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2 Shelly Spiro, Executive Director, Pharmacy HIT Collaborative reports no relevant financial relationships.

3 1. Discuss the vision, mission, and goals of the Pharmacy HIT Collaborative as it relates to informatics, health information exchanges (HIEs) and pharmacy practice. 2. Describe a roadmap the pharmacy practice can follow to adopt pharmacist electronic health records (EHRs) to facilitate safe and effective medication use through integrating pharmacist provided patient care service documentation with other health care providers and the patients. 3. Describe how collection, documentation and exchange of standard electronic clinical information through HIEs will assist in value based payment models for pharmacists for transitions of care, Medication Therapy Management (MTM), and other pharmacist provided patient care services. 4. Describe how pharmacists adoption of EHR system functionality for documentation and exchange of pharmacist provided patient care services helps to bring together all providers on the health care team to reach better patient outcomes. 5. Discuss the importance of Pharmacy State Associations and organizations involvement in integrating pharmacists into the national health IT infrastructure.

4 1. Discuss the vision, mission, and goals of the Pharmacy HIT Collaborative as it relates to informatics, health information exchanges (HIEs) and pharmacy practice. 2. Describe a roadmap the pharmacy practice can follow to adopt pharmacy provider electronic health records (EHRs) to facilitate safe and effective medication use through integrating pharmacist provided patient care service documentation with other health care providers and the patients. 3. Describe how collection, documentation and exchange of standard electronic clinical information through HIEs will assist in value based payment models for pharmacists for transitions of care, Medication Therapy Management (MTM), and other pharmacist provided patient care services. 4. Describe how pharmacy adoption of EHR system functionality for documentation and exchange of pharmacist provided patient care services helps to bring together all providers on the health care team to reach better patient outcomes. 5. Discuss the importance of Pharmacy State Associations and organizations involvement in integrating pharmacists and pharmacy technicians into the national health IT infrastructure.

5 1. How does the Pharmacy HIT Collaborative s mission, vision and goals affect pharmacists providing patient care services? 2. What s value does pharmacy data bring to Health Information Exchanges? 3. What type of pharmacist provided patient care services would provide patient value if clinical data is exchanged with other health care providers?

6 Meaningful Use (MU) EHR CMS incentive program Pharmacy and pharmacists health IT struggles Joint Commission Pharmacy Practitioners (JCPP) 11 national pharmacy associations Vision: Pharmacists will be health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes. Pharmacy HIT Collaborative formed to be a JCPP area of focus

7 JCPP PQA Patient Care Process Quality Measures and Standards JCPP Pharmacy HIT AACP, ACPE, CCP JCPP Provider Status and Payment Health Information Technology (HIT) Education and accreditation standards Evidence that demonstrates and validates value

8 Founding Organizations 9 Professional Pharmacy Associations Represents over 250K members in all practice settings Members AACP ACCP ACPE AMCP APhA ASCP ASHP NASPA NCPA Associate Members Surescripts NCPDP RelayHealth ScriptPro OutcomesMTM Amgen Pfizer Greenway Health Cardinal Health, Fuse 8

9 Vision The US healthcare system is supported by meaningful use of Health Information Technology (HIT) and the integration of pharmacists for the provision of quality patient care. Mission To advocate and educate key stakeholders regarding the meaningful use of HIT and the inclusion of pharmacists within a technology enabled integrated health care system. 9 9

10 Access Ensure HIT supports pharmacists in health care service delivery Connectivity Achieve pharmacists integration within health information exchange Quality Support national quality initiatives enabled by HIT 10

11 Roadmap for Pharmacy Heath Information Technology Integration in U.S. Health Care is an updated version of the update to the Pharmacy Health Information Technology Collaborative s revised Roadmap. It provides guidance to provider organizations, policymakers, vendors, payers, and other stakeholders striving to integrate pharmacy HIT into the national (U.S) HIT infrastructure. The revisions align the roadmap to the Collaborative s strategic plan, vision, and mission. A synopsis of the document provides a shorten overview of the Roadmap. 11

12 Interoperability describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user. Source: HIMSS What is Interoperability (accessed August 12, 2014) 12

13 Meds, Labs, Diagnosis CDA (SNOMED, RxNorm, LOINC) LOINC RxNorm Labs Meds SNOMED Diagnosis Output EHR 1 Reporting Health Information Exchange (HIE) Output EHR 2 RxNorm, LOINC, SNOMED CT Quality & Registries CDA (SNOMED, RxNorm, LOINC) 13

14 Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Named in Meaningful Use for clinical documentation Procedure Situation Finding Clinical Documentation 14

15 Download through National Library of Medicine (NLM) SNOMED CT web browser Resides in International Health Terminology Standards Development Organization (IHTSDO) and NLM for U.S. realm Free for use in U.S., requires NLM Unified Medical Language System (UMLS ) license Updated twice yearly 15

16 Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) Vital signs Height Weight Blood pressure Smoking status Adverse drug events Allergies Encounter diagnosis Problems 16

17 Pharmacy HIT Collaborative project Medication Therapy Management (MTM) value set Search under SNOMED browser Topic: Medication Therapy More than 270 MTM clinical terms Other types of pharmacy value sets being considered by Pharmacy HIT Collaborative 17

18 Clinical Documentation Medication Therapy Management Services Clinical Documentation: using a structured coding system SNOMED CT Documenting Comprehensive Medication Management in Team Based Models Using SNOMED CT Codes pharmacyhi t.org/pdfs/w orkshopdocuments/ WG2-Post pdf pharmacyhi t.org/pdfs/w orkshopdocuments/ WG2-Post pdf 18

