HITSP Real World Sites Medication Management

1enabling healthcare interoperability

2009 Webinar Series

Sponsored by the HITSP Education, Communications and Outreach Committee

HITSP Real World SitesMedication Management

Webinar 8 September 10th, 2009 | 2:00 – 3:30 pm (Eastern)

Moderator: Ken Majkowski, Surescripts

Presenters: J. Marc Overhage, Regenstrief Institute Peter Kaufman, DrFirst

Slide 2HITSP – enabling healthcare interoperability 2009 Webinar Series

Learning Objectives

During this 90-minute webinar, participants will learn:

— Learn how the HITSP Medication Management Interoperability Specification is being used today by the Regenstrief Institute, DrFirst, and Surescripts

— Explore the value and limitations of external sources of medication history

— Learn how various standards are employed in the HITSP Medication Management transactions

— Discover how DrFirst and Regenstrief have employed HITSP in the real world in the areas of e-prescribing, patient eligibility, formulary and benefit inquiry, and medication reconciliation


Agenda

What is HITSP?

Surescripts case study

Regenstrief Institute case study

DrFirst case study

Overview of the 2009 Webinar Series

Questions?


Mission

To serve as a cooperative partnership between the public and

private sectors for the purpose of achieving a widely accepted

and useful set of standards specifically to enable and support

widespread interoperability among healthcare software applications,

as they will interact in a local, regional, and national health

information network for the United States.


HITSP is a volunteer-driven, consensus-based organization

that is funded through a contract from the Department of

Health and Human Services

— Created in 2005

HITSP develops Interoperability Specifications (IS) – documents

that harmonize and recommend the technical standards that are

necessary to assure the interoperability of electronic health records

— Production to date:13 IS and 60 related constructs

Overview


HITSP Stakeholders

Patients

Consumers

Employers

General

Practitioners

Outpatient

Providers

Government

Agencies

Hospitals

Review Boards

Practice

Guidelines

Residential

Care Providers

Standards

Developers

Specialists

Payers

Suppliers

Current Participation in HITSP:

800+ organizations 1,000+ individuals

Over 25,000 volunteer hours


HIT Standardization

HITSP members agreed that a standard is a

well-defined approach that supports a business

process and . . .

— has been agreed upon by a group of experts

— has been publicly vetted

— provides rules, guidelines, or characteristics

— helps to ensure that materials, products, processes and services are fit for their intended purpose

— is available in an accessible format

— is subject to an ongoing review and revision process

Standards Harmonization is required when a proliferation of

standards prevents progress rather than enabling it.


Released Accepted Recognized

Federal projects must use HITSP recognized standardsPer Executive Order 13410

Panel approved for submission to HHS

Secretary of HHS has accepted for a period

of testing

Secretary of HHS has recognized the IS for

immediate implementation

Status: Interoperability Specifications


IS 01Electronic Health Record (EHR) Laboratory Results Reporting

IS 02 Biosurveillance

IS 03 Consumer Empowerment

IS 04Emergency Responder Electronic Health Record (ER-EHR)

IS 05Consumer Empowerment and Access to Clinical Information via Media

IS 06 Quality

IS 07 Medication Management

HITSP Interoperability Specifications (IS)

Accepted

Recognized


IS 08 Personalized Healthcare

IS 09 Consultations and Transfers of Care

IS 10 Immunizations and Response Management

IS 11 Public Health Case Reporting

IS 12 Patient – Provider Secure Messaging

IS 77 Remote Monitoring

IS 107 EHR Centric

HITSP Interoperability Specifications (IS)

Released /Panel

Approved

Accepted


“Meaningful Use”

From existing Interoperability

Specifications, determine subset

required for “meaningful use” as

called for in the American Recovery

and Reinvestment Act (ARRA).

Effort began on April 7, 2009.


