Pharmacy Workflow Changes with EHRp13/APSP 1017

1. Pharmacy Workflow Changes with EHRp13/APSP 1017 Pharmacy PSG Sponsored Training September 2014

2. Presenter CDR Katie Johnson, Pharm D NPAIHB EHR Integrated Care Coordinator Pharmacy PSG Chair Pharmacy Workflow Changes

3. Pharmacy Package Changes • Removal of POV function: • Paperless refill, Suspense POV, All Rx POV. • Removal of POV in Pharm Ed button. • BCMA (Bar Code Med Administration). • RxNorm mapping to Drug file. • SNOMED Route mapping. • Discharge medication prompt. Pharmacy Workflow Changes

4. Refill, Suspense, and Workflow Pharmacy Workflow Changes

5. Refills and POVs • No more Paperless Refill function: • Medication will be refilled in Pharmacy Package. • Visit “shell” created. • Primary Provider will be added manually. • POVs will need to be added manually from EHR GUI using the new Integrated Problem List. Pharmacy Workflow Changes

6. EHR Integrated Problem List • The only way to add a POV to a visit is to choose something on the Integrated Problem List (IPL). Pharmacy Workflow Changes

7. EHR IPL Pharmacy Workflow Changes

8. Medication Refill POV • Recommended SNOMED equivalent for V68.1 Med Refill code = Dispensing Medication 373784005. • Recommend making a Pharmacy SNOMED Picklist with this code on it. Pharmacy Workflow Changes

9. Example Pharmacy Picklist Pharmacy Workflow Changes

10. Workflow Considerations • “Routine” refills. • IVR refills – batch POV entry vs. POV as you go. • CMOP – Running reports and entering POVs after CMOP fills prescription (work in progress). • All Rx POV. Pharmacy Workflow Changes

11. Sample Pharmacy EHR layout Pharmacy Workflow Changes

12. Additional Considerations • IPL Conversion to SNOMED. • Coordinate with EHR Team and Medical Staff. • Pharmacy will often be the first contact patients have with the clinic post patch installation. • Pharmacy will play a role in IPL conversion. • Problems must be converted before they can be used as POV. Pharmacy Workflow Changes

13. IPL Problems preceded by an asterisk (*) are not converted Pharmacy Workflow Changes

14. Pharm ed button Pharmacy Workflow Changes

15. Removal of POV from Pharm Ed Button Pharmacy Workflow Changes

16. Removal of POV from Pharm Ed Button • Options to deal with Pharm Ed Button: • Local decision – discuss with EHR Team and Coding Department. • Option 1: Pharmacy enter POV through IPL and Coding complete visits. • Option 2: Coding enter POV and complete visit. Pharmacy Workflow Changes

17. Pharm Ed Button • If Pharmacy is entering POV for dispensing only visits from IPL: • Recommended SNOMED = Dispensing Medication Education 409021006. • Add to a Pharmacy Picklist. Pharmacy Workflow Changes

18. Coding Workflow Considerations • ACRX Auto-Complete Pharmacy Education Only Visits in PCC DE: • This menu option automatically completes visits that were only pharmacy dispensing visits. • No longer functional since dependent on V-codes. • Coders will have to complete these visits manually. Pharmacy Workflow Changes

19. Enhancements coming Pharmacy Workflow Changes

20. Relief in EHRp14/APSP1018 • Refill and Suspend functions will automatically: • Create Pharmacy Visit. • Stuff person processing med as primary provider. • Add generic POV. Pharmacy Workflow Changes

21. Relief in EHRp14/APSP1018 • Pharm Ed Button: • Parameters delivered to map ICD and SNOMED codes to the Pharm Ed button. • ACRX Report restored for coding. • Basically, functionality restored. Pharmacy Workflow Changes

22. Drug File Med Route File Discharge Med Prompt Other Pharmacy Package Updates Pharmacy Workflow Changes

23. RxNorm Mapping • This option will update a drug file entry RXNorm field using the Apelon Tool or alternatively by data entry. • Do you want to update the Drug File RXNorm data using the Apelon Tool? Y// ES • Enter DRUG file entry: LISINOPRIL • 1 LISINOPRIL 10MG TAB UD CV800 51079-0982-20 • 2 LISINOPRIL 10MG TAB** CV800 -523032 00006-0106-82 • DEMO PHARMACY • 3 LISINOPRIL 2.5MG TAB UD CV800 00143-1266-10 • 4 LISINOPRIL 20MG TAB** CV800 -515471 00006-0207-82 • DEMO PHARMACY • 5 LISINOPRIL 40MG TAB UD CV800 INPATIENT USE ONLY 51709-0984-20 • Press <RETURN> to see more, ‘^’ to exit this list, OR • CHOOSE 1-5: 2 LISINOPRIL 10MG TAB** CV800 -523032 00006-0106-82 • DEMO PHARMACY • Using local DRUG file NDC data for Apelon query... • LISINOPRIL 10MG TAB** CV800 -523032 00006-0106-82 • Querying Apelon site...ENTRY UPDATED – RXCUI field set to: 314076 Pharmacy Workflow Changes

24. RxNorm Mapping (NDF rematch) • < Enter "Y" for yes, "N" for no > • Is this a match ? Y • You have just VERIFIED this match and MERGED the entry. • Resetting Possible Dosages.. • Press Return to continue: • Querying Apelon site...ENTRY UPDATED – RXCUI field set to: 314076 • Just a reminder...you are editing LISINOPRIL 10 MG TAB**. • Strength from National Drug File match => 10 MG • Strength currently in the Drug File => 10 MG • Strength => 10 Unit => MG Pharmacy Workflow Changes

25. Route Mapping to SNOMED • NAME: INHALATION ORAL// • ABBREVIATION: INHL ORAL// • PACKAGE USE: ALL PACKAGES// • OUTPATIENT EXPANSION: • OTHER LANGUAGE EXPANSION: • IV FLAG: • PROMPT FOR INJ. SITE IN BCMA: • DSPLY ON IVP/IVPB TAB IN BCMA?: • Snomed: • STANDARD MEDICATION ROUTE: INHALATION INHALATION • Querying Apelon site... • SNOMED Added 243132000 • Local Route: 'INHALATION ORAL' has been mapped to • Stnd Route: 'INHALATION' FDB Route: 'INHALATION' Pharmacy Workflow Changes

26. Discharge Med prompt Pharmacy Workflow Changes

27. Discharge Med prompt • SUBSTITUTION: // • DISCHARGE MEDICATION (In-House Inpatient/ER only): Yes// ?? • Choose from: • 1 YES • 2 NO • Enter YES if this is a discharge medication from the In-House Inpatient unit or In-House Emergency Department. • This should ONLY be entered for In-House discharge medications and not external discharge medication from other hospitals or emergency departments, • DISCHARGE MEDICATION (In-House Inpatient/ER only): Yes// Pharmacy Workflow Changes