RESOURCE AND PATIENT MANAGEMENT SYSTEM. e-prescribing (BEPR) Pre-Deployment Guide. Version 1.0 October 2011

Transcription

1 RESOURCE AND PATIENT MANAGEMENT SYSTEM e-prescribing (BEPR) Version 1.0 Office of Information Technology (OIT) Division of Information Resource Management Albuquerque, New Mexico

2 Table of Contents 1.0 Introduction IHS Central Ensemble Staging Server IHS Central Ensemble Production Server Types of e-prescribing Sites I/T/U Site without Onsite Pharmacy T/U Site with Commercial Pharmacy package I/T/U site with Pharmacy using RPMS Pharmacy 7 package Implementation and Deployment Phase 1 Site Preparation Phase Establishing a local e-prescribing team e-prescribing Prerequisite Tasks Phase 2 Verification Phase Phase 3 Staging Phase Phase 4 Production Phase Drug File Optimization e-prescribing Medication Quick Orders Medication Clinical Indication Surescripts Provider Identifier Number Prerequisites for requesting an SPI# Demo Patients and e-prescribing Glossary Acronym List Contact Information ii Table of Contents

3 Preface Indian Health Service (IHS) and Surescripts, LLC have entered into a partnership to provide an electronic connection between IHS sites and community pharmacies participating in the Surescripts network. In the spring of 2011, the e-prescribing project was certified by Surescripts and as part of the certified Electronic Health Record. As the project begins to deploy in the fall of 2011, providers will acquire the functionality to transmit prescriptions from their local workstations to outside community pharmacies participating in the Surescripts network. The implementation of this new functionality will improve clinical workflows revolving around medication management for both the patient and provider. e-prescribing functionality has been shown to reduce healthcare costs, improve patient safety, and increase efficiency when it comes to processing prescriptions. The Office of Information Technology is pleased to offer this new functionality to all IHS partners including Federal sites, Tribal sites, and Urban programs. iii Preface

4 1.0 Introduction This manual provides the prerequisite information necessary to prepare sites for the IHS Resource and Patient Management System (RPMS) Electronic Health Record (EHR) e-prescribing project. RPMS enhancements released in EHR patch 9 provide functionality to allow providers to electronically transmit prescriptions to a community pharmacy by means of the IHS e-prescribing Network. In the effort to provide this functionality, IHS has developed two separate networks in order to accommodate e-prescribing functionality. The following networks include: IHS Central Ensemble Staging Server IHS Central Ensemble Production Server 1.1 IHS Central Ensemble Staging Server The IHS Central Ensemble Staging Server is used specifically for e-prescribing development and testing. Figure 1-1: IHS RPMS/EHR e-prescribing Staging Network 1 Introduction

5 Transitioning sites to e-prescribing entails: Configuring the local system to communicate with the Staging server Testing the local configuration with Surescripts test pharmacies to ensure that all e-prescribing functionality is working appropriately. Once testing has been completed and the site has successfully transmitted prescriptions from their local site to the test pharmacy, the National e-prescribing team will transition the site to the IHS Central Ensemble Production Server. 1.2 IHS Central Ensemble Production Server This is the live server that is configured to communicate with the live Surescripts production server. This server routes messages from each site using e-prescribing functionality through the Surescripts network and ultimately a participating Surescripts pharmacy (i.e. Walgreens, Walmart, Rite Aid, etc.). Once a site is transitioned to this server it is considered a live e-prescribing site. Figure 1-2: IHS RPMS/EHR e-prescribing Production Network 2 Introduction

6 2.0 Types of e-prescribing Sites At this time there are three types of pharmacy configurations within the IHS/Tribal/Urban (I/T/U) setting. I/T/U Site without Onsite Pharmacy T/U Site with Commercial Pharmacy package I/T/U site with Pharmacy using RPMS Pharmacy 7 package Each of these scenarios is unique to the site and the existing pharmacy setting. Please use the next section of this guide to find the pharmacy setting that corresponds to the target facility in order to learn more about the e-prescribing configuration. 2.1 I/T/U Site without Onsite Pharmacy Sites that do not have an onsite pharmacy usually bypass the medication functionality associated with EHR and continue to write paper prescriptions. With the development of e-prescribing these sites can use the full functionality of RPMS EHR to improve patient care and documentation including the ability to: Maintain and manipulate a complete medication list for the patient. Capture medications administered in clinic. Document medications that patients receive outside of the facility including prescription medications that were ordered by a private physician s office, overthe-counter medications, and herbal medications. Take advantage of medication order checks to ensure there are no existing drugdrug or drug-allergy interactions. In order to use e-prescribing functionality offered through EHR, a site must: Configure and optimize the RPMS pharmacy package. Establish EHR medication quick orders and medication menus to meet the prescriber s needs. Setup and configure the medication order checks within EHR (i.e. drug-drug interaction and drug allergy interactions). Site personnel must work with a Pharmacy Consultant to establish the site s drug file. Once a site has implemented/optimized the drug file, long-term maintenance is required. The pharmacy package is complex and must be managed by someone with experience to ensure the drug file stays optimized as new patches are released. 3 Types of e-prescribing Sites

