7/31/2015. Shelly Spiro, Executive Director, Pharmacy HIT Collaborative reports no relevant financial relationships.

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1 Pharmacy Health Information Technology Collaborative Shelly Spiro, Executive Director, Pharmacy HIT Collaborative reports no relevant financial relationships. 1. This session will describe the struggles pharmacies face with understanding electronic health records (EHRs) adoption by hospitals and physician office s as a result of the Centers for Medicare & Medicaid Services (CMS) Meaningful Use of the EHR incentive program and the participant will learn how the voice of pharmacy has an impact on building this awareness. 1. This session will discuss the importance of adoption of electronic standards and terminology to support collecting, documenting and exchanging clinical and medication-related information. The participant will understand how exchanging this clinical information in a meaningful way has an impact on enhancing pharmacy practice and patient safety. 1. This session will describe the benefits of pharmacy management systems adopting pharmacists patient care process workflow using EHR functionality. The participant will identify how this adoption can support value based payment models. 1. Discuss the barriers and driving factors for consultant pharmacists to adopt newer technology solutions. 1

2 1. This session will describe the struggles pharmacies face with understanding electronic health records (EHRs) adoption by hospitals and physician office s as a result of the Centers for Medicare & Medicaid Services (CMS) Meaningful Use of the EHR incentive program and the participant will learn how the voice of pharmacy has an impact on building this awareness. 1. This session will discuss the importance of adoption of electronic standards and terminology to support collecting, documenting and exchanging clinical and medication-related information. The participant will understand how exchanging this clinical information in a meaningful way has an impact on enhancing pharmacy practice and patient safety. 1. This session will describe the benefits of pharmacy management systems adopting pharmacists patient care process workflow using EHR functionality. The participant will identify how this adoption can support value based payment models. 1. Discuss the barriers and driving factors for pharmacies to adopt newer technology solutions. 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 JCPPPatient Care Process PQA Quality Measures and Standards JCPP Provider Status and Payment PharmacyHealth Information Technology (HIT) HIT AACP, ACPE, Education and accreditation standards CCP JCPP Evidence that demonstrates and validates value 2

3 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 7 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. 8 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 9 3

4 TechnologyCollaborative 7/31/2015 Pharmacy Health Information 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 synopsis of the document provides a shorten overview of the Roadmap. 10 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 11 Meds, Labs, Diagnosis CDA (SNOMED, RxNorm, LOINC) LOINC R xn o r m Labs M ed s SNOMED Diagnosis Quality & Registries Health Information Exchange (HIE) Output EHR 1 Output EHR 2 Reporting CDA (SNOMED, RxNorm, LOINC) RxNorm, LOINC, SNOMED CT 12 4

5 Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) Named in Meaningful Use for clinical documentation Procedure Situation Finding Clinical Documentation 13 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 14 Syste m a tize d N o m e n c la tu r e o f M e d ic in e C lin ic a l T e r m s ( S N O M E D C T ) Vital signs Height Weight Blood pressure Smoking status Adverse drug events Allergies Encounter diagnosis Problems 15 5

6 Ph armac y HIT Collaborative proj ect 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 16 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 pharmacyhit.org/pdfs/w orkshopdocuments/ WG2-Post pdf pharmacyhit.org/pdfs/w orkshopdocuments/ WG2-Post pdf 17 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,

7 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 19 Source: ONC 2015 Edition Proposed Rule Modifications to the ONC Health IT Certification Program and 2015 Edition Health IT Certification Criteria Presentation, HIT Policy CommitteeMeeting , 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) 21 7

8 SDO s Virtual involvement Health Level Seven (HL7)www.HL7.org NCPDP Collaborative Workspace Continuity of care document (CCD) using ccda National Council for Prescription Drug Programs (NCPDP) Recommendations for Use of the HL7 Consolidated CDA Templates for Pharmacy Version 1. Ø, ruseccda.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 22 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?) 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 pharmacistpatientcenteredcollaborative careprocess for pharmacists providingmedication 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. 24 8

9 Quality &VatuAssessment Colle ct Patient- Centered Care 7/31/2015 Pharmacists" Patient Care Process Structure Documents Pharmacy Careliate with Reconciled Medication List Pharmacy Care Transitions Document Follow-up: Monitor and Evaluate Assess Implement Plan Medication Action Plan Adapted from Pharmacists' Patient Care Process, May 29, 2014, Pharmacists_Patient Care Process,pdf Mi Pharmacy Health Information Technology Collaborative Pharmacists Workflow Workflow of Pharmacist Clinical Documentation Process in Pharmacy Practice Settings System Vendor Checklist for Pharmacist Clinical Documentation Workflow pharmacyhit.org/pdfs/w orkshopdocuments/ WG3-Post pdf pharmacyhit.org/pdfs/w orkshopdocuments/ WG3-Post pdf 26 Adopting Health Level 7 International (HL7) EHR functionality HL7 EHR-S Functional Model Release 1 NCPDP/HL7 Pharmacist/Pharmacy Provider EHR Functional Profile 27 9

