System Interface Between Two Vendors: Cerner Powerchart with CSC iPharmacy Louis Cheung, Peninsula Health SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Jun 08, 2015
System Interface Between Two Vendors: Cerner Powerchart with
CSC iPharmacy
Louis Cheung, Peninsula Health
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Peninsula Health - background
Major public health care provider serving metro and rural areas on Victoria’s Mornington Peninsula (catchment area of approx. 850 sq. kms)
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Peninsula Health - background
Measure 2011-2012
Staff (EFT) Medical 373
Nursing 1517
Allied Health 328
Other 1168
Total 3386
Structure Facilities Acute (incl. Maternity), Sub-
acute (incl. residential care),
Mental Health and Community
Health
Beds 878 (Acute -527, Mental Health
– 74, Rehabilitation, Aged and
Palliative Care – 277)
Theatres 8
Throughput Admissions(Overnight/Day) 75,345
Community Occasions of Care 235,467
Babies Born 2675
Emergency Visits 79,311
Operations 15,121
Development of e-MR at Peninsula Health – Background/Timelines
2007 2002 October
2009 June
2011
June 2012 August
2013 Oct 2014
Investigated other
clinical solutions.
Business case
developed
Orion implementation: e-
results viewing, Dis Summ,
Dis meds &e-prescribing
(sub-acute)
Announced as Lead
Agency (with Austin
Health) to implement
HealthSMART Clinicals
using Cerner First Go-Live of
Stage 1, Phase A
Final Go-Live
of Stage 1,
Phase A
First Go-Live
of Stage 1,
Phase B Final Go-Live
of Stage 1
Phase B
Proposed
EDIS Go-Live
November
2011
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Clinical system at Peninsula Health – 2013
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Cerner
Millenium
iPM
Synapse
Dorevitch
Radiology
PAS
Pathology
Pharmacy iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Why interface?
Marianne Lisby, Lars Peter Nielsen, and Jan Mainz. Errors in the medication process: frequency, type, and potential clinical consequences
Int J Qual Health Care (2005) 17 (1): 15-22
Dispensing
Inventory Control
Purchasing
PBS Claim
Reports
Prescribe in Cerner Powerchart
Clinical review & product assignment in
Cerner’s PharmNet e-Rx (inpatient &
discharge)
De
cisi
on
su
pp
ort
iPharmacy X
Integration between two vendors
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
ACK
Medication Process Workflow
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Boy accepts dare…
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
"The Simpsons Movie" Copyright © Fox Network
Boy loses control of his skateboard…
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
"The Simpsons Movie" Copyright © Fox Network
On admission
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Bart’s details are entered into iPM
• Weight and allergies are documented
• Pathology and radiology tests are ordered
Document home medication and Admission medication reconciliation
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Home medications are documented electronically
• Home medications are reconciled on admission and inpatient medications charted on the same screen
Clinical ordering
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Inpatient medications are ordered
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Inpatient eRx
• Cerner Powerchart will differentiate between imprest and non-imprest items
• Only verified items will send an eRx message
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Discern report to replace inpatient eRx
• PH has developed a discern analytics report + Excel macro to filter all non-imprest orders regardless of verification status
Doctor rounds
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Discharge reconciliation
• Home and inpatient medications are electronically converted and reconciled in Cerner Powerchart
iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
Refill
• These discharge orders appear in PharmNet Retail ready to be ‘refilled’
• Select a dispensing pharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
• Pick the product off the shelf then select that product in the PharmNet product window
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
• Check that the order (quantity, SIG) is OK to be sent to iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Refilling the prescription in PharmNet
• Repeat for other eRx orders
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• Open iPharmacy 5.7.1002 build 6 or later version
• Click on Dispensing > e-Rx orders
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• Search for patient UR and select appropriate eRx orders
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• Check that the orders are OK to be dispensed and click ‘Process’
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
• iPharmacy will do a patient entitlement and financial values check
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dispensing the prescription in iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Records of dispensing in Powerchart
• Right click the discharge prescription order in Powerchart > click ‘Order Info’ > History tab
Difference between inpatient and discharge eRx
Data Inpatient Discharge
Application Med Manager Retail
Product Automatic Manual
Verification/Refill Automatic Manual
SIG translation No Yes
Quantity Automatic (system) Automatic (doctor)
Other Cartfill reports
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
• Pilot wards for discharge eRx: ED, ESSU, ESW
Build Design
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
e-Chinese Whispers
Cerner PharmNet
CSC iPharmacy
HSS IE
PH IE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Testing, testing and more testing…
Devil is in the details
Prescriber
• Name, alias, PBS prescriber #
Patient
• Name, Medicare, concession, address, etc
Order details
• Product, Order ID, dispense ID, SIG, quantity, UOM
PBS data
• PBS restriction, streamline, authority codes, reg 24
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Where’s Wally?
