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EHR Parameters for Pharmacy

EHR Parameters for Pharmacy. Learning Objectives. Assess need to have a properly configured Information Management system and use of uniform data to assure medication accuracy, timely access to patient information and patient safety.

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EHR Parameters for Pharmacy

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  1. EHR Parameters for Pharmacy

  2. Learning Objectives • Assess need to have a properly configured Information Management system and use of uniform data to assure medication accuracy, timely access to patient information and patient safety. • Explain the necessity to configure Information Management system in medication management to correlate to physical processes to assure that the system supports but does not supplant the process. • Evaluate package parameters relating to medications and medication use in both outpatient and inpatient settings to function for useability and workflow including IHS specific options, a uniform print format for EHR, controlled substance orders, the PharmEd Button, inpatient user parameters, inpatient ward setup, Ward Groups, Unit Dose Parameters and MAR/MAR Labels. Determine best practices.

  3. Definition of Parameter • A Parameter is a Quantity whose value is selected for the particular circumstances and in relation to which other variable quantities may be expressed.

  4. Definition of Parameter • For RPMS-EHR, this means that a CAC can change behavior of a part of the software without having to perform a programming change simply by changing the value of a Parameter.

  5. Parameters: • Provide a way to Control Configuration at the Local Level by non-programmers • Allow for Flexibility and Customization of RPMS-EHR at each Site • Allow for different Configuration for Divisions and Individual Users

  6. Parameter Structure • The Structure of Parameters within RPMS-EHR is Hierarchical • Parameters range from User at the top to Package at the bottom

  7. Hierarchy Levels 1 User 2 Team (OE/RR) 3 Device 4 Location 5 Service 6 Division 7 System 8 Package

  8. Parameter Hierarchy • How does the Hierarchy work? • A Package first Checks the Highest Level (e.g. “User”) to see if a Value is set • The Package will continue to check each succeeding Level until a Value is found • When a Value is found, the Package stops and uses that Value for the Operation in question

  9. Parameter Hierarchy • Note that not all Levels are available for all Parameters, but only those that make sense for that particular item. ORWOR WRITE ORDERS LIST may be set for the following: 1 User USR [choose from NEW PERSON] 2 Location LOC [choose from HOSPITAL LOCATION] 2.3 Service SRV [choose from SERVICE/SECTION] 2.7 Division DIV [MEDSPHERE DEMO HOSPITAL] 3 System SYS [DEMO.MEDSPHERE.COM] 4 Package PKG [ORDER ENTRY/RESULTS REPORTING]

  10. Setting Parameters • Most Parameters are set at the System or Division Level. • For some Parameters, it may be necessary to use Location, Team or User. • The “higher” the level used, the more effort required to maintain the Parameter (e.g. 1 Setting at System, vs. 30 at Location, vs. 300 at User).

  11. Setting Parameters • Package levels should NOT be changed by the CAC. • The Package Level should be considered the “Reference” Value. • New Patches for a Package may sometimes reset the Package Level value which could have interesting consequences if was changed locally.

  12. Setting Parameters • RPMS-EHR Parameters can be set in two ways: • Using the RPMS menu option: General Parameter Tools • Using various RPMS menus from: RPMS-EHR Configuration Master Menu

  13. Parameters – MedsCORE-EHR-BEH-MED ACT Days of Medication Activity DEA Print DEA on all Prescriptions MAX Maximum Allowable Days Supply MEC Medication Counseling Configuration OMD Outside Med Dosage Form ORD Default Collation Order REN Renewal Limit for Expired Meds SPL Med Tab Splitter Size

  14. Days of Medication Activity

  15. Print DEA on all Prescriptions • Allows for local customization for DEA printing on all prescriptions instead of only on controlled prescriptions.

  16. Maximum Allowable Days Supply • This controls the upper limit for days supply of a dispensed medication: • The range is 90-365 days.

  17. Medication Counseling Configuration

  18. Medication Counseling Configuration DCMP Default Comprehension Value DCTM Default Counsel Time EDTX Edit Disclaimer Text ELST Education Topics HL Hospital Location for Visit PLST POV List DPOV Default POV PNL POV Narrative Text

  19. Medication Counseling Configuration Default Comprehension Value Default Counsel Time

  20. Medication Counseling Configuration Edit Disclaimer Text Education Topics

  21. Medication Counseling Configuration Hospital Location for Visit POV List

  22. Medication Counseling Configuration Default POV POV Narrative Text

  23. Outside Med Dosage Form

  24. Default Collation Order Controls the default collation order for the medication list. May be one or more of the following values: C = Chronic med status E = Expiration date F = Last fill date I = Issue date M = Medication name N = Rx # P = Provider name R = Refills remaining S = Status To reverse the collation order, use the lowercase equivalent.

  25. Default Collation Order

  26. Renewal Limit for Expired Meds • This is the maximum number of days following the expiration of a prescription that it may still be renewed: • Typically set to between 90-120 days.