All based on previous HITSP work

CAP140 Exchange Administrative Benefits/Eligibility transactions specification

CAP141 Exchange Administrative Referral/Authorization Transactions Specifications

CAP142 Retrieve Communications Recipient

CAP143 Consumer Preferences and Consent Management

CAP146 Identification of communications Recipient Specifications

CAP117 Communicate Ambulatory and Long Term Care Prescription Specification

CAP118 Communicate Hospital Prescription Specification

CAP119 Communicate Structured Document Specification

CAP120 Communicate Unstructured Document Specification

CAP121 Communicate Clinical Referral Request Specification

CAP122 Retrieve medical Knowledge Specifications

CAP123 Retrieve existing data Specifications

CAP124 Establish Secure web access Specifications

CAP125 Retrieve Genomic Decision Support Specifications

CAP126 Communicate Lab Results Message Specifications

CAP127 Communication of Lab Results Document Specifications

CAP128 Communicate Imaging Information Specifications

CAP129 Communicate Quality Measure Data Specifications

CAP130 Communicate Quality Measure Specification Specifications

CAP131 Immunization Registry update Specifications

CAP132 Immunization Registry Query Specifications

CAP133 Communication of Immunization Summary Specifications

CAP135 Retrieve Pre-populated Form for Data Capture Specifications

CAP136 Emergency Alerting Specifications

CAP137 Send and Receive clinical data message Specifications

CAP138 Assign pseudo-identity SpecificationsEmergency CAP139 Communicate Resource Utilization Specifications

ADMINISTRATIVE and FINANCIAL

HITSP Capabilities

Immunization

Case Reporting and

Bio-surveillance

Medication Management

CLINICAL OPERATIONS

(Care Delivery, Emergency Responder

and Consumer Empowerment)

Exchange of Clinical Data

Exchange of Laboratory and Imaging Data

Quality Management

CLINICAL QUALITY AND

PUBLIC HEALTH


IS 01Electronic Health Record (EHR) Laboratory Results Reporting

IS 02 Biosurveillance

IS 03 Consumer Empowerment

IS 04Emergency Responder Electronic Health Record (ER-EHR)

IS 05Consumer Empowerment and Access to Clinical Information via Media

IS 06 Quality

IS 07 Medication Management

Today’s Focus . . .

Accepted

Recognized


2009 Webinar Series


Medication Management Real World Sites

Surescripts

Ken Majkowski, Pharm. D.Vice President, Clinical Affairs and Product Strategy, Surescripts


Definition of E-Prescribing

E-Prescribing supports a shift to a paperless and more informed way for payers, prescribers and pharmacists to communicate.

E-Prescribing occurs when a prescriber uses a computer or handheld device with software that enables him or her to:

— Electronically access that patient’s prescription benefit.

— With a patient’s consent, electronically access that patient’s prescription history.

— Electronically route the prescription to the patient’s choice of pharmacy. When the patient runs out of refills, his or her pharmacist can also electronically send a prescription renewal request to the physician’s office for approval.

Prescription Benefit

Prescription History

Prescription Routing


Provides electronic delivery of patient prescription history from payers and pharmacies to prescribers

Prescription History Data:

Date Range of History

Drug Name (Brand/Generic)

Oldest Fill Date, Most Recent Fill Date

Number of Fills, Days Supply, Quantity Dispensed

Pharmacies/Prescribers


Surescripts National Progress Report Summary

Adoption 2006 2007 2008 Q2 2009

Prescription Benefit

33M 37M 79M9% patient visits

66M

Prescription History

4M 7M 16M1.8% patient visits

24M

Prescription Routing

11M 29M 68M4% eligible Rxs

78M

Total Message Volume

69M 107M 242M 303M

Opportunity:

According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons.According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)


Opportunity:

Adoption 2006 2007 2008 Q2 2009

Prescribers 16K 36K 74K 126K 21% prescribers

Payer Member Records

160M 200M 230M 222M

Community Pharmacies

34K 41K 47K 50K82% pharmacies

Mail Order Facilities

3 3 6 6

According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons.According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)

Surescripts National Progress Report Summary, continued


Medication History for Hospitals

Provides clinicians access to up-to-date medicationhistory for patients they are treating in an inpatient setting

Person search

Dispensed claims medication history


Medication History for Hospitals, continued

Delivered to the acute care setting via strategic distribution partners:

— DrFirst

— Emerging Health

— GE Healthcare

— Healthcare Systems

— InterMedHx

HL7 Interface

— ADT

— RDS

— ORU

— Regenstrief

— Siemens

— Standard Register

— others


Value Drivers – Disaster Relief

In response to the lessons learned in the aftermath of Hurricane Katrina, a collaborative of public and private organizations launched ICERx.org (In Case of Emergency Prescription Database).

