HITSP Real World Sites Medication Management

1. HITSP Real World Sites Medication Management Webinar 8 September 10th, 2009 | 2:00 – 3:30 pm (Eastern) Moderator: Ken Majkowski, Surescripts Presenters: J. Marc Overhage, Regenstrief Institute Peter Kaufman, DrFirst

2. Learning Objectives During this 90-minute webinar, participants will learn: Learn how the HITSP Medication Management Interoperability Specification is being used today by the Regenstrief Institute, DrFirst, and Surescripts Explore the value and limitations of external sources of medication history Learn how various standards are employed in the HITSP Medication Management transactions Discover how DrFirst and Regenstrief have employed HITSP in the real world in the areas of e-prescribing, patient eligibility, formulary and benefit inquiry, and medication reconciliation

3. Agenda What is HITSP? Surescripts case study Regenstrief Institute case study DrFirst case study Overview of the 2009 Webinar Series Questions?

4. Mission To serve as a cooperative partnership between the public and private sectors for the purpose of achieving a widely accepted and useful set of standards specifically to enable and support widespread interoperability among healthcare software applications, as they will interact in a local, regional, and national health information network for the United States.

5. HITSP is a volunteer-driven, consensus-based organization that is funded through a contract from the Department of Health and Human Services Created in 2005 HITSP develops Interoperability Specifications (IS) – documents that harmonize and recommend the technical standards that are necessary to assure the interoperability of electronic health records Production to date:13 IS and 60 related constructs Overview

6. HITSP Stakeholders • Patients • Consumers • Employers • General Practitioners • Standards Developers • Specialists • Payers • Suppliers • Review Boards • Practice Guidelines • Residential Care Providers • Outpatient Providers • Government Agencies • Hospitals Current Participation in HITSP: 800+ organizations 1,000+ individuals Over 25,000 volunteer hours

7. HIT Standardization HITSP members agreed that a standard is a well-defined approach that supports a business process and . . . • has been agreed upon by a group of experts • has been publicly vetted • provides rules, guidelines, or characteristics • helps to ensure that materials, products, processes and services are fit for their intended purpose • is available in an accessible format • is subject to an ongoing review and revision process Standards Harmonization is required when a proliferation of standards prevents progress rather than enabling it.

8. Status: Interoperability Specifications Recognized Released Accepted Secretary of HHS has recognized the IS for immediate implementation Secretary of HHS has accepted for a period of testing Panel approved for submission to HHS Federal projects must use HITSP recognized standards Per Executive Order13410

9. HITSP Interoperability Specifications (IS) Recognized Accepted

10. Accepted Released / Panel Approved HITSP Interoperability Specifications (IS)

11. “Meaningful Use” From existing Interoperability Specifications, determine subset required for “meaningful use” as called for in the American Recovery and Reinvestment Act (ARRA). Effort began on April 7, 2009.

12. All based on previous HITSP work

13. Today’s Focus . . . Recognized Accepted

14. Medication Management Real World Sites Surescripts Ken Majkowski, Pharm. D. Vice President, Clinical Affairs and Product Strategy, Surescripts

15. Prescription Benefit Prescription History PrescriptionRouting Definition of E-Prescribing Improved Safety Reduced Cost Increased Efficiency • E-Prescribing supports a shift to a paperless and more informed way for payers, prescribers and pharmacists to communicate. • E-Prescribing occurs when a prescriber uses a computer or handheld device with software that enables him or her to: • Electronically access that patient’s prescription benefit. • With a patient’s consent, electronically access that patient’s prescription history. • Electronically route the prescription to the patient’s choice of pharmacy. When the patient runs out of refills, his or her pharmacist can also electronically send a prescription renewal request to the physician’s office for approval.