10 EHR Functional Model EHR Functional Profile Certification Conformance Criteria (Testing Scenarios) 28 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 pharmacyhit.org/pdfs/w orkshopdocuments/ WG4-Post pdf 29 Source: 2015 EditionHealth IT Certification Criteriahttps://www.federalregister.gov/articles/2015/03/30/ /2015-edition-health-information-technology-health-it-certification-criteria-2015-edition-base. 10

11 P h ysic ia n o f f ic e a n d h o s p ita l E H R a d o p tio n a r e driving the standard collection and exchange of e le c tr o n ic m e d ic a tio n - r e la te d c lin ic a l d a ta 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 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 32 Interoperability for data exchange Cost savings by decreasing proprietary interfaces Capture metadata used by pharmacists for clinical quality measures 33 11

12 Access-Connectivity-Quality 01 Pharmacists' clinical services are a critcal component of our nation's health care system and can effectively contribute to the meaningful use of EHR. Pharmacy Health Information Technology Collaborative Which organization jointly develops the voice of awareness for the professional practice of pharmacy including health IT as a focus area? a. Joint Commission of Health Care Organizations b. Joint Commission of Pharmacy Practitioners c. National Association of Boards of Pharmacy d. None of the above 1. Which organization jointly develops the voice of awareness for the professional practice of pharmacy including health IT as a focus area? a. Joint Commission of Health Care Organizations b. Joint Commission of Pharmacy Practitioners c. National Association of Boards of Pharmacy d. None of the above 12

13 2. Which standards have been jointly developed between NCPDP and HL7 to help facilitate electronic collection, documentation and exchange of clinical data for pharmacists providing patient care services? a. Telecommunications and SCRIPT b. SCRIPT and Formulary/Benefits c. SCRIPT and Pharmacist EHR Functional Profile d. Pharmacist EHR Functional Profile and Structured Documents using CDA 2. Which standards have been jointly developed between NCPDP and HL7 to help facilitate electronic collection, documentation and exchange of clinical data for pharmacists providing patient care services? a. Telecommunications and SCRIPT b. SCRIPT and Formulary/Benefits c. SCRIPT and Pharmacist EHR Functional Profile d. Pharmacist EHR Functional Profile and Structured Documents using CDA 3. Which standardized terminology is recommended for use by all health care providers to document clinical services? a. National Drug Code (NDC) a. Current Procedure Terminology (CPT) a. Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) a. Logical Observation Identifiers Names and Codes (LOINC) 13

14 3. Which standardized terminology is recommended for use by all health care providers to document clinical services? a. National Drug Code (NDC) a. Current Procedure Terminology (CPT) a. Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) a. Logical Observation Identifiers Names and Codes (LOINC) 4. Which are not examples of clinical workflow outlining pharmacists patient care process steps a. Prescription processing b. Collection of subjective and objective information c. Develop patient-centered care plan d. None of the above e. All of the above 4. Which are not examples of clinical workflow outlining pharmacists patient care process steps a. Prescription processing b. Collection of subjective and objective information c. Develop patient-centered care plan d. None of the above e. All of the above 14

15 5. What are types of scenarios would pharmacy clinical workflow fit into EHR functionality? a. Display medications, problems and allergy section for pharmacist to reconcile a. Community pharmacy receiving a structured document (e.g. continuity of care document, CCD) during a transition of care from a hospital a. Pharmacist receiving an electronic prescription for dispensing a. a and b b. All of the above 5. What are types of scenarios would pharmacy clinical workflow fit into EHR functionality? a. Display medications, problems and allergy section for pharmacist to reconcile a. Community pharmacy receiving a structured document (e.g. continuity of care document, CCD) during a transition of care from a hospital a. Pharmacist receiving an electronic prescription for dispensing a. a and b b. All of the above Shelly Spiro Executive Director, Pharmacy HIT Collaborative

16 1. Slow rate of adoption of electronic clinical exchange for Consultant Pharmacists recommendations to LTC facilities and physicians 1. Benefits and roadblocks to LTPAC e-prescribing 1. Barriers and driving factors for LTPAC and consultant pharmacists to adopt newer technology solutions 16

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