1. 1 Pharmacy Re-Engineering (PRE) Project Overview April 24, 2007 Birmingham, AL Mike Mims Program Manager for Pharmacy Systems

2. 2 PRE Background Many VHA technology problem areas and weaknesses identified  Prior to 2001 First Consulting study  Included patient safety issues SwRI awarded multi-year, fixed-price contract  FY04 to develop new pharmacy system  Renewable annually starting in FY05  Period of performance ends January 2008

3. 3 FY07 - Changing Environment Entire VA Environment changed New Organizational Structure Continuing Resolution No Approved Budget (80% of FY06 Budget) Unable to move forward with New Contract with SwRI Generated Re-planning effort

4. 4 PRE Restructuring in FY07 Reasons for change: Budget reductions, PRE & dependent projects Uncertain/incomplete HeV Architecture Lack of Common Services maturity Pharmacy “Out of Sequence” Perceived Duplication of Efforts  Standards and Terminology Services

5. 5 2007 Development Plans Goals for New Plan Stay within expected budget Release something of value to field in 12-18 months Priority to address recent patient safety issue Reduce/delay dependencies on other development efforts Review scope of SwRI contract & distribute work as appropriate

6. 6 2007 Development Plans Goals for New Plan (cont’d) Spread release of PRE functionality over long period to allow architecture to mature Phase new staff into VA Teams to help transition PRE development in-house Incorporate Standards and Terminology competencies/resources into project team

7. 7 Standards And Terminology Services Added to PRE Team Terminology standardization includes:  Analysis of current usage and existing standards  Determination of the VHA standard  Assignment of unique identifiers (VUIDs)  Modeling the term to ensure consistent meaning  Implementation/Deployment of the standard

8. 8 Standards And Terminology Services Added to PRE Team (cont’d) Terminology standardization includes:  Maintenance of the national standard through additions and deletions of terms  Monitoring sites for compliance with the national standard

9. 9 Revised PRE Plan – Overview SwRI FY07 Contract  $2M for PEPS v0.5  $5M proposed to develop significant v1.0 components FY08: Recruit staff for transition to in-house development Redistribute SwRI tasks to other development teams 5 major releases deployed over 7 years

10. 10 PRE Versions PRE v0.5, v1.0 and Remaining Work  Major Features  Schedule  Costs (current)

11. 11 PRE v0.5 Order Checks

12. 12 PRE v0.5 Builds on December 2006 Proof of Concept Implements all demonstrated order checks  Use commercial drug database services Enhanced order checks New dosing checks APIs to support order-check enhancements through legacy Pharmacy & CPRS

13. 13 PRE v0.5 Major Features VistA Enhancements Enhanced Checks  Drug-Drug  Duplicate ingredient (drug)  Duplicate Therapy (class) New Checks  Maximum Single Dose  Daily Dose Range

14. 14 PRE v0.5 Major Features VistA Enhancements Renal/Hepatic Impairment Dose Indicators APIs to support order check enhancements Ability to i.d. recently DC’d/expired med orders

15. 15 PRE v0.5 Major Features HealtheVet Construction Create COTS Drug database - Legacy VistA interfaces  Components developed for Proof of Concept

16. 16 PRE v0.5 Assumptions No local data migration or conversion required Minimal FDB–VistA data mapping required FDB Enhanced Therapeutic Classification (ETC) used for duplicate therapy checks only Standard FDB processes for database updates GCN_SeqNO populated in NDF for all drugs in order checks

17. 17 PRE v0.5 Responsibilities PRE Team Overall project governance Design & develop  VistA changes to legacy pharmacy  VistA interfaces with PEPS

18. 18 PRE v0.5 Responsibilities Standards and Terminology Services (STS) Lead VistA NDF data standardization efforts  Provide requirements to PRE team Lead Structural/content analysis  Med Routes, Drug Interactions, VA Product, & Drug Units files  Model Terminology  Maintain standard terminology Possible VistA-PEPS-COTS data mapping Validate local mappings

19. 19 PRE v0.5 Responsibilities Southwest Research Institute (SwRI) Design & develop PEPS interfaces for VistA - FDB order-check messaging  Based on FY06 PEPS v1.0 Proof of Concept Support PRE v0.5 stages I and II testing