16. Provides electronic delivery of patient prescription history from payers and pharmacies to prescribers Prescription History Data: • Date Range of History • Drug Name (Brand/Generic) • Oldest Fill Date, Most Recent Fill Date • Number of Fills, Days Supply, Quantity Dispensed • Pharmacies/Prescribers

17. Surescripts National Progress Report Summary Adoption 2006 2007 2008 Q2 2009 Prescription Benefit 33M 37M 79M9% patient visits 66M Prescription History 4M 7M 16M1.8% patient visits 24M Prescription Routing 11M 29M 68M4% eligible Rxs 78M Total Message Volume 69M 107M 242M 303M Opportunity: According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons. According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)

18. Surescripts National Progress Report Summary, continued Adoption 2006 2007 2008 Q2 2009 Prescribers 16K 36K 74K 126K 21% prescribers Payer Member Records 160M 200M 230M 222M Community Pharmacies 34K 41K 47K 50K82% pharmacies Mail Order Facilities 3 3 6 6 Opportunity: According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons. According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)

19. Medication History for Hospitals Provides clinicians access to up-to-date medicationhistory for patients they are treating in an inpatient setting • Person search • Dispensed claims medication history

20. Medication History for Hospitals, continued • Delivered to the acute care setting via strategic distribution partners: • DrFirst • Emerging Health • GE Healthcare • Healthcare Systems • InterMedHx • HL7 Interface • ADT • RDS • ORU • Regenstrief • Siemens • Standard Register • others

21. Value Drivers – Disaster Relief • In response to the lessons learned in the aftermath of Hurricane Katrina, a collaborative of public and private organizations launched ICERx.org (In Case of Emergency Prescription Database). • This online resource allows authorized physicians and pharmacists to get evacuees’ medication records • Prescription history information is pooled from a variety of sources, including Surescripts, payers and state Medicaid programs. • This information allows health care professionals to safely renew prescriptions for evacuees and help coordinate care, while avoiding harmful prescription errors and potential drug interactions. • For more information, visit www.icerx.org.

22. Additional External Medication History Sources • State Medicaid Programs • Enterprise Medication History Databases • Pharmacy Benefits Managers (PBMs) • Health Plans • Pharmacies • Personal Health Records (PHRs) • Others

23. For More Information The E-Prescribing Resource Center www.surescripts.com A Comprehensive Resource Center for Payers, Prescribers and Pharmacists http://www.surescripts.com/news-sign-up.html

24. Medication Management Real World Sites Regenstrief Institute J. Marc Overhage, M.D., Ph.D. Director of Medical Informatics and Research Scientist, Regenstrief Institute

25. Background

26. Regenstrief – Solutions and Problems Solved Incomplete medication histories Fragmented patient data Difficult to obtain electronic formularies Difficult to maintain pharmacy data Providers without an Electronic Medical Record (EMR)

27. ePrescribing Provide a comprehensive medication history (greater starter set) Incorporate allergies and other clinical data Incorporate formulary decision support Capture prescriptions written Medication Management Provide a comprehensive medication history Incorporate allergies and other clinical data Incorporate formulary decision support Regenstrief – Use Cases

28. E-Prescribing Flowchart Surescripts Dispensing Databases Provider’s Appointment System • Merge Sources • Merge providers • Aggregate • De-duplicate Records • Age Records • Compute MPRs HL7 Appointment Patient Matching PBM Databases • Matching prescription and dispensing data • Provide views of merged data • Allergy checking • Clinical decision support MedicationHistory Claims Database Formulary Databases Prescribing Databases Prescription Records Formulary

29. E-Prescribing Flowchart, continued HITSP T43 Med Order NCPDP SCRIPT Std. Surescripts Prescription Update Prescribing Database Prescribing Databases

30. Constructs C 26 : Nonrepudiation of Origin C 38 : Patient Level Quality Data Document C 44 : Secure Web Connection C 80: Clinical Document and Message Terminology HITSP Constructs Used • Transaction Packages • TP13: Sharing of documents • TP20: Access Control Transaction Package • T 15: Collect and Communicate Security Audit Trail Transaction • TP 43: Medication Orders Transaction Package • TP 46: Medication Formulary and Benefits Information Transaction Package • Transactions • T 16: Consistent Time • T 17: Secured Communication Channel • T 31: Document Reliable Interchange • T 68: Patient Health Plan Authorization Request and Response

31. Solution & Benefits More complete medication histories for more patients Data from multiple sources enriched the clinical context (laboratory results, allergies, diagnoses) More formularies available Patients cared for by providers without Electronic Medical Records (EMRs) still received the benefit of clinical decision support