This online resource allows authorized physicians and pharmacists to get evacuees’ medication records

Prescription history information is pooled from a variety of sources, including Surescripts, payers and state Medicaid programs.

This information allows health care professionals to safely renew prescriptions for evacuees and help coordinate care, while avoiding harmful prescription errors and potential drug interactions.

For more information, visit www.icerx.org.


Additional External Medication History Sources

State Medicaid Programs

Enterprise Medication History Databases

Pharmacy Benefits Managers (PBMs)

Health Plans

Pharmacies

Personal Health Records (PHRs)

Others


For More Information

The E-Prescribing Resource Centerwww.surescripts.com

A Comprehensive Resource Center for Payers, Prescribers and Pharmacists

http://www.surescripts.com/news-sign-up.html


2009 Webinar Series



Regenstrief Institute

J. Marc Overhage, M.D., Ph.D.Director of Medical Informatics and Research Scientist, Regenstrief Institute


Background


Regenstrief – Solutions and Problems Solved

Incomplete medication histories

Fragmented patient data

Difficult to obtain electronic formularies

Difficult to maintain pharmacy data

Providers without an Electronic Medical Record (EMR)


ePrescribing— Provide a comprehensive medication history (greater starter set)

— Incorporate allergies and other clinical data

— Incorporate formulary decision support

— Capture prescriptions written

Medication Management— Provide a comprehensive medication history

— Incorporate allergies and other clinical data

— Incorporate formulary decision support

Regenstrief – Use Cases


E-Prescribing Flowchart

DispensingDatabases

PBMDatabases

ClaimsDatabase

FormularyDatabases

Provider’sAppointment

System

PrescribingDatabases

MedicationHistory

Patient Matching

• Merge Sources• Merge providers• Aggregate• De-duplicate Records• Age Records• Compute MPRs

• Matching prescription and dispensing data

• Provide views of merged data

• Allergy checking• Clinical decision support

Formulary Prescription Records

HL7 Appointment

Surescripts


E-Prescribing Flowchart, continued

Surescripts

PrescribingDatabases

Prescription

HITSP T43 Med OrderNCPDP SCRIPT Std.

Update Prescribing Database


Constructs

— C 26 : Nonrepudiation of Origin

— C 38 : Patient Level Quality Data Document

— C 44 : Secure Web Connection

— C 80: Clinical Document and Message Terminology

Transactions

— T 16: Consistent Time

— T 17: Secured Communication Channel

— T 31: Document Reliable Interchange

— T 68: Patient Health Plan Authorization Request and Response

Transaction Packages

— TP13: Sharing of documents

— TP20: Access Control Transaction Package

— T 15: Collect and Communicate Security Audit Trail Transaction

— TP 43: Medication Orders Transaction Package

— TP 46: Medication Formulary and Benefits Information Transaction Package

HITSP Constructs Used


Solution & Benefits

More complete medication histories for more patients

Data from multiple sources enriched the clinical context (laboratory results, allergies, diagnoses)

More formularies available

Patients cared for by providers without Electronic Medical Records (EMRs) still received the benefit of clinical decision support


Successes

Reduced number of adverse drug events

Improved therapeutic monitoring

Improved formulary adherence lower patient costs

Improved provider satisfaction



www.regenstrief.org


2009 Webinar Series



DrFirst

Peter N. Kaufman, M.D.Chief Medical Officer, DrFirst, Inc.


Impact of E-Prescriptions on Physician Office Workflow

Improve efficiency - Increase staff productivity

Improve patient safety, quality of care, and satisfaction

Minimize time spent phoning/faxing to clarify prescriptions and authorize renewal requests

Minimize time spent phoning and faxing to ensure formulary compliance

Minimize chart pulls - Reduce time to find prescribing information

Simplifying staff workflow, allowing completion of refill authorizations in seconds, not hours

Remotely check patient medications and allergies – and prescribe


Information Available in the E-Prescribing Workflow via HITSP and SDO

Technical Standards

Patient Demographics (HL-7, CCD)

Eligibility (X12 270/271)

Medication History (NCPDP SCRIPT)

— Pharmacies

— Payors

Formulary and Benefits (tiers, co-pays, substitution) (NCPDP SCRIPT)

Renewal Requests (NCPDP SCRIPT)