MSH|^~\&|CERNERPHARM|FH|PHIE|FH|20140307191711||ORM^O01|Q77776745T80839191|P|2.3.1
PID|1||0000000^^^FH^MR~~ERROR^^^AUSHIC^PEN~~30026770712^^^AUSHIC^MC||Dummy^Fred^John^^^^CURRENT~Dummy^Fred^Tester^^^^A||19210101000000|M||8|Kkljklk.^3 Frankston-Dandenong Rd^Frankston^VIC^3199^Australia^4~10 Olive St^^Overseas^VIC^8888^Overseas^3~Po Box 25 Bruce Stre^^Mentone^VIC^3194^Australia^2||(097)870-9999^PRN^PH||8179|5|2011||||||||0|||||N
PV1|1|PBS Outpatient Invoice|E2220^F020^F020^2220^^Bed170^2220|6|||^^^^^^^^^^^^BUILD_ERROR||||||||||PH00129^HEWITT^Helen^^^Dr.^^^^^^^External Identifier~R173^HEWITT^Helen^^^Dr.^^^2220^^^^ORGANIZATION DOCTOR~0584286A^HEWITT^Helen^^^Dr.^^^2220^^^^Provider Num|E|6583907^^^2220|NON PBS||Y|||||||||||||||||2220||C|||20130920080000|20130920152255
ORC|NW|185227631^HNAM_ORDERID|15072268^DISPENSEID|15072270^HNAM_RUNID|NW||^^D1^20140307000000^20150307235959^CD:7159890^^Take 6 mL FOUR times a day||20140307191710||^CHEUNG^LOUIS|PH00090^PH00090 PH00090 Katherine BRISTOW^0874363~~|CD:18579840^^^CD:9572758^^Pha193^2220||20140307191710|NW|CD:28549375
RXO|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^Stocca|1||^bottle(s)|CD:318203^|||E2220^F020|||1||0||||15072268
RXR|^Oral
RXE|^^D1^20140307000000^20150307235959^CD:7159890^^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle T6 ELIXIR QID #1|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^AMT-TPP^22589011000036109^paracetamol 240 mg/5 mL elixir 200 mL^AMT-MPP|1||mls^mL|CD:318203|^T6 ELIXIR QID~^Take 6 mL FOUR times a day~^Take 6 mL FOUR times a day||Y|1|mls^mL|0|PH00090^BRISTOW^Katherine^^^Dr.^^^^^^^External Identifier~0874363^BRISTOW^Katherine^^^Dr.^^^AUSHIC^^^^PRES~SS10^BRISTOW^Katherine^^^Dr.^^^2220^^^^ORGANIZATION DOCTOR~2049737X^BRISTOW^Katherine^^^Dr.^^^2220^^^^Provider Num|PH04471^Cheung^Louis^^^^^^^^^^External Identifier|33723628-||00|20140307000000|||~^PBS~~OPDRX^Outpatient Pharmacy
RXR|^Oral|||MED
RXC|B|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^AMT-TPP^22589011000036109^paracetamol 240 mg/5 mL elixir 200 mL^AMT-MPP|1|mls^mL|1
OBX|1||1770E^N||||||||
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Aligning the databases
• 1,200 doctors mapped and cross-checked.