  27. Parameters – OrderingCORE-EHR-BEH-ORD-PAR HLD Disable Hold/Unhold Actions in EHR IND Enable Clinical Indicator Prompt MSC Miscellaneous Parameters ORD Disable Ordering in EHR RSN Edit DC Reasons UOV Set Unsigned Orders View on Exit VER Enable/Disable Order Verify Actions

  28. Enable Clinical Indicator Prompt • Places a prompt for providers to enter a clinical indication for medication orders. • Required to be turned on for e-prescribing. • EHR Patch 9: • Requires a coded diagnosis • Pull in problem list and POVs for providers to select from • Renew, copy, and change pre-populates with clinical indication of new order

  29. Clinical Indication prompt

  30. Ordering - Miscellaneous ParametersCORE-EHR-BEH-ORD-PAR-MSC Active Orders Context Hours 24 Allow Clerks to act on Med Orders NO Allow Clerks to act on Outside Med Orders Auto Unflag YES Confirm Provider YES (Exclude ORES) Default Provider Error Days 7 New Orders Default Sign & Release Restrict Requestor YES (ORELSE & OREMAS) Review on Patient Movement NO Show Lab # YES Show Status Description YES Signature Default Action Release w/o Signature Signed on Chart Default NO

  31. Parameters - Order ChecksCORE-EHR-BEH-ORD-OCX CON Creatinine Date Range for Contrast Media Orders CTH CT Scanner Height Limit CTW CT Scanner Weight Limit DAN Set Clinical Danger Level DBG Enable/Disable Debug Message Logging DPL Lab Duplicate Order Range DPO Orderable Item Duplicate Order Range DPR Radiology Duplicate Order Range EDT Mark Order Checks Editable by User ENA Enable/Disable an Order Check GLU Creatinine Date Range for Glucophage-Lab Results LCL Edit Local Terms MRH MRI Scanner Height Limit MRW MRI Scanner Weight Limit PLY Number of Medications for Polypharmacy USR Order Checks a User Can Receive

  32. Parameters – NotificationsCORE-EHR-NOT DET Determine Recipients DIS Display Notifications a User Can Receive ERA Erase Notifications FLG Flag Orderable Items to Send Notifications FWD Forward Notifications PAR Notification Parameters PRC Enable/Disable Notifications REC Display Patient Alerts and Alert Recipients SYS Enable/Disable Notification System UNV Set Delays for Unverified Orders URG Set Urgency for Notifications

  33. Parameters – ReportsCORE-EHR-BEH-RPT FMT Print Formats HSM Health Summary Configuration ... PAR Report Parameters ... SYS System Display Parameters USR User Display Parameters

  34. EHR Patch 9: Auto-finish & e-Prescribing Parameters • BEHORX PRINT LABEL • Optional

  35. EHR Patch 9: Auto-finish and e-Prescribing Parameters • BEHORX PRINT FORMATS

  36. EHR Patch 9: Auto-finish and e-Prescribing Parameters • BEHORX PRINT FORMAT TYPE

  37. EHR Patch 9: Auto-finish & e-Prescribing Parameters • APSP AUTO RX DIV • Sets Pharmacy Division to divisions setup in Outpatient Site File • Must be done before APSP AUTO RX

  38. EHR Patch 9: Auto-finish & e-Prescribing Parameters • APSP AUTO RX

  39. EHR Patch 9: Auto-finish & e-Prescribing Parameters • APSP AUTO RX SCHEDULE RESTRICT • Not editable • APSP AUTO RX ERX OF CII • Not editable • APSP AUTO RX ADD PRV COMMENT • Set to NO • APSP AUTO RX DEF PT STATUS • Set to OUTPATIENT

  40. EHR Patch 9 – New Printing Functionality • “Smart logic” is used to determine which order requires a print job and if so which type based on: • Status (Active or Pending) • Pick up location • Type of drug (Controlled or not) • “Queues” the print jobs for printing. • Formats may be defaulted to specific templates. • Formats may be defaulted to specific printers at the User, Location, Division and System level .

  41. Queue Print

  42. Queue Print

  43. Queue Print After signing, the meds that have print jobs are highlighted and the Queue Print button is active

  44. Queue Print Click the Queue Print button and the print jobs are displayed, associated with pre-defined templates for each format and default printer (user may change)

  45. Rx Print Format (Template) editor Set up: • Design mode> Desktop Properties> Custom Menus • Add Menu item “Rx Template Editor” • Add the following in Action (lightening bolt) $(BEHRXGENERATORSERVICE.RXGENERATOR.edittemplates) • Click Apply and Ok • Make sure you have BEH Rx Generator Service checked under “required services” • Only place on EHR GUI templates of those who are responsible for editing Prescription formats (ie. CAC, pharmacy Ad Pac)

  46. Rx Print Format (Template) Editor Design Mode Rx Template Editor

  47. Rx Print Format (Template) Editor • Template type (format) • Prescription (Non-CII) • Prescription (CII) • Order for signature (CII) • Order for signature (Non-CII) • Receipt (Non-CII) • Receipt (CII) • Template • Default template for each template type delivered with EHRp9

  48. Rx Print Format (Template) Editor Importing template: The files are .ptxml files Click “active on” Select Yesterday at 6:00 am, then OK Now you may edit the template Click OK to store • Save the files to a local drive • Open Rx template editor • Select template type • Click Import • Change the name if desired, click OK

  49. Rx Print Format (Template) Editor • Active on – set activation date (usually Yesterday at 6:00am) • Preview – Display preview of current template • Import – import template • Export – export template • Add Free Text – you may add as many as you like. May include header info for format, alternate signature lines, etc. • Mark Inactive – inactivates template so users cannot select • *** Tip *** • To Copy a template - export, save and import: • - Change to a local name on imports. • - Set “active on” to Yesterday at 6:00 am. • - Make changes then click OK • Highly recommend using the copy process and creating local templates • rather than editing nationally delivered default templates ***

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