Tom Fagan Pharmacy Benefits Management Clinical Informatics Instructor

1. Product Effectiveness  Benefits Realization Assessment of the Pharmacy Re-Engineering (PRE) Medication Order Check Healthcare Application (MOCHA) software Tom Fagan Pharmacy Benefits Management Clinical Informatics Instructor

2. Learning Objectives • Understand the Mission of Pharmacy Benefits Management • Understand the Background on Pharmacy Re-Engineering Project (PRE) including (MOCHA) Medication Order Check Healthcare Application • Understand the reason and goals for Benefits Realization assessment of PRE including MOCHA by OHI PE Team • Understand the data sources, methodology and rationale used in assessment • Understand initial assessment findings and recommendations

3. Mission of Pharmacy Benefits Management • To improve the health status of veterans by encouraging the appropriate use of medications in a comprehensive medical care setting. • Functions • Drug Benefit Design • Evidence-Based Formulary Management • Utilization Management • Staff Education • Patient Safety

4. Clinical Informatics • Application of Information Technology to deliver Healthcare Services

5. (PRE) Pharmacy Re-engineering Background • Began in 2002 • Multiple Increments Project Management • Main Goal to Improve VistA Pharmacy Package • Respond to Patient Safety Issues • Medication cost reduction • Improved workflow and process

6. PRE Increments • First Iteration Increment 1 – PRE Foundational Enhancement Increment 2 – Pharmacy Enterprise Customization System (PECS) Increment 3 – Medication Order Check Healthcare Application (MOCHA v1.0 ) (Non-Dosing) Increment 4 – Medication Order Check Healthcare Application (MOCHA v2.0 ) (Dosing) Increment 5 – Pharmacy Enterprise Customization System Enhancements Increment 6 – Enhanced Order Checks

7. PRE Pharmacy Re-engineering Components • MOCHA • Medication Order Check Healthcare Application • PECS • Pharmacy Enterprise Customization System • PPS • Pharmacy Product System

8. Accessing PECS • Have your ADPAC assign you the following security key:  PSS_CUSTOM_TABLES_REQUESTOR • Access PECS through this link:      https://vapreapp1.aac.va.gov:8443/ct/public/ Welcome.action

9. MOCHA V1.0 • Medication Order Check Healthcare Application • MOCHA v1.0 • Rolled out during the summer of 2011 • Delivers a valuable enhancement to medication order checks in the Pharmacy and CPRS packages • Utilization of a clinical drug database vendor, First Databank (fdb) • Enhanced Therapeutic Classification (ETC) allows for multiple classes per drug, thereby reducing the number of clinically inexact or inappropriate warnings

10. MOCHA V2.0 • MOCHA v2.0 (Dosing) Development • Introduces dosage order check functionality which will reduce medication errors, adverse events, and potential deaths • Provides an extremely valuable tool to VA clinicians in CPRS, Inpatient Pharmacy, and Outpatient Pharmacy • Version 2.0 consists of a maximum single dose check derived from the patient’s age, weight, and body surface area (BSA) • Currently installed in six test site environments with a planned national release of July 2012

11. Stated Benefits of PRE • Increased Patient Safety • Increased Efficiency of Prescription and Order Processing • Decreased Costs • Increased Satisfaction • Increased Regulatory Compliance

12. Goal for Assessment • Office of Health Information (OHI) Product Effectiveness (PE) Benefits Realization (BR) Assessment • One key question • Is VHA realizing the intended benefits from the PRE functionality, and if not, what can be done to make needed improvements?

13. Measureable Goals • Patient Safety • Increased Efficiency of Order Processing • Decreased Costs • Increased Satisfaction • Increased Regulatory Compliance

14. Data Sources • PBM Database ProClarity Cube • HR Employee Cube • Non-Formulary Request Processing Reports • National Drug File support Group • PBM Inventory Data • PBM Order Check Analysis Worksheet • vaADERS • Office of Information IT Patient Safety Office Database:

15. Surveys • VHA National Survey of Pharmacists • PE Customer Satisfaction Focus Groups • VA All Employees Survey • Survey of Healthcare Experiences of Patients

16. Methodology Overview of BR • Product Effectiveness Mission – Independent Assessment and Analysis • Benefit Realization - evaluate benefits against a specific outcome • Initial Measurement (now) • Post Implementation Performance (future)

17. Methodology Scope • PRE Multiple Increments • Initial • Post Implementation

18. Rationale • Measurements • Findings • Recommendations

19. Initial Assessment Findings • Establish a Baseline before PRE upgrades

20. Initial Assessment Recommendations • Patient Safety • Alert Fatigue • Staff Satisfaction

21. Major Recommendation • Measurements on Annual Basis • Identify Trends due to upgrades

22. Recommendation Monitoring Details • Safety Metrics • MOCHA • Staff Satisfaction • Work Flow

23. Key Findings • Increased Patient Safety and Decreased Costs • Increased Satisfaction Mixed -MOCHA

24. ASHP 2009 Drug Drug Interaction (DDI) Survey • Pharmacists • Identify Areas for Improvement • Knowledge Gap –no formal education on how to evaluate and respond to order checks

25. Summary • Benchmark Established • Increment Assessment Is VHA realizing the intended benefits from PRE if not what can be done to make needed improvements?