– Name, unique ID and prescriber #
– Currently 1,400 doctors mapped
– IT provisioning send doctor codes to pharmacy
• iPM (PAS) feeds patient information into both Cerner applications and iPharmacy
– no mapping required between Cerner & iPharmacy
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Aligning the databases
• Using the Trade Product Pack (TPP) code,
– 3,200 formulary items mapped and cross-checked
• Generic, brand, strength, form and pack size
– 3,200 product unit of measure (UOM) cross-checked and discrepancies addressed
– 5,600 item formulary statuses mapped
– Review every 3 - 6 months
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Aligning the databases
• 3,200 drug imprest locations mapped
– Only non-imprest items are sent through the inpatient eRx
• 40 inpatient wards mapped
– Outpatient wards not currently using Powerchart
• PBS codes
– Various salts (e.g. clopidogrel)
– Dispersible vs. non-dispersible (e.g. omeprazole)
– Various pack sizes (e.g. Slow-K vs. Span K)
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Building/translating the SIG
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Dosage Form
Verb Quantity per dose
Unit of measure
Route Frequency
Tablet Take x Tablet -
Capsule Take x Capsule -
Inhaler Inhale x Puff -
Liquid Take x mL by metric measure
-
Eye Drops Instill x Drop [route]
Patch Apply x Patch To the skin
• Example of SIG translations
Lessons Learnt
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Issues
• Problems on both sides of the fence
• PharmNet Retail
– unable to check PBS codes
– not suitable for PBS claiming
– Reg 24 and PRN not immediately obvious
– SIG does not always generate
• ‘Zz’, SIG = [dose][route][freq][duration][PRN][spec inx]
• iPharmacy issues
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
iPharmacy issues
Date Issue
16/08/13 When Editing a dispensing written by a doctor processed via e-Rx, it only allows us to choose a
16/08/13 Doctor prescribed Clopidogrel-DRLA with PBS code 5436D. In e-Rx pharmacist changed product to Pla
7/03/13 Want to be able to tick the 'Own Supply' tickbox from the e-Rx orders screen
5/07/12 Want to be able to alter the number of repeats from the e-Rx orders screen
19/03/12 The Total Qty being displayed in the Rx Details window is incorrect for orders passed from the
1/10/12 Cannot get the 'Team' field in the e-Rx screen to populate with the Prescriber's Team in i
28/05/12 The e-Rx module is unable to dispense an item not listed in the PBS/RPBS list but has been approved
10/05/12 In the e-Rx interface for Cerner, the Script Classification matches the first word in i.Pharmacy.
8/05/12 When the TPP from the ORM message does not automatically assign a product in the eRx window and
14/02/12 The "On Imprest" 'Action' default in the e-Rx window needs to consider the 'Check Imprest' value
14/02/12 Patient Price and PBS Claim Price are appearing as 0
19/01/12 Placer Filler number (Dispense_ID from Cerner) according to specs supposed to populate dspn_order_id
18/06/13 When dispensing a script from eRx functionality for a patient with GOLD card and SN card, it is rej
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Issues
• Initial testing shows increased time taken to dispense
– Due to iPharmacy issues
• Doctors don’t always get the quantity right
– Direct information to iPharmacy
• SIG is not always correct
– E.g. Spiriva inhalation capsules
• iPharmacy (Stocca) will reject messages
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Lessons Learnt
• Novel approach
– Process could be more streamline
– Preferable if eRx order could be dispensed straight from the eRx window
– Potential full roll-out across network if successful
• Testing, testing, testing…
• Vlookups will be your best friend
• Development/maintenance is a full-time job
SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
Thank you