32. Successes Reduced number of adverse drug events Improved therapeutic monitoring Improved formulary adherence  lower patient costs Improved provider satisfaction

33. For More Information www.regenstrief.org

34. Medication Management Real World Sites DrFirst Peter N. Kaufman, M.D. Chief Medical Officer, DrFirst, Inc.

35. Impact of E-Prescriptions on Physician Office Workflow • Improve efficiency - Increase staff productivity • Improve patient safety, quality of care, and satisfaction • Minimize time spent phoning/faxing to clarify prescriptions and authorize renewal requests • Minimize time spent phoning and faxing to ensure formulary compliance • Minimize chart pulls - Reduce time to find prescribing information • Simplifying staff workflow, allowing completion of refill authorizations in seconds, not hours • Remotely check patient medications and allergies – and prescribe

36. Information Available in the E-Prescribing Workflow via HITSP and SDO Technical Standards • Patient Demographics (HL-7, CCD) • Eligibility (X12 270/271) • Medication History (NCPDP SCRIPT) • Pharmacies • Payors • Formulary and Benefits (tiers, co-pays, substitution) (NCPDP SCRIPT) • Renewal Requests (NCPDP SCRIPT) • New Prescription (retail and mail order) (NCPDP SCRIPT)

37. Workflow: example • Staff confirms on arrival: • Demographics • Pharmacy - ask patient • Medication History List - pull down through Surescripts and confirm with patient • Prescriber: • Reviews current medication list • Insurance eligibility is displayed • Formulary alerts, substitution, co-pay etc. present when medication is chosen • Clinical alerts present during prescribing, if applicable

38. Standards Not Yet in Wide Use for E-Prescriptions • Allergies (CCD) • Diagnoses (CCD) • Prior authorization (NCPDP SCRIPT) • RxNorm (to supplement/replace NDC codes) • Structured and codified SIG (NCPDP SCRIPT)

39. Remember . . . Having a feature is not the same as having a usable feature

40. How Physicians Realize the Benefits of True Electronic Prescribing • Improves efficiency • Minimizes time spent phoning and faxing to clarify prescriptions, authorize renewal requests and ensuring formulary compliance • Inbound calls decreased from 36% to 18.5% of RX filled; outbound calls were reduced by more than 50% • Increases staff productivity • Simplifies staff workflow, allowing completion of refill authorizations in seconds, not hours • Enables remote access to patient medications and allergies • Re-allocate staff time to other activities

41. How Physicians Realize the Benefits of True Electronic Prescribing, continued • Improves quality of care • Improves safety and quality of care: drug/drug drug/allergy, drug/diagnosis and dose checking, medication history • Reduces errors due to misread prescriptions and medications with similar sounding names • Increases patient satisfaction • Decreases pharmacy wait times while improving safety • Formulary compliance can reduce co-pays

42. For More Information Peter N. Kaufman, MD CMO, DrFirst 3206 Tower Oaks Blvd. #310 Rockville, MD 20854 Cell: 301-806-8004 pkaufman@drfirst.com

43. The 2009 Webinar Series www.HITSP.org/webinars        

44. Questions Welcomed

45. View the Complete Set of HITSP Deliverableswww.HITSP.org

46. Use or specify recognized HITSP Interoperability Specifications in your HIT efforts and in your Requests for Proposals (RFPs) Ask for CCHIT certification Leverage Health Information Exchanges to promote HITSP specifications to make connections easier in the future Ask . . . Is there a HITSP standard we could be using? Get involved in HITSP . . . Help shape the standards Implementation feedback to HITSP is welcome How YOU can become involved

47. Join HITSP in developing a safe and secure health information network for the United States Visit www.hitsp.orgor contact: Michelle Deane, ANSI mmaasdeane@ansi.org Re: HITSP, its Board and Coordinating Committees Allyn Clemons, HIMSS Theresa Wisdom, HIMSS aclemons@himss.orgtwisdom@himss.org Re: HITSP Technical Committees

48. Sponsor Strategic Partners www.HITSP.org