Electronic Medication Administration Record with Assistive Technology

1. Electronic Medication Administration Record with Assistive Technology Bar Code Medication Administration

2. Indian Health Service (IHS) Office of Information Technology (OIT) BCMA Cross-functional Team Members David Taylor, MHS, RPh, PA-C, RN OIT EHR Training and Deployment Manager BCMA Federal Lead Mollie Ayala, MHI OIT USET BCMA Co-Federal Lead & Co-Project Manager Michael Allen, MIS, RPh OIT USET EHR Pharmacy Consultant and MU Stage 2 EHR Certification Cathy Whaley, PMP (Contractor) Data Networks Corporation (DNC) Project Manager Bradley Bishop, PharmD, MPH OIT Pharmacy Consultant BCMA

3. IHS OIT BCMA Cross-Functional Team Members (Cont.) Chris Saddler, RN OIT Information Technology Specialist Carla Stearle, PharmD, BCPS OIT USET EHR Pharmacy Consultant Deborah Burkybile, MSN, RN, CPC OIT EHR Deployment Specialist Sean Cook (Contractor) Data Networks Corporation (DNC) Application Systems Analyst Philip Taylor, BA, RN (Contractor) Medsphere Systems Corporation (MSC) Clinical Application Specialist BCMA

4. Biographies (Cont.) CDR Bradley Bishop, PharmD, MPH IHS OIT Pharmacy Consultant CDR Bradley Bishop is a Commissioned Officer in the United States Public Health Service and has been in the Indian Health Service since 2001. CDR Bishop received his Doctor of Pharmacy from the University of Tennessee College of Pharmacy and Master of Public Health from the University of Massachusetts-Amherst. He has been assigned to Sells, AZ, Tahlequah, OK, Tucson Area Office, and IHS Headquarters as a pharmacist, chief pharmacist, clinical applications coordinator, and pharmacy consultant. CDR Bishop currently serves as the National Pharmacy Consultant for IHS Office of Information Technology. BCMA

5. Biographies (Cont.) Sean Cook (Contractor) Data Networks Corporation (DNC) Application Specialist Sean Cook is an Applications Systems Analyst with Data Networks Corporation and has worked on contract with the Indian Health Service since 2010. His professional experience in Pharmacy spans more than a decade and includes in-depth experience in interoperability, automation, and team leadership. Sean spent several years with, Omnicare, the largest long term care pharmacy in Northern Illinois and a year with Provident Hospital of Cook County, Chicago. Prior to coming to Albuquerque, he provided systems and programming support for six pharmacies at Columbia St. Mary’s in Milwaukee. BCMA

6. Biographies (Cont.) Chris Saddler, RN IHS OIT Information Technology Specialist Chris Saddler began working for IHS in 1980 as a Nurse Epidemiologist at the Alaska Native Medical Center. In 1984, she joined the fledgling IHS RPMS Development Team. She was responsible for the initial development of the VA’s Laboratory package and instrument interfaces for IHS. Transferring to OIT National Programs in 2003, her initial assignment was upgrading the Radiology package for EHR. Other projects included the upgrade to Kernel v 8 and other infrastructure packages, PCC+, Vista Imaging, Women’s Health, and serving as IHS Database Administrator for two years. She provided technical support for EHR deployment in Alaska, and continues to support multi-division and urban sites. BCMA

7. Biographies (Cont.) Catherine Whaley, PMP (Contractor) Data Networks Corporation (DNC) OIT IHS EHR & ePrescribing Project Manager BCMA Co-Project Manager Catherine Whaley is a Data Networks Corporation Project Manager based in Tucson, AZ. She holds an AAS in Accounting and an AA in General Studies from Anoka-Ramsey Community College with a PMP Certification from PMI. Her experience includes over 20 years of Information Technology including customer support, software development, design and development of classroom training documentation, training/instruction/facilitation, testing, business analysis, and project management. She has participated in the requirements gathering efforts and developed requirements for multiple applications. Since she started with IHS in 2010, she has worked as Project Lead for the 2012 Meaningful Use Certification project, Project Manager of the Stage 1 Meaningful Use Team and most recently Project Manager for the EHR Deployment and Training, eRx Deployment and BCMA projects. BCMA

8. VA-IHS Interagency Agreement (IAA) BCMA

9. Interagency Agreement • Similar to VA-IHS IAA for Vista Imaging • Support for IHS to use BCMA “out of the box” • Involves several VA divisions • Bar Code Resource Office (BCRO) • Employee Education Services (EES) • VA Office of Information Technology (VA OIT) • Includes VA direct support for training, configuration, testing, three implementations (test and production) and consultative support thereafter BCMA

10. VHA BCRO Involvement • The IHS does not have the capacity to establish its own Bar Code Resource office. • The Bar Code Resource Office was established in 2009 within the Veterans Health Administration (VHA) to provide centralized leadership and strategic direction for the use and implementation of bar code technology within critical health care systems at the enterprise level. • Bar Code Resource Office (BCRO) is committed to quality and safety. • The VHA BCRO will supply services to IHS to include, but not limited to: • Managing Scanning Failures Data Results • Assists IHS with submission of BCMA New Service Requests (NSR) • Provides guidance, coordination and oversight of BCMA related NSRs • Business Process and clinical workflow • Identify and communicate standards and best practices BCMA

