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Overview of Technology Approaches of Medication Management in Long-Term Care

Overview of Technology Approaches of Medication Management in Long-Term Care. Rachelle “Shelly” Spiro, RPh, FASCP President, Spiro Consulting. Overview. LTC Electronic Health Record (EHR) Standards e-Prescribing and eMAR LTC e-Prescribing standards and pilots Summary.

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Overview of Technology Approaches of Medication Management in Long-Term Care

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  1. Overview of Technology Approaches of Medication Management in Long-Term Care Rachelle “Shelly” Spiro, RPh, FASCP President, Spiro Consulting

  2. Overview • LTC Electronic Health Record (EHR) Standards • e-Prescribing and eMAR • LTC e-Prescribing standards and pilots • Summary

  3. HHS-ASPE Study to Access Business Case for LTC HIT • Types of Health Information Technology (HIT) applications and functionalities in Post Acute Care (PAC) and Long-Term Care (LTC) • Based on stakeholder description and technical expert panel (TEP) input • Exhibit A-1 summarizes the types of HIT applications, functionalities, and the applicable PAC/LTC setting in which the applications are used Source: U.S. Department of Health and Human Service (HHS) Assistant Secretary for Planning and Evaluation (ASPE) Office of Disability, Aging and Long-Term Care Policy EVALUATION DESIGN OF THE BUSINESS CASE OF HEALTH INFORMATION TECHNOLOGY IN LONG-TERM CARE http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf

  4. Source: U.S. Department of Health and Human Service Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy EVALUATION DESIGN OF THE BUSINESS CASE OF HEALTH INFORMATION TECHNOLOGY IN LONG-TERM CARE http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf

  5. LTC EHR Standards • E-prescribing • CMS-AHRQ LTC e-prescribing pilot • Modifications to NCPDP SCRIPT standard • HL7 Continuity of Care Document (CCD) • Standard for the exchange of clinical documents • Replaces MDS • HL7 EHR System (EHR-S) Functional Model • The standard for the functions needed in an EHR-S

  6. CCHIT LTC Roadmap Source: http://www.ahima.org/infocenter/whitepapers/documents/Public_Comment_Expanding_CCHIT_Certification_Roadmap_20070202.pdf Proposed for August 2009

  7. e-Prescribing and eMARs • e-Prescribing • Prescription order entry • Bar code scanner for re-supply • Web connections • NCPDP Script • HL7 • Electronic Medication Administration Records (eMARs) • Proprietary or HL7 • System at a minimum include the “Five Rights” • Right Resident • Right Medication • Right Dosage • Right Route • Right Time

  8. eMAR Standards • Pharmacy versus facility driven • Integration • Hardware and software • Further standards of eMAR and inventory management is needed • REMOTE DISPENSING* *Covered in next presentation

  9. Reduction in Adverse Drug Events • Theoretically an integrated eMAR and EHR would help reduce adverse drug events (ADE) and medication errors • July 2006 the Institute of Medicine’s report on “Preventing Medication Errors” concluded that of the 1.6 million nursing home population in the U.S., 800,000 preventable ADEs could occur each year Source: http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf

  10. Grantee/Contractor Project Titles for e-Prescribing AHRQ Pilot Project

  11. Purpose of LTC e-Prescribing Pilot • To study the effects of the electronic prescribing standards in long-term care on cost, quality and safety • Validate that the e-Prescribing and electronic Prior Authorization standards work in a LTC setting

  12. e-Prescribing in the LTC Setting • Three way communication: prescriber, nurse, pharmacy • Resident is not a patient • SCRIPT adjustments for unit/room/bed, resident, facility information • Medications are delivered • Communicate admission and discharge information to the pharmacy (new census message) • Medication “chart” orders are open-ended • Orders need to be cancelled or discontinued • Facility needs to know the medication was actually dispensed • Resupply requests represent 80% of LTC orders • Resupply message

  13. Summary • LTC industry is working on EHR-S standards • LTC setting e-Prescribing can be supported with some technical modifications to the standards • Additional research should be done on electronic prior authorization (e-PA) • Further standards of eMAR and inventory management is needed • These efforts are ways the industry is improving medication safety in the LTC setting

  14. Thank you Shelly Spiro President, Spiro Consulting 1200 First Street, Suite 1632 Alexandria, VA 22314 703-599-5051 www.spiroconsulting.net

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