7 Once the site has deployed e-prescribing, providers will transition from writing paper prescriptions to using EHR to order and transmit medications via e-prescribing. A site connected to the IHS e-prescribing server and the Surescripts network (Figure 2-1) can electronically send prescriptions to local community pharmacies registered in the Surescripts network. In addition to sending prescriptions, sites receive information from the Surescripts pharmacy indicating that the prescription was successfully delivered. Other messages, such as transmission errors are transmitted via the network. Figure 2-1: IHS RPMS/EHR e-prescribing Production Network, no Site Pharmacy 2.2 T/U Site with Commercial Pharmacy package Tribal and Urban (T/U) sites with an onsite pharmacy utilizing a Commercial off the Shelf (COTS) pharmacy package may take advantage of the IHS RPMS EHR e-prescribing network. These sites normally focus their formulary management within the COTS pharmacy package, while moving away from the day to day maintenance activities of the RPMS Pharmacy 7 package. 4 Types of e-prescribing Sites

8 However, to use e-prescribing functionality these sites must: Configure and optimize the RPMS pharmacy package Establish EHR medication quick orders and medication menus to meet the prescribers needs Setup and configure the medication order checks within EHR (i.e. drug-drug and drug allergy interactions). A site may continue to use the local COTS pharmacy package however, it will also need to implement, optimize, and maintain the RPMS Pharmacy package. The e-prescribing functionality associated with EHR is directly tied to the RPMS pharmacy package therefore, a site planning to implement e-prescribing while using a COTS system will need expertise in RPMS Pharmacy Package as well as the local COTS package. Both the COTS system and the RPMS pharmacy package must be maintained in order to use the e-prescribing functionality. In addition to maintaining two pharmacy packages, site personnel must work with their local COTS vendor to establish a relationship with Surescripts LLC as a participating pharmacy. The Office of Information Technology (OIT) can provide a certified e-prescribing vendor application, but OIT is not able to assist the site in becoming a participating Surescripts pharmacy. Once a site s COTS vendor has registered with Surescripts and has become a participating Surescripts pharmacy, the site will show up in a list of pharmacies that download daily from Surescripts. Once this list is downloaded, the provider can select the in-house pharmacy from a list of participating Surescripts pharmacies during the medication order entry process in EHR. Remember there is no charge to send prescriptions using the e-prescribing functionality however, each site that registers as a participating Surescripts Pharmacy will incur a fee based on a local agreement with Surescripts to receive patient prescriptions. This will only occur at sites that prefer to keep their onsite COTS package and use the IHS e-prescribing functionality. 5 Types of e-prescribing Sites

9 The overall diagram for a site utilizing e-prescribing and a COTS pharmacy package is shown in Figure 2-2. In addition to having the option to select the local COTS pharmacy, the site s providers will have the added benefit of being able to select other participating Surescripts pharmacies in the area to meet patient needs. Figure 2-2: IHS RPMS/EHR e-prescribing Production Network, Site Pharmacy 2.3 I/T/U site with Pharmacy using RPMS Pharmacy 7 package Sites who have an onsite pharmacy utilizing RPMS Pharmacy 7 and EHR already meet the Meaningful Use requirements for e-prescribing. With this in mind, these sites may or may not decide to implement the e-prescribing functionality. Those that do implement it will have the added benefit of enhancing their formulary options. In order for these sites to use e-prescribing functionality they must: Optimize their current RPMS pharmacy package settings Optimize EHR medication quick orders and medication menus to meet the prescriber s needs 6 Types of e-prescribing Sites

10 Figure 2-3: IHS RPMS/EHR e-prescribing Production Network These sites continue to use the resources and conveniences of their local onsite pharmacy and will be able to prescribe medications not commonly found on the local formulary. In order to provide access to both methods of ordering, the provider has the option to select window to order from the local onsite pharmacy or electronic to e-prescribe the prescription to an outside pharmacy participating in the Surescripts network. The following diagram details out both the in-house prescribing options and the outside prescribing options provided with e-prescribing functionality. 7 Types of e-prescribing Sites

