Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL

1. Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL Mike Mims Program Manager for Pharmacy Systems

2. PRE Background • Many VHA technology problem areas and weaknesses identified • Prior to 2001 First Consulting study • Included patient safety issues • SwRI awarded multi-year, fixed-price contract • FY04 to develop new pharmacy system • Renewable annually starting in FY05 • Period of performance ends January 2008

3. FY07 - Changing Environment • Entire VA Environment changed • New Organizational Structure • Continuing Resolution • No Approved Budget (80% of FY06 Budget) • Unable to move forward with New Contract with SwRI • Generated Re-planning effort

4. PRE Restructuring in FY07 Reasons for change: • Budget reductions, PRE & dependent projects • Uncertain/incomplete HeV Architecture • Lack of Common Services maturity • Pharmacy “Out of Sequence” • Perceived Duplication of Efforts • Standards and Terminology Services

5. 2007 Development PlansGoals for New Plan • Stay within expected budget • Release something of value to field in 12-18 months • Priority to address recent patient safety issue • Reduce/delay dependencies on other development efforts • Review scope of SwRI contract & distribute work as appropriate

6. 2007 Development PlansGoals for New Plan (cont’d) • Spread release of PRE functionality over long period to allow architecture to mature • Phase new staff into VA Teams to help transition PRE development in-house • Incorporate Standards and Terminology competencies/resources into project team

7. Standards And Terminology Services Added to PRE Team • Terminology standardization includes: • Analysis of current usage and existing standards • Determination of the VHA standard • Assignment of unique identifiers (VUIDs) • Modeling the term to ensure consistent meaning • Implementation/Deployment of the standard

8. Standards And Terminology Services Added to PRE Team (cont’d) • Terminology standardization includes: • Maintenance of the national standard through additions and deletions of terms • Monitoring sites for compliance with the national standard

9. Revised PRE Plan – Overview • SwRI FY07 Contract • $2M for PEPS v0.5 • $5M proposed to develop significant v1.0 components • FY08: Recruit staff for transition to in-house development • Redistribute SwRI tasks to other development teams • 5 major releases deployed over 7 years

10. PRE Versions • PRE v0.5, v1.0 and Remaining Work • Major Features • Schedule • Costs (current)

11. PRE v0.5 Order Checks

12. PRE v0.5 Builds on December 2006 Proof of Concept • Implements all demonstrated order checks • Use commercial drug database services • Enhanced order checks • New dosing checks • APIs to support order-check enhancements through legacy Pharmacy & CPRS

13. PRE v0.5 Major Features VistA Enhancements • Enhanced Checks • Drug-Drug • Duplicate ingredient (drug) • Duplicate Therapy (class) • New Checks • Maximum Single Dose • Daily Dose Range

14. PRE v0.5 Major Features VistA Enhancements • Renal/Hepatic Impairment Dose Indicators • APIs to support order check enhancements • Ability to i.d. recently DC’d/expired med orders

15. PRE v0.5 Major Features HealtheVet Construction • Create COTS Drug database - Legacy VistA interfaces • Components developed for Proof of Concept

16. PRE v0.5 Assumptions • No local data migration or conversion required • Minimal FDB–VistA data mapping required • FDB Enhanced Therapeutic Classification (ETC) used for duplicate therapy checks only • Standard FDB processes for database updates • GCN_SeqNO populated in NDF for all drugs in order checks

17. PRE v0.5 Responsibilities PRE Team • Overall project governance • Design & develop • VistA changes to legacy pharmacy • VistA interfaces with PEPS

18. PRE v0.5 Responsibilities Standards and Terminology Services (STS) • Lead VistA NDF data standardization efforts • Provide requirements to PRE team • Lead Structural/content analysis • Med Routes, Drug Interactions, VA Product, & Drug Units files • Model Terminology • Maintain standard terminology • Possible VistA-PEPS-COTS data mapping • Validate local mappings

19. PRE v0.5 Responsibilities Southwest Research Institute (SwRI) • Design & develop PEPS interfaces for VistA - FDB order-check messaging • Based on FY06 PEPS v1.0 Proof of Concept • Support PRE v0.5 stages I and II testing

20. PRE v0.5 Schedule PRE v0.5: Enhanced Order Checking Functionality Coding/St. I Test 1 2 3 4 5St. II 6St. III 7Deployment

21. PRE v0.5 Risks • Production environment • Support staff • Legacy system enhancements • Performance • COTS drug database licenses

22. PRE v0.5 Dependencies • Standards & Terminology Services (STS) • SwRI • CPRS • COTS Drug Database

23. PRE v0.5 Costs • VA staff: $1.34 million • Non-VA: $4.07 million • Includes • PRE contract staff • PRE support from CPRS, STS, BCMA, EVS contractors • Contractor travel • Equipment: $70k

24. PRE v1.0 Remaining Pharmacy Enterprise Product Systems (PEPS) Functionality

25. PRE v1.0 Major Features VistA Enhancements • All v0.5 functional plus: • Identify  • Product type and storage requirements • High-risk drugs for follow-up • Drugs requiring witness for administration • Display of lab/vitals information

26. PRE v1.0 Major Features VistA Enhancements (cont’d) • Implement dispensing limits (qty/days supply) • Enhanced do-not-mail functionality • Order Checks • Lifetime cumulative dose • IV compatibility

27. PRE v1.0 Major Features HealtheVet Construction • Replace legacy PDM and NDF applications • Drug update and maintenance tools • Ability to manage pharmacy users’ roles • Enhanced system management tools • Improved reporting capabilities

28. PRE v0.5 Schedule PRE v1.0: Remaining Pharmacy Enterprise Product System (PEPS) functions Coding 1 2 3 4 5 6Test I 7Test II 8Test III 9Deployment

29. PRE v1.0 Costs • VA staff: $928k • Non-VA: $8.85 million • Includes • PRE contract staff • PRE support from CPRS, STS, BCMA, EVS contractors • Contractor travel *v1.0 SwRI Costs estimated based on remaining contract funds • Equipment: $40k

30. Beyond PRE v1.0 Remaining Pharmacy Enterprise Product Systems (PEPS) Functionality

31. Beyond PRE v1.0 • Working with Business Owners • Organize • Prioritize • Sequencing must consider: • Patient safety issues • Funding requirements • Availability of common services • Ability of other applications to implement

32. Major Features – Remaining PRE PRE v2.0Inventory • Replace current packages • Controlled Substances • Drug Accountability • Automatic Replenishment/Ward Stock • Requirements gathering based on SwRI work

33. Major Features – Remaining PRE • PRE v3.0Order Entry, Clinical Monitoring • Replace parts of current packages • Outpatient • Inpatient • IV order processing • Changes to support ordering through CPRS • Based on requirements gathered by SwRI • In-house analysis & construction

34. Major Features – Remaining PRE • PRE v4.0Dispensing functions • Replace remaining order processing parts • Outpatient • Inpatient • IV • Based on requirements gathered by SwRI • In-house analysis & construction

35. Major Features – Remaining PRE • PRE v5.0Administration • Replace current BCMA functions • Based on requirements gathered by SwRI • In-house analysis & construction

36. Schedule Remaining PRE Functionality PRE v0.5 PRE v1.0 PRE v2.0 Inventory PRE v3.0Order Entry, Activate & Clin Mon (HeV) Coding PRE v4.0Dispense PRE v5.0Administration & Migration

37. Questions?