EHR for Outpatient Pharmacy: E-Prescribing

1. EHR for Outpatient Pharmacy: E-Prescribing Lori Moore Pharm D Office of Information Technology National Pharmacy Consultant June 16, 2011

2. E-Prescribing Objectives • Define E-Prescribing (aka E-Rx) • Delineate the E-Prescribing process • Identify sites who SHOULD implement E-Rx vs those where E-Prescribing is OPTIONAL • Identify requirements to be completed PRIOR to E-Prescribing implementation • Review the E-Prescribing deployment plan

3. E-Prescribing Terminology • I/T/U • IHS Federal Sites/Tribal/Urban Clinic Setting • Onsite Pharmacy • Pharmacy located “within” the health care clinic of an I/T/U site • Offsite Pharmacy • Pharmacy located outside of the I/T/U setting • AKA community pharmacy • Wal-Mart, Walgreens, CVS, Target, local “mom-n-pop” pharmacy, etc.

4. E-Prescribing Terminology Cont… • Outpatient Medications • Prescriptions processed by an onsite pharmacy located within an I/T/U clinic setting • Display on the medications tab under “Outpatient Medications” • RX # assigned after pharmacy finalizes the prescription review • RX# is numeric in value and specific to the site dispensing the medication • E-Prescribed Medications • Medications not available at your facility BUT they are ordered by your local I/T/U clinic providers and are processed/filled at the outside/community pharmacy • Display on the medications tab under “Outpatient Medications” • RX# generated once provider applies electronic signature and order is exported outside of your facility • RX is Identified with an “X” + a generic numeric number NOT specific to the actual prescription that will be handed to the patient once picked up at community pharmacy. • Outside Medications • Medications prescribed to a patient by a provider outside of the I/T/U clinic setting. • Example: Specialist writing for medications not filled/order by your staff but captured/documented by your staff to complete medication reconciliation • Displays on medications tab under “Outside Medications” • NO RX # associated with outside medications

6. E-Prescribing Overview

7. IHS RPMS/EHR E-Prescribing Functionality Today…. New Rx (Retail Pharmacy)

8. E-Prescribing & Surescripts Provider Identifier (SPI) Number

10. Preparing for E-Prescribing • RPMS Pharmacy 7 Drug File Clean-up • Drug generic name • VA Classification • DEA Special Handling Code • Order Unit fields • NDC • NDF Matching • Dosages • Application Packages • Orderable Item Management

11. Preparing for E-Prescribing Cont… • Implement clinical indications for medication orders • Every script sent out will require a clinical indication • Clinical indication field pulls ICD-9 diagnosis from: • Problem list • Today’s Purpose of Visit (POV) • Or providers can search for a diagnosis • Clean problem list will make e-rx more successful and easier on the provider

12. Preparing for E-Prescribing Cont… • Verify Station Number • Is it populated in RPMS? Is it accurate? • Prepare for SPI Request • Collect/Update Provider Information in RPMS

13. Preparing for E-Prescribing Cont… • Review the Surescripts website for local pharmacies participating in the Surescripts Network http://www.surescripts.com/ Look for the Find E-Prescribing Pharmacies tab

15. Preparing for E-Prescribing Cont… • No participating Surescripts pharmacies in your neighborhood? • Start surveying your patients and find out where they get their prescriptions filled • Contact the local pharmacy and find if there is a “plan in place” to become a participating pharmacy • If there is NOT a plan please contact the E-Rx team for more information……

16. Preparing for E-Prescribing Cont…

17. Preparing for E-Prescribing Cont… • Please go to the RPMS Training website to register for RPMS Pharmacy 5/7 Drug File Virtual Class Room trainings on the next slide: http://www.ihs.gov/RPMS/index.cfm?module=Training&option=index&sortChoice=Title&newquery=1

18. Implementing E-Prescribing • WHO can implement E-Rx? • E-Prescribing is available to any (I/T/U) site utilizing : • IHS RPMS EHR • RPMS Pharmacy 7 • Which version of E-Rx is right for me? • EHR Patch 8 • Sites with no pharmacy • Sites with pharmacy using COTS • Patch 9 • Sites with pharmacy using pharmacy 7

19. E-Prescribing Deployment Plan (Tentative) March 2011 Sites strive for 40% E-Rx MU Goal Surescripts Certification (Tentative) RPMS/EHR Sites with Onsite Pharmacy using RPMS Pharmacy 5/7 Implement E-Rx AVA patch v93.2p21 (Tentative) RPMS/EHR Sites with NO onsite Pharmacy Implement E-rx IHS RPMS/EHR Ambulatory EHR Certification Drug File Clean up Sites with onsite Pharmacy using RPMS Pharmacy 5/7 Sites strive for 40% E-Rx MU Goal Patch 8 Release (Tentative) Patch 9 Release (Tentative) E-Prescribing Demo\Overview for I/T/U Drug File Clean up for Sites with NO onsite Pharmacy Drug File Clean up for Sites with onsite Pharmacy using COTS Sites with onsite Pharmacy using COTS Implement e-rx 03 - 2011 04 -2011 09 - 2011 05 - 2011 08 - 2011 06 - 2011 07 - 2011 10 - 2011

20. E-Rx Deployment Plan Cont…

21. E-Rx Deployment Plan Cont… • Items still in the works: • Agreements for the T/U sites • Additional options for COTS that would eliminate need to register as a participating Surescripts pharmacy • Other enhancements: • Refill/Renew • Improved clinical indications • Improved copy to new order functionality

22. Questions?