1. “ Incorporating an “Ask A Pharmacist” program into MyHealtheVet and Secure Messaging ” Presented by : Presented by : Eric Spahn, Pharm D, Veteran Healthcare System of the Ozarks (VHSO)/VISN 16 Contributors : Contributors : Lynn Sanders, Pharm D, Director, Pharmacist Re-Engineering, VACO PBM LuAnn Barron, RPH Pharmacy Program Manager, VACO PBM Maureen Layden, MD, MPH Director of the Medication Reconciliation Initiative, VACO PBM 2011 VA Pharmacy Informatics Conference (West Coast Edition) 1

2. Healthcare literacy, medication adherence, adverse drug events, and access have contributed to a nationwide medication use crisis Patients have limited “real time” access to comprehensive pharmacy services that mitigate this crisis by concentrating on safe, effective, and patient centered medication treatment management, review, and counseling Patients have questions about their medications at home, after hours, and seek answers on the internet or in the non VA health care settings Adverse drug events (ADE)s are the most common of all healthcare- associated adverse events and can occur when multiple changes to medication regimens take place in the context of poor patient education, inadequate medication resources, and lack of concise communication between the patient and provider Face the Facts 2

3. Description of Innovation “Ask A Pharmacist” incorporated within the MyHealtheVet (MHV) Pharmacy Section will provide Veterans, families and their caregivers info on: – Their VA Pharmacy: The CMOP, VA Formulary, and Frequently Asked Questions – Their Medications: From trusted sources – How to connect with their pharmacist directly through a triage group within Secure Messaging (SM) called “Ask A Pharmacist” Veteran Centered - this program will connect the patient to the pharmacy and the pharmacist to the healthcare team Both Veterans and the VA benefit as Veterans are motivated to become “In-Person Authenticated” and healthcare teams to increase awareness of available resources within MHV 3

4. Key Components 4 1.Ask A Pharmacist Secure Messaging Triage Group Utilize slocal triage group development within SM, in which messages sent to “Ask A Pharmacist VHSO" can be triaged from patient or primary care provider to pharmacy tech, then to staff pharmacist. In effect, this should provide less interruption to on-site patient care as well as a reasonable time frame for appropriate response and follow- up. (Can currently being incorporated at local sights) 2.Ask A Pharmacist Clinical Content Addition to Pharmacy Section of MHV MHV will host an Ask A Pharmacist site which will include a Frequently Ask Questions (FAQ) archive developed by a National Pharmacy Workgroup as well as links to internal and external medication resources, maintained by the workgroup and MHV. This component is currently being developed by various MHV and PBM representatives using the CAB content addition process.

5. Do you have a question for a Pharmacist..? “VA pharmacists are dedicated to your health and well-being. You can search our archive for answers to general questions about health and medications any time, day or night. VA pharmacists have prepared hundreds of answers to commonly asked questions. In addition, Veterans who have completed the In-Person Authentication Process (IPA) can submit specific questions for a prompt, personal response through SECURE MESSAGING!”SECURE MESSAGING

6. Location In MyHealtheVet

7. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist View In MyHealtheVet

8. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Frequently Asked Questions

9. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Frequently Asked Questions

10. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Frequently Asked Questions

11. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Links to resources within content Frequently Asked Questions

12. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Frequently Asked Questions

13. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Frequently Asked Questions

14. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Links to SM within content Frequently Asked Questions

15. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Links to Medications: Play It Safe within content Frequently Asked Questions

17. Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Link(s) to Secure Messaging

18. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Secure Messaging: Ask A Pharmacist

19. The way to do this within current functionality would be as follows: 1.Have the MHV coordinator activate the Pharmacy Staff at a VAMC whose job it would be to respond to the Ask a Pharmacist messages. 2.Create a Triage Group called Ask a Pharmacist Portland or Ask a Pharmacist VHSO, etc and put the pharmacy staff on this Group. 3.Have a CAC run a Reminders Due Report on the patients at that site who have gone through In-Person Authentication and choose the Option to save this report as an OE/RR List. Name the OE/RR list Ask A Pharmacist and be sure to make this list Public. 4.Associate the Ask a Pharmacist Triage Group with the Ask a Pharmacist OE/RR list. 5.Patients will now be able to select the Ask A Pharmacist triage group as a recipient of a New Message. 6.The CAC will have to periodically refresh this list as new patients go through In-Person Authentication. David Douglas, MD – Facility Chief Health Informatics Officer – Portland VAMC, VISN 20 Secure Messaging: Ask A Pharmacist Setup

25. PATIENT A PATIENT B Secure Messaging: Ask A Pharmacist Example PATIENT B PROVIDER

26. PATIENT A Secure Messaging: Ask A Pharmacist Example

27. PATIENT A PATIENT A, Secure Messaging: Ask A Pharmacist Example PATIENT A

28. Secure Messaging: Ask A Pharmacist Results David Douglas, MD – Facility Chief Health Informatics Officer – Portland VAMC, VISN 20

29. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Trusted Resources

30. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Medications: Play It Safe!

31. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist VA Pharmacy

32. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Medications and Health

33. Frequently Asked Questions Send A Secure Message Trusted Resources Medications: Play It Safe VA Pharmacy Medications and Health Ask A Pharmacist Medications and Health

34. Our colleagues agreed!

35. Strategic Goals Improve patient care – Safety: Communicating the right information from VA resources and trusted external resources –Quality: Activates patients to participate in shared and informed decisions about their medications –Access: Provides asynchronous communication determined by the Veteran, family, or caregiver Increase satisfaction across many stakeholders –Veteran, family, or caregiver –Their healthcare team Improve Workflow –Decreases phone calls, visits, and time waiting at the pharmacy window. –Assists in prescription processing questions as well as other medication related topics 35

36. Strategic Goals (cont) Address multiple unmet needs ― Use MyHealtheVet (MHV) as a provider of an "Ask the Pharmacist" Program ― Give Veterans a chance to “Ask Pharmacists” questions about medications and health concerns through a pharmacy archive and/or secure messaging ― Provide both general and patient-specific drug information to our Veteran in one venue: MHV Help meet organizational requirements ― VA Medication Reconciliation Directive ― Joint Commission ― Meaningful Use 36

37. Success Metrics Process Metrics –Site usage statistics –Deployment across the VA Outcome Metrics –Decrease calls and visits to clinic and pharmacy –Decrease medication misadventure-related encounters Satisfaction –Patient, caregiver, and family –Staff 37

38. Impacts Stakeholders –The Veteran, family, and caregiver –Patient Aligned Care Teams(PACT)s, pharmacy, clinic, and support staff –MyHealtheVet, VA Pharmacy Benefits Management, National Medication Reconciliation Initiative Current Support –Pharmacy Benefits Management  VA Medication Reconciliation Initiative  Clinical Pharmacy –MyHealtheVet –Daily Plan 38

39. Approach Assemble a stakeholder and subject matter workgroup – Develop business requirements for each task and functionality – Draw mock ups, use cases, and describe potential scenarios – Plan for unintended consequences and comply fully with VA patient information security standards Submit request for proposal to contracting per VA policy 39

40. Team and Environment Levels of support –Veteran Healthcare System of the Ozarks (VHSO)  Patient Satisfaction Surveys (SHEP) – Meets or exceeds National and VISN statistics  VISN 16 Veterans Rank 3 rd in nation for online utilization of MHV  Ask a Pharmacist VHSO has 297 associated, 266 opted in –Enabled “Ask A Pharmacist” Secure Messaging Triage Group spread  Portland VAMC VISN 20 –MyHealtheVet Clinical Advisory Board (CAB) content addition approval since 2008 Subject Matter and Stakeholder Workgroup –Pharmacists, providers, nurses, clinical application coordinators, patient safety, quality & performance, and informational technologists –Program office and field representatives 40

41. Implementation Resources needed – FTEE Program Analyst – FTEE Program Manager – Contracting for Prototype Development and Testing Pre-Work: Local Pharmacist Secure Messaging Triage Group Roll Out –This pre-work is ongoing now within our facility (VHSO) and Portland VAMC Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet – Assemble candidate pilot groups – Identify project plan, key milestones, and communication strategies with leadership 41

42. Timeline Definition of Above Steps: Pre Work: Local Pharmacist Secure Messaging Triage Group Roll Out Step 1: Pre-work “Ask A Pharmacist” Secure Messaging Triage Group Roll Out Step 2: Completions of requirements and supporting documents Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet Step 3: Contracting process Step 4: Prototype Development Step 5: Integration MHV applications Step 6: Complete Testing InnovationPre-Work 42

43. Budget Narrative Pre-Work: Local Pharmacist Secure Messaging Triage Group Roll Out ― Clinical Application Coordinator/MHV Coordinator development and implementation ― Local projected costs based on 1hr/mo is ~$2000/yr Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet – The cost of developing and deploying the software to support the business requirements $150,000 – The cost of the supporting pilot implementation $100,000 – After the pilots have been deployed, operations and maintenance costs for spreading throughout the VA $50,000 per fiscal year 43

44. Challenges and Risks Challenges & Risks Lack of full incorporation with MHV business architecture Poor usage by patients, family, and caregivers Lack of seamless integration with existing VA facility workflow Mitigation Ongoing and effective collaboration with MyHealtheVet Broad-based outreach campaign Ongoing and iterative feedback with key stakeholders in the field 44

45. Measures of Success Ask: Veterans deserve access to comprehensive pharmacy services to help promote full participation in the successful management of their medication treatment plans A Pharmacist: The most accessible healthcare profession will participate and promote multidisciplinary team based care via their Pharmacist On MHV: The most patient friendly platform in the VA: MHV promotes internal sites and services as well as In-Person-Authentication (IPA) while reducing patients waiting on the phone or at the pharmacy window Our colleagues agreed, ranked this 13 th out of 4700 ideas, added positive comments like: “Great Idea!” “Possibilities are endless!” “Connects the patient to the pharmacist” “Helps with pharmacy and MHV integration” We’ll know we are successful when we hear one Veteran say to another, “Its easy, I just went on “Ask a Pharmacist” and found the answer I was looking for”. 45

46. Questions