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Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL

Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL. Mike Mims Program Manager for Pharmacy Systems. PRE Background. Many VHA technology problem areas and weaknesses identified Prior to 2001 First Consulting study Included patient safety issues

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Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL

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  1. Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL Mike Mims Program Manager for Pharmacy Systems

  2. PRE Background • Many VHA technology problem areas and weaknesses identified • Prior to 2001 First Consulting study • Included patient safety issues • SwRI awarded multi-year, fixed-price contract • FY04 to develop new pharmacy system • Renewable annually starting in FY05 • Period of performance ends January 2008

  3. FY07 - Changing Environment • Entire VA Environment changed • New Organizational Structure • Continuing Resolution • No Approved Budget (80% of FY06 Budget) • Unable to move forward with New Contract with SwRI • Generated Re-planning effort

  4. PRE Restructuring in FY07 Reasons for change: • Budget reductions, PRE & dependent projects • Uncertain/incomplete HeV Architecture • Lack of Common Services maturity • Pharmacy “Out of Sequence” • Perceived Duplication of Efforts • Standards and Terminology Services

  5. 2007 Development PlansGoals for New Plan • Stay within expected budget • Release something of value to field in 12-18 months • Priority to address recent patient safety issue • Reduce/delay dependencies on other development efforts • Review scope of SwRI contract & distribute work as appropriate

  6. 2007 Development PlansGoals for New Plan (cont’d) • Spread release of PRE functionality over long period to allow architecture to mature • Phase new staff into VA Teams to help transition PRE development in-house • Incorporate Standards and Terminology competencies/resources into project team

  7. Standards And Terminology Services Added to PRE Team • Terminology standardization includes: • Analysis of current usage and existing standards • Determination of the VHA standard • Assignment of unique identifiers (VUIDs) • Modeling the term to ensure consistent meaning • Implementation/Deployment of the standard

  8. Standards And Terminology Services Added to PRE Team (cont’d) • Terminology standardization includes: • Maintenance of the national standard through additions and deletions of terms • Monitoring sites for compliance with the national standard

  9. Revised PRE Plan – Overview • SwRI FY07 Contract • $2M for PEPS v0.5 • $5M proposed to develop significant v1.0 components • FY08: Recruit staff for transition to in-house development • Redistribute SwRI tasks to other development teams • 5 major releases deployed over 7 years

  10. PRE Versions • PRE v0.5, v1.0 and Remaining Work • Major Features • Schedule • Costs (current)

  11. PRE v0.5 Order Checks

  12. PRE v0.5 Builds on December 2006 Proof of Concept • Implements all demonstrated order checks • Use commercial drug database services • Enhanced order checks • New dosing checks • APIs to support order-check enhancements through legacy Pharmacy & CPRS

  13. PRE v0.5 Major Features VistA Enhancements • Enhanced Checks • Drug-Drug • Duplicate ingredient (drug) • Duplicate Therapy (class) • New Checks • Maximum Single Dose • Daily Dose Range

  14. PRE v0.5 Major Features VistA Enhancements • Renal/Hepatic Impairment Dose Indicators • APIs to support order check enhancements • Ability to i.d. recently DC’d/expired med orders

  15. PRE v0.5 Major Features HealtheVet Construction • Create COTS Drug database - Legacy VistA interfaces • Components developed for Proof of Concept

  16. PRE v0.5 Assumptions • No local data migration or conversion required • Minimal FDB–VistA data mapping required • FDB Enhanced Therapeutic Classification (ETC) used for duplicate therapy checks only • Standard FDB processes for database updates • GCN_SeqNO populated in NDF for all drugs in order checks

  17. PRE v0.5 Responsibilities PRE Team • Overall project governance • Design & develop • VistA changes to legacy pharmacy • VistA interfaces with PEPS

