Implementing a Medication Interface with the EMR and OTTR

1. Implementing a Medication Interface with the EMR and OTTR Josh Clifton Database Analyst | OTTR Administrator Georgia Regents Health System Kidney and Pancreas Transplant Program Augusta, Georgia

2. Agenda • Overview • Challenges • Limitations • Go-live strategy • Workflows • Success factors

3. Overview • One-way, real-time HL-7 medication interface from EMR (Cerner Millennium) to OTTR • Goal • Complete medication lists in both information systems; consistency throughout the health system • Eliminate dual entry

4. Overview • Scope • Outpatient • A new interface for the hospital EMR (Cerner) • Medications by history • Prescriptions within the health system • Ambulatory/in-office meds (verified by pharmacist) • Inpatient • Existing flows from pharmacy system to dispensing system utilized • Hospital formulary medicines (verified by pharmacist)

5. Challenges • Two medication entry points to one • Rule of thumb is to defer/adapt OTTR to the hospital standard • i.e. frequency codes, route codes, formulary • EMR medication list is naturally more complex than OTTR • Make appropriate adjustments to HL7 on sending side to accommodate data elements OTTR can accept

6. Challenges • Formulary • Performed medication mapping for OTTR flowsheet medicines (immunosuppressants) • Identify all EMR medicines requiring mapping to corresponding OTTR column • Create master HL-7 files • During test phase add each pertinent medicine to EMR • Spool transactions within OTTRFeed and retain a copy for use during PROD cutover • Perform mapping using OTTR Admin | Database Editor by updating DATAFEED_MEDStable

7. Medication Mapping

8. Challenges • Freetext medications / special instructions • Dosage: [null] • Units: “See Instructions” Freetext entry populates medication comments

9. Challenges • Suspended home medicines at inpatient admission • When suspended in EMR, comment populated from sending side. • When resumed in EMR, comment removed. Comment also populates mapped flowsheet medicines in OTTR 6

10. Limitations • Multi-ingredient medicines (administered at hospital) • Unable to store RXCs in OTTR without major code change • Solution deemed acceptable by clinicians as EMR is primary system utilized within inpatient venue • Medication = orderable in EMR • Dose = volume dose (of all ingredients) Comments populate with text “See EMR medication profile for full order details”

11. Go-live Conversion Strategy • Challenge • OTTR and EMR contained separate medicine lists, using different formularies • Existing OTTR medicines could not be ended by interface due to obvious differences

12. Go-live Conversion Strategy • Solution • End all OTTR medicines programmatically • Implement a data conversion workflow, requiring a one-time manual review between OTTR and EMR • First clinic visit post-go-live • First patient call referencing medications post-go-live

13. Go-live Conversion Strategy • Pre go-live Configuration • End OTTR medicines • Add pending action to affected patients • Add “severe” alert list(s) for tracking • Pending patients with upcoming clinic visits • All pending patients for general tracking

14. Go-live Conversion Strategy • Pre go-live Configuration (con’t) • Develop OTTR custom window and corresponding report to walk user through process • Add custom window link to patient review window • Revoke medication permissions for user roles

15. Workflow Staff member reviews OTTR workflow/patient population-specific action tracking list: Pending Medication Interface Data Conversion - [population] User opens EMR medication list and OTTR Current Medications (Data Conversion) Custom Window Start OTTR medication list only displays ended medicines. OTTR custom window displays current medicines as of interface go-live. Custom window utilized for review/update in EMR OTTR current medication(s) in EMR? Yes No Medication type In EMR, resendHxmedication Add OTTR medication(s) to EMR Hx Rx OTTR medication list displays current medicines received via interface from EMR. OTTR medication list left in state where exclusively updated by interface. OTTR custom window no longer used for patient. In EMR, resend Rx medication Medication transmitted and stored in OTTR medication list EMR current medication(s) in OTTR? Mark OTTR action done: Medications Interface Data Conversion End Yes No

16. Patient ListPending Medication Interface Data Conversion • Check pending action list for patients with upcoming clinic visits

17. Patient Demo Strip • Launch data conversion window directly from patient review window

18. OTTR Custom WindowCurrent Medications – Interface Data Conversion(Incomplete) Optional: Print reconciliation worksheet and notate changes on paper during review process OTTR medications as of go-live To be compared with current EMR list

19. Initial Reconciliation Worksheet Compare OTTR medications (as of go-lve) with current EMR list. Indicate corresponding med type as in EMR. Following instructions on worksheet, initiate a “resend” from EMR to OTTR. If med in EMR/not in OTTR, it is suggested to indicate on worksheet. i.e. “Not in OTTR, need to resend: Methadone 10mg oral tablet, 10mg PO Q6HR”

20. OTTR Custom WindowCurrent Medications – Interface Data Conversion (Complete) EMR medications currently stored in OTTR When all EMR medications are in OTTR, mark Interface Data Conversion action done

21. Success factors • Get to know your EMR • Outpatient and inpatient medication workflows • Back-end verification tasks by pharmacist • Identify all actions user can perform to a single medication • Test each action and ensure interface transaction is triggered if pertinent details change

22. Success factors • Unit testing • Try to break it • Integration testing • Develop detailed scripts testing each workflow • Require end users to test (also serves as training)

23. Success factors • Create a detailed cutover plan • GRHealth went live in EMR first (Cerner PROD results sent to OTTR TEST) • Able to document steps and time to complete • Able to validate using real data (i.e. patient tracers) • Result: Successful go-live in OTTR with no major surprises

24. Questions?