11. VHA EES Involvement • Employment Education Services • Assistance with: • Developing and conducting training • Drug File Clean Up • BCMA Coordinator training for the IHS OIT Core Team • BCMA Coordinator training for IHS Area and Hospital Teams BCMA

12. VHA OIT Involvement • Provide BCMA Version PSB*3*42 • Provide documentation for BCMA Version PSB*3*42 • Assist configuration and testing • Assist with implementation at 2 production sites BCMA

13. Meaningful Use Stage 2 BCMA

14. eMAR (BCMA) • Eligible Hospital and Critical Access Hospital • Core Measures Measure 16 of 16 • Electronic Medication Administration Record (eMAR) Objective BCMA

15. eMAR Objective Automatically track medications from order to administration using assistive technologies in conjunction with an electronic medication administration record (eMAR) BCMA

16. eMAR Measure • More than 10 percent of medication orders created by authorized providers of the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period for which all doses are tracked using eMAR BCMA

17. eMAR Exclusion • Any eligible hospital or CAH with an average daily inpatient census of fewer than 10 BCMA

18. Definition of Terms • electronic Medication Administration Record (eMAR) – Technology that automatically documents the administration of medication into certified EHR technology using electronic tracking sensors (for example, radio frequency identification (RFID)) or electronically readable tagging such as bar coding). • Average daily inpatient census – The total number of patients admitted during the previous calendar year divided by 365 (or 366 if the previous calendar year is a leap year). BCMA

19. Attestation Requirements • DENOMINATOR: Number of medication orders created by authorized providers in the eligible hospital's or CAH's inpatient or emergency department (POS 21 or 23) during the EHR reporting period. • NUMERATOR: The number of orders in the denominator for which all doses are tracked using eMAR. • THRESHOLD: The resulting percentage must be more than 10 percent in order for an eligible hospital or CAH to meet this measure. • EXCLUSION: Any eligible hospital or CAH with an average daily inpatient census of fewer than 10 patients. BCMA

20. Additional Information • The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. • If a medication is ordered but not all doses of the medication are tracked using eMAR, then that order may not be included in the numerator of the measure. • It is not required that eMAR is implemented in both inpatient and emergency departments in order to meet this measure, only that more than 10 percent of medication orders created by authorized providers of either the inpatient or emergency department (POS 21 or 23) during the EHR reporting period are tracked using eMAR. • In order to meet this objective and measure, an eligible hospital or CAH must use the capabilities and standards of CEHRT at 45 CFR 170.314(a)(16), (g)(1), (g)(2). BCMA

21. Inpatient – EHR Sites BCMA

22. BCMA (eMAR) Sites BCMA

23. Certification Requirements BCMA

24. Certification CriteriaAutomated Measure Calculation • §170.314(g)(2) Automated measure calculation. For each meaningful use objective with a percentage based measure that is supported by a capability included in an EHR technology, electronically record the numerator and denominator and create a report including the numerator, denominator, and resulting percentage associated with each applicable meaningful use measure. BCMA

25. Certification Criteria • NIST Script 170.314 (a)(16) Inpatient setting only – electronic medication administration record • (i) In combination with assistive technology that provides automated information on the “rights” specified in paragraphs (a)(16)(i)(A) through (E) of this section, enable a user to electronically verify the following before administering medication(s): BCMA

26. (i) Five Rights • Right Patient. The patient to whom the medication is to be administered matches the medication to be administered. • Right Medication. The medication to be administered matches the medication ordered for the patient. • Right Dose. The dose of the medication to be administered matches the dose of the medication ordered for the patient. • Right Route. The route of the medication delivery matches the route specified in the medication order. • Right Time. The time that the medication was ordered to be administered compared to the current time. BCMA

27. (ii) Right Documentation • Electronically record the time recorded with the standard specified in § 170.210(g), and user identification when a medication is administered. • § 170.210(g) Synchronized clocks: The date and time recorded utilize a system clock that has been synchronized following (RFC 1305) Network Time Protocol. BCMA

28. Type of Certification Testing • Create patient records showing the verification of Five Rights when all of the Rights are correct. • Create patient records showing the verification of Five Rights when some or all of the Rights are incorrect. • Need alerts for incorrect rights. • Document and record the rights within the EHR. • Use of Network Time Protocol. BCMA

29. Additional Information • The provider is permitted, but not required, to limit the measure of this objective to those patients whose records are maintained using certified EHR technology. • If a medication is ordered but not all doses of the medication are tracked using eMAR, then that order may not be included in the numerator of the measure. • It is not required that eMAR is implemented in both inpatient and emergency departments in order to meet this measure, only that more than 10 percent of medication orders created by authorized providers of either the inpatient or emergency department (POS 21 or 23) during the EHR reporting period are tracked using eMAR. • In order to meet this objective and measure, an eligible hospital or CAH must use the capabilities and standards of CEHRT at 45 CFR 170.314(a)(16), (g)(1), (g)(2). BCMA

30. Questions and Discussion BCMA