: Mathew.Garber@tma.osd.mil Mr. Henry Gibbs Phone: 703-681-0064 x3670 DSN: 761-0064 Fax: 703-681-1242 E-Mail: Henry.Gibbs@tma.osd.mil

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