New Prescription (retail and mail order) (NCPDP SCRIPT)


Workflow: example

Staff confirms on arrival:

— Demographics

— Pharmacy - ask patient

— Medication History List - pull down through Surescripts and confirm with patient

Prescriber:

— Reviews current medication list

— Insurance eligibility is displayed

— Formulary alerts, substitution, co-pay etc. present when medication is chosen

— Clinical alerts present during prescribing, if applicable


Standards Not Yet in Wide Use for E-Prescriptions

Allergies (CCD)

Diagnoses (CCD)

Prior authorization (NCPDP SCRIPT)

RxNorm (to supplement/replace NDC codes)

Structured and codified SIG (NCPDP SCRIPT)


Remember . . .

Having a feature is not the same as

having a usable feature


How Physicians Realize the Benefits of True Electronic Prescribing

Improves efficiency

— Minimizes time spent phoning and faxing to clarify prescriptions, authorize renewal requests and ensuring formulary compliance

Inbound calls decreased from 36% to 18.5% of RX filled; outbound calls were reduced by more than 50%

Increases staff productivity

— Simplifies staff workflow, allowing completion of refill authorizations in seconds, not hours

— Enables remote access to patient medications and allergies

— Re-allocate staff time to other activities


Improves quality of care

— Improves safety and quality of care: drug/drug drug/allergy, drug/diagnosis and dose checking, medication history

— Reduces errors due to misread prescriptions and medications with similar sounding names

Increases patient satisfaction

— Decreases pharmacy wait times while improving safety

— Formulary compliance can reduce co-pays

How Physicians Realize the Benefits of True Electronic Prescribing, continued


Peter N. Kaufman, MDCMO, DrFirst

3206 Tower Oaks Blvd. #310Rockville, MD 20854Cell: 301-806-8004

[email protected]



Webinar 1 Advances in Sharing Information in Healthcare IT

Thursday, January 15, 2009 — 2:00-3:30 pm Eastern

Webinar 7 HITSP eTown Hall II with Dr. John Halamka

Thursday, August 27, 2009 — 2:00-3:30 pm Eastern

Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)

Thursday, February 12, 2009 — 2:00-3:30 pm Eastern

Webinar 8 Medication Management Real World Sites

Thursday, September 10, 2009 — 2:00-3:30 pm Eastern

Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)

Thursday, March 12, 2009 — 2:00-3:30 pm Eastern

Webinar 9 HITSP EHR Centric Interoperability Specification

Thursday, October 8, 2009 — 2:00-3:30 pm Eastern

Webinar 4 NHIN Real World Sites

Thursday, April 16, 2009 — 2:00-3:30 pm Eastern

Webinar 10 Security, Privacy, and Infrastructure

Thursday, November 12, 2009 — 2:00-3:30 pm Eastern

Webinar 5 HITSP eTown Hall I with Dr. John Halamka

Thursday, June 18, 2009 — 2:00-3:30 pm Eastern

Webinar 11 Quality Measures Real World Sites

Tuesday, December 8, 2009 — 2:00-3:30 pm Eastern

Webinar 6 Health Information Exchange (HIEs) in the Real World

Thursday, July 9, 2009 — 2:00-3:30 pm Eastern

NOTE:Recent schedule changes reflect HITSP’s response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.

The 2009 Webinar Serieswww.HITSP.org/webinars


Questions Welcomed


View the Complete Set of HITSP Deliverableswww.HITSP.org


Use or specify recognized HITSP Interoperability Specifications in your HIT

efforts and in your Requests for Proposals (RFPs)

Ask for CCHIT certification

Leverage Health Information Exchanges to promote HITSP specifications to

make connections easier in the future

Ask . . . Is there a HITSP standard we could be using?

Get involved in HITSP . . . Help shape the standards

Implementation feedback to HITSP is welcome

How YOU can become involved


Allyn Clemons, HIMSS Theresa Wisdom, [email protected] [email protected]

Re: HITSP Technical Committees

Michelle Deane, ANSI [email protected]

Re: HITSP, its Board and Coordinating Committees

Join HITSP in developing a safe and secure

health information network

for the United States

Visit www.hitsp.org or contact:


Sponsor Strategic Partners

www.HITSP.org

HITSP Real World Sites Medication Management

Documents