19 RxNorm Medications Logical Observation Identifiers Names and Codes (LOINC) Laboratory test results CVX for immunizations ICD10 CPT National Library of Medicine Tools for EHR Certification and Meaningful Use, accessed February 26,

20 Billing Codes and MTM Use Cases MTM CPT Transitional care management services (TCMS) and Complex chronic care coordination services (CCCCS) Support team based (multidisciplinary) patient care harmacyhit. org/pdfs/wo rkshopdocuments/ WG1-Post pdf harmacyhit.o rg/pdfs/work shopdocuments/ WG1-Post pdf 20

21 Source: ONC 2015 Edition Proposed Rule Modifications to the ONC Health IT Certification Program and 2015 Edition Health IT Certification Criteria Presentation, HIT Policy Committee Meeting ,

22 Normalized terminologies with standardized structured documents Clinical Document Architecture (CDA) when exchanging clinical information between health care providers HL7 Clinical Document Architecture (CDA) Templates Patient care summary (continuity of care document, CCD) Discharge summary Progress note Care plan Extendable Markup Language (XML) 22

23 SDO s Virtual involvement Health Level Seven (HL7) NCPDP Collaborative Workspace Continuity of care document (CCD) using C CDA National Council for Prescription Drug Programs (NCPDP) Recommendations for Use of the HL7 Consolidated CDA Templates for Pharmacy Version 1. Ø, r_use_ccda.pdf Implementation Guide for CDA Release 1 MEDICATION THERAPY MANAGEMENT PROGRAM MEDICARE PART D HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templates for Clinical Notes d=379 for transitions of care 23

24 Revision to the MTM sections of Specialized Implementation Guide to reflect requests for MTM and/or Pharmacist Professional Services by entities other than the payer Request for service Added examples using SNOMED CT E Prescribing MU EHR certification changes Names pharmacists 15 times supporting prescribers and pharmacists to bidirectionally communicate during e prescribing RXFILL, RXCHANGE, RXCANCEL Structured and Codified Sig (include indication?)

25 Source: Pharmacists Patient Care Process, May 29, https://www.accp.com/docs/positions/misc/jcpp_pharmacists _Patient_Care_Process.pdf.. The figure depicts a proposed standardized pharmacist patientcentered collaborative care process for pharmacists providing medication therapy management (MTM) services. The pharmacists patient care process described in this illustration was developed by examining a number of key source documents on pharmaceutical care and MTM. Patient care process components in each of these resources were catalogued and compared to create the following process that encompasses a contemporary and comprehensive approach to patientcentered care that is delivered in collaboration with other members of the health care team. 25

26

27 Pharmacists Workflow Workflow of Pharmacist Clinical Documentation Process in Pharmacy Practice Settings System Vendor Checklist for Pharmacist Clinical Documentation Workflow pharmacyhi t.org/pdfs/w orkshopdocuments/ WG3-Post pdf pharmacyhi t.org/pdfs/w orkshopdocuments/ WG3-Post pdf 27

28 Adopting Health Level 7 International (HL7) EHR functionality HL7 EHR S Functional Model Release 1 NCPDP/HL7 Pharmacist/Pharmacy Provider EHR Functional Profile 28

29 EHR Functional Model EHR Functional Profile Certification Conformance Criteria (Testing Scenarios) 29

30 Pharmacists EHR Certification Pharmacist Electronic Health Record (EHR) Implementation Guide for Community Practice Electronic Health Record Certification: Making the Pharmacists Case to System Vendors hl7.org/doc umentcente r/public/sta ndards/infor mative/13-294_hitsb ook_hl7_ Web.pdf pharmacyhi t.org/pdfs/w orkshopdocuments/ WG4-Post pdf 30

31 Source: 2015 Edition Health IT Certification Criteria https://www.federalregister.gov/articles/2015/03/30/ /2015-edition-health-information-technology-health-it-certification-criteria-2015-edition-base.

32 Physician office and hospital EHR adoption are driving the standard collection and exchange of electronic medication related clinical data Pharmacies can be meaningful users and ACOs to meet safety and care coordination quality measures Improve inter professional collaborative practice models with one pharmacy and multiple providers

33 Prescriber workflow is different than pharmacist workflow Data needs to be standardized, prioritized, meaningful and useable Data standardization and EHR certification supports ability to capture data for quality measures Useful clinical data sharing can be used to improve pt care, increase medication safe use and reduce costs 33

34 Interoperability for data exchange Cost savings by decreasing proprietary interfaces Capture metadata used by pharmacists for clinical quality measures 34

35 35

36 1. What are the Pharmacy HIT Collaborative s three key goal points? a. Access Connectivity Quality b. Connect Work Help c. Collect Document Exchange d. None of the above

37 2. Which pharmacist provided patient care services would provide patient value if clinical data is exchanged with other health care providers? a. Medication Therapy Management Services b. Transitions of Care Service c. Travel Immunization Services d. All of the above

38 3. What nationally recognized electronic structured document standard is used to exchange clinical information between healthcare providers? a. Continuity of Care Document (CCD) b. E Prescribing SCRIPT 10.6 c. Consolidated Clinical Document Architecture (C CDA) d. None of the above

39 4. What involvement does National Alliance of State Pharmacy Associations (NASPA) have with the Pharmacy HIT Collaborative? a. No involvement b. Sometimes participates in Pharmacy HIT Collaborative initiatives c. Is an active voting member of the Pharmacy HIT Collaborative

40 Shelly Spiro Executive Director, Pharmacy HIT Collaborative 40

41 1. Slow rate of adoption of electronic clinical exchange for Pharmacists with hospitals and physicians 2. Benefits and roadblocks to e prescribing 3. Barriers and driving factors for pharmacists to adopt newer technology solutions 41

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