1. Pharmacist Informaticist Training July 16, 2012 - Albuquerque, NM 1 Pharmacist Role in the CMS e-Prescribing Program & Meaningful Use e-Prescribing Measure

2. 2 Presenter: Lori Moore, Pharm D. IHS e-Prescribing Federal Lead USET Pharmacy Consultant Office of Information Technology (OIT)

3. Objectives Compare and contrast the CMS e-Prescribing Program to the Meaningful Use e-Prescribing Measure. Delineate necessary steps to optimize and maintain pharmacy data management, allergies, quick orders, and medication order menus to successfully implement e-Prescribing. Examine the importance of the on-demand drug interaction checker in EHR. 3

4. e-Rx HOT Topics MU e-Prescribing Measurement Established 2010 Incentives/Penalties Required Functionality Prescription Routing CMS e-Prescribing Program Established in 2008 Incentives/Penalties Required Functionality Prescription Routing Medication History Formulary Eligibility 4

5. E-RX OVERVIEW 5

6. RPMS/EHR e-Prescribing Functionality Today: New Rx (Retail Pharmacy) 6

7. E-Prescribing & Surescripts Provider Identifier (SPI) Number 7

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9. IHS Central e-Prescribing Server Total Daily Incoming Messages 9

10. IHS Central e-Prescribing Central Server Total Monthly Incoming Messages 10

11. RPMS EHR e-Prescribing Functionality 11

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13. Participating Surescripts Pharmacies 13

14. Pharmacist Role: Maintain an Optimized Drug File 14

15. Drug File Optimization 15 Pharmacy Drug Management Prompt Additional Information and Guidance DRUG GENERIC NAME All sites moving towards E-Prescribing will need to review the drug file names to ensure a standard naming convention that aligns with Generic Name (plus) Strength (plus) Dosage Form. It is also critical to avoid special characters within the drug name that can result in transmission errors. VA CLASSIFICATION: The VA Classification field controls the EHR medication order checks. This includes order checks for allergies & drug-drug interactions. This field will populate automatically when the pharmacist matches the drug to the National Drug File (NDF). DEA, SPECIAL HDLG: Remember controlled substances are excluded from the E-Rx MU report logic. This report determines which EP’s will have to meet the 40% threshold. Therefore errors in the DEA, Special HDLG field could negatively impact your EP’s when reporting this specific e-Prescribing Measurement.

16. Drug File Optimization (cont) Pharmacy Drug Management Prompt Additional Information and Guidance ORDER UNIT: Next 3 fields work together and impact Provider Order Entry. Pharmacy should always complete the documentation for these 3 fields based on the correct product information. DISPENSE UNIT: See Order Unit above for more details. DISPENSE UNITS PER ORDER UNIT: See Order Unit above for more details. DISPENSE UNIT NCPDP CODE: National Council for Prescription Drug Programs (NCPDP) Provides a standard for the exchange between prescribers, pharmacies, intermediaries, and payers. NDC: National Drug Code (NDC) is a unique number assigned to all prescription and over the counter medications approved by the FDA. 16

17. Drug File Optimization (cont) 17 Pharmacy Drug Management Prompt Additional Information and Guidance NATIONAL DRUG FILE You MUST match each and every drug to the National Drug File (NDF) to obtain VA Drug Class. This will allow allergy checking and Drug/Drug interactions to operate correctly. Without this code your providers will NOT get the appropriate order checks, which can ultimately result in adverse patient outcomes. DOSAGES All medications in the RPMS drug file need to have appropriate dosages assigned to improve provider order entry, decrease medication errors, and to prevent any E-Rx transmission failures.

18. Drug File Optimization Cont… 18 Pharmacy Drug Management Prompt Additional Information and Guidance APPLICATION PACKAGES Marking a drug “O” authorizes it to be ordered in an Outpatient (aka Ambulatory Setting) and it will be processed through the Outpatient Pharmacy Drug File or it can be E-Prescribed. Marking a drug “X” allows you to order it as a NON-VA Medication and is not necessary for E-Prescribing functionality. ORDERABLE ITEM MANAGEMENT Pharmacy should optimize the orderable item file to ensure that the orderable item matches the intended dispense drug that the patient will receive in the dispensing process.

19. Prescription Clinical Content Quality Report Card Indian Health Service 19

20. Pharmacist Role: Maintain Drug File Updates Be proactive with adding new medications to your drug file 20

22. Pharmacist Role: Collaborate on multidisciplinary teams to optimize clinic workflows to improve utilization of EHR medication management tools Work with providers to develop/enhance quick orders & quick order menus Stay INFORMED by attending online courses to keep up with the constant changes in RPMS packages and then share it with your providers to improve medication management 22

23. Pharmacist Role: Improve patient safety Improve quality and efficiency of the prescribing process Improve health outcomes Improve cost savings 23

24. Questions? 24

25. National e-Prescribing Team Lori Moore, Pharm D. USET/OIT National Pharmacy Consultant Federal Lead lori.moore@ihs.gov Carla Stearle, Pharm D., BCPS USET/OIT National Pharmacy Consultant carla.stearle@ihs.gov Gail Crane Deployment Project Manager (DNC Contractor) gail.crane@ihs.gov Sean Cook e-Prescribing Analyst (DNC Contractor) sean.cook@ihs.gov 25

26. e-Prescribing Pharmacy Consultants OIT Mary Ann Niesen, OIT Pharmacy Consultant Mike Allen, OIT Pharmacy Consultant Carla Stearle, OIT Pharmacy Consultant Lori Moore, OIT Pharmacy Consultant USET Bob Adams (PEI) Sarah Michael (PEI) Preston Van Curen (PEI) Shelly Foster CRIHB Denise Vermilyea Alaska Carlene McIntyre 26