  18. PRE v0.5 Responsibilities Standards and Terminology Services (STS) • Lead VistA NDF data standardization efforts • Provide requirements to PRE team • Lead Structural/content analysis • Med Routes, Drug Interactions, VA Product, & Drug Units files • Model Terminology • Maintain standard terminology • Possible VistA-PEPS-COTS data mapping • Validate local mappings

  19. PRE v0.5 Responsibilities Southwest Research Institute (SwRI) • Design & develop PEPS interfaces for VistA - FDB order-check messaging • Based on FY06 PEPS v1.0 Proof of Concept • Support PRE v0.5 stages I and II testing

  20. PRE v0.5 Schedule PRE v0.5: Enhanced Order Checking Functionality Coding/St. I Test 1 2 3 4 5St. II 6St. III 7Deployment

  21. PRE v0.5 Risks • Production environment • Support staff • Legacy system enhancements • Performance • COTS drug database licenses

  22. PRE v0.5 Dependencies • Standards & Terminology Services (STS) • SwRI • CPRS • COTS Drug Database

  23. PRE v0.5 Costs • VA staff: $1.34 million • Non-VA: $4.07 million • Includes • PRE contract staff • PRE support from CPRS, STS, BCMA, EVS contractors • Contractor travel • Equipment: $70k

  24. PRE v1.0 Remaining Pharmacy Enterprise Product Systems (PEPS) Functionality

  25. PRE v1.0 Major Features VistA Enhancements • All v0.5 functional plus: • Identify  • Product type and storage requirements • High-risk drugs for follow-up • Drugs requiring witness for administration • Display of lab/vitals information

  26. PRE v1.0 Major Features VistA Enhancements (cont’d) • Implement dispensing limits (qty/days supply) • Enhanced do-not-mail functionality • Order Checks • Lifetime cumulative dose • IV compatibility

  27. PRE v1.0 Major Features HealtheVet Construction • Replace legacy PDM and NDF applications • Drug update and maintenance tools • Ability to manage pharmacy users’ roles • Enhanced system management tools • Improved reporting capabilities

  28. PRE v0.5 Schedule PRE v1.0: Remaining Pharmacy Enterprise Product System (PEPS) functions Coding 1 2 3 4 5 6Test I 7Test II 8Test III 9Deployment

  29. PRE v1.0 Costs • VA staff: $928k • Non-VA: $8.85 million • Includes • PRE contract staff • PRE support from CPRS, STS, BCMA, EVS contractors • Contractor travel *v1.0 SwRI Costs estimated based on remaining contract funds • Equipment: $40k

  30. Beyond PRE v1.0 Remaining Pharmacy Enterprise Product Systems (PEPS) Functionality

  31. Beyond PRE v1.0 • Working with Business Owners • Organize • Prioritize • Sequencing must consider: • Patient safety issues • Funding requirements • Availability of common services • Ability of other applications to implement

  32. Major Features – Remaining PRE PRE v2.0Inventory • Replace current packages • Controlled Substances • Drug Accountability • Automatic Replenishment/Ward Stock • Requirements gathering based on SwRI work

  33. Major Features – Remaining PRE • PRE v3.0Order Entry, Clinical Monitoring • Replace parts of current packages • Outpatient • Inpatient • IV order processing • Changes to support ordering through CPRS • Based on requirements gathered by SwRI • In-house analysis & construction

  34. Major Features – Remaining PRE • PRE v4.0Dispensing functions • Replace remaining order processing parts • Outpatient • Inpatient • IV • Based on requirements gathered by SwRI • In-house analysis & construction

  35. Major Features – Remaining PRE • PRE v5.0Administration • Replace current BCMA functions • Based on requirements gathered by SwRI • In-house analysis & construction

  36. Schedule Remaining PRE Functionality PRE v0.5 PRE v1.0 PRE v2.0 Inventory PRE v3.0Order Entry, Activate & Clin Mon (HeV) Coding PRE v4.0Dispense PRE v5.0Administration & Migration

  37. Questions?

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