20. 20 2007200820092010 PRE v0.5: Enhanced Order Checking Functionality Coding/St. I Test 6 St. III 7 Deployment 5 St. II 1234 1Feb 1-Apr 30 ‘07Coding Discontinue/Hold Functionality 2May 1-Jul 31 ’07Coding New Order Checks/Warnings 3Aug 1-Sep 30 ’07Coding Enhanced Order Checks 4Oct 1-31 ’07Stage I/User Acceptance Testing 5Nov 1-Dec 31 ’07Stage II/Lab Testing 6Jan 1-Mar 31 ’08Stage III/Field Testing 7Apr 1-Aug 31 ‘08Deployment PRE v0.5 Schedule

21. 21 PRE v0.5 Risks Production environment Support staff Legacy system enhancements Performance COTS drug database licenses

22. 22 PRE v0.5 Dependencies Standards & Terminology Services (STS) SwRI CPRS COTS Drug Database

23. 23 PRE v0.5 Costs VA staff: $1.34 million Non-VA: $4.07 million  Includes PRE contract staff PRE support from CPRS, STS, BCMA, EVS contractors Contractor travel Equipment: $70k

24. 24 PRE v1.0 Remaining Pharmacy Enterprise Product Systems (PEPS) Functionality

25. 25 PRE v1.0 Major Features VistA Enhancements All v0.5 functional plus: Identify  Product type and storage requirements  High-risk drugs for follow-up  Drugs requiring witness for administration Display of lab/vitals information

26. 26 PRE v1.0 Major Features VistA Enhancements (cont’d) Implement dispensing limits (qty/days supply) Enhanced do-not-mail functionality Order Checks  Lifetime cumulative dose  IV compatibility

27. 27 PRE v1.0 Major Features HealtheVet Construction Replace legacy PDM and NDF applications Drug update and maintenance tools Ability to manage pharmacy users’ roles Enhanced system management tools Improved reporting capabilities

28. 28 PRE v1.0: Remaining Pharmacy Enterprise Product System (PEPS) functions 2007200820092010 6 Test I 9 Deployment 8 Test III 7 Test II 2354 1 Mar 1-May 31 ‘07Coding PEPS Local & Nat’l GUIs, Definition of VUID Messaging 2 Jun 1-Aug31 ’07Coding Enhanced Item Mgmt Functionality 3 Sep 1-Dec 31 ’07Coding Enhanced Complex Item Mgmt Functions 4 Jan 1-Mar 31 ‘08Coding VistA DRUG file synchronization 5 Apr 1-Jun 30 ‘08Coding VistA PDM file synchronization 6 Jul 1-Sep 30 ’08Stage I/User Acceptance Testing 7 Oct 1-Dec 31 ’08Stage II/Lab Testing 8 Jan 1-Mar 31 ’09Stage III/Field Testing 9 Apr 1’09 –Feb 28 ‘10Deployment 1 Coding PRE v0.5 Schedule

29. 29 PRE v1.0 Costs VA staff: $928k Non-VA: $8.85 million  Includes PRE contract staff PRE support from CPRS, STS, BCMA, EVS contractors Contractor travel *v1.0 SwRI Costs estimated based on remaining contract funds Equipment: $40k

30. 30 Beyond PRE v1.0 Remaining Pharmacy Enterprise Product Systems (PEPS) Functionality

31. 31 Beyond PRE v1.0 Working with Business Owners  Organize  Prioritize Sequencing must consider:  Patient safety issues  Funding requirements  Availability of common services  Ability of other applications to implement

32. 32 Major Features – Remaining PRE PRE v2.0 Inventory  Replace current packages Controlled Substances Drug Accountability Automatic Replenishment/Ward Stock Requirements gathering based on SwRI work

33. 33 Major Features – Remaining PRE PRE v3.0 Order Entry, Clinical Monitoring  Replace parts of current packages Outpatient Inpatient IV order processing  Changes to support ordering through CPRS Based on requirements gathered by SwRI In-house analysis & construction

34. 34 Major Features – Remaining PRE PRE v4.0 Dispensing functions  Replace remaining order processing parts Outpatient Inpatient IV Based on requirements gathered by SwRI In-house analysis & construction

35. 35 Major Features – Remaining PRE PRE v5.0 Administration  Replace current BCMA functions Based on requirements gathered by SwRI In-house analysis & construction

36. 36 Remaining PRE Functionality Schedule PRE v0.5 PRE v2.0 Inventory PRE v3.0 Order Entry, Activate & Clin Mon (HeV) Coding PRE v4.0 Dispense PRE v5.0 Administration & Migration 20072008200920102011201220132014 PRE v1.0

37. 37 Questions?