11 3.0 Implementation and Deployment Due to the complexity of this project, e-prescribing deployment will occur in a controlled release. The following diagram delineates the deployment phases for this project and includes four phases of implementation and deployment. 3.1 Phase 1 Site Preparation Phase Establishing a local e-prescribing team Each site must identify a multidisciplinary team to setup, implement, and deploy this functionality. Here is the current role for each member of the local e-prescribing team: Provider Informaticist: Prior to being placed into the deployment queue, each site will need to select a provider champion to oversee the e-prescribing project. e-prescribing was specifically designed around a credentialed provider authorized to write medications at the local facility. With this in mind, the site s provider champion is the only staff member authorized to use the e-prescribing Network during the initial phases of deployment. As testing and roll-out progresses, additional providers (who have the appropriate credentials) will receive access to the system, but only after testing has been completed. He/she is required to participate in e-prescribing training, testing, and deployment. In order to complete these tasks, the clinical champion should be someone who can participate in e-prescribing meetings and participate in short WebEx sessions (30-45 minutes in duration) with the Area and National e-prescribing teams to complete each task. Pharmacy Informaticist: The key to a successful e-prescribing deployment is to complete Drug file optimization. The Pharmacy Informaticist will prepare the drug file for the new functionality and assist the provider and Clinical Applications Coordinator (CAC) when issues arise related to drug file configuration. The Pharmacy Informaticist should provide long term maintenance for the site s drug file and manage patches that are generally released on a monthly basis. CAC: The CAC configures parameters specific to auto-finish, e-prescribing, and setup the e-receipt, provides basic support for EHR, and should be familiar with the e-prescribing process in order to assist providers when necessary. 8 Implementation and Deployment

12 Information Technology (IT) Specialist: Local IT assistance is required during the initial setup phase of e-prescribing. The site manager (aka IT) conducts the initial setup for the following: Install and setup of the local instance of Ensemble Configure e-prescribing TaskMan options Assign additional RPMS menu access to staff Setup and configuration of mailman groups Credentialing Officer: The credentialing officer is a critical role for a site using e-prescribing. This staff member generally collects information for each new provider starting at the facility. In addition to collecting the standard information (i.e. Unique Personal Identification Number, Medicare number, etc.), the credentialing officer will also need to collect information required for a Surescripts Provider Identifier Number (SPI#). All credentialed providers who will use e-prescribing in EHR must be assigned an SPI#. The information collected includes (but is not limited to) the provider s: National Provider Identifier (NPI) number address Fax number Area CAC: The Area CAC assists the local site and the National e-prescribing team to identify sites ready for e-prescribing Phase 2 in the deployment process. Once identified the area CAC assists in supporting the site and the National team with: Troubleshooting Setup Implementation Go-live The Area CAC will also provide contact information and assist the National Pharmacy and United South & Eastern Tribes Pharmacy consultants to gain access to those sites requiring hands on assistance in order to prepare the drug file for e-prescribing functionality. Area IT Specialist: Area IT expertise should be available during the implementation of the e-prescribing project and should collaborate with the local site to setup/troubleshoot the following areas: RPMS 9 Implementation and Deployment

13 EHR Server configuration Network configuration Once the site configures the local instance of Ensemble, OIT will test the configuration to ensure that all technical specifications have been configured accurately. With the unique design of this project, some sites will likely experience issues pertaining to one or more of these four areas. In order to expedite the resolution OIT will need the added expertise of the Area IT department. At the same time Area IT will need to become familiar with the routine processes associated with e-prescribing so that they can provide additional troubleshooting expertise as the site continues to use this new functionality. Area Information Security Officer (ISO): The Area ISO is only required in the initial stages of preparing the site for e-prescribing. In order to gain access to the e-prescribing network, tribal and urban sites will need to review their existing agreements with IHS. More information pertaining to specific agreements will be released in a separate document. Once this document has been released, sites are encouraged to contact the local Area ISO to complete this review. All agreements shall be assessed by the Area and National e-prescribing teams to ensure that all prerequisites have been completed prior to the site accessing the e-prescribing Network e-prescribing Prerequisite Tasks A site must complete multiple tasks prior to implementing e-prescribing. Here is a brief overview of each task that must be addressed: Agreements (T/U Sites only): More information on specific agreement requirements will be communicated in the near future. Drug File Optimization: See Section 4.0 for more information regarding reports and objectives that must be met before e-prescribing implementation can take place. Clinical Indication for Medications activated in EHR: See Section 5.0 on how to configure EHR and the clinical indication prompt for medications as required for e-prescribing deployment. Site Station Number has been verified and/or updated: See Appendix B: to find the site s National Station Number list assignment. SPI# data has been collected on all providers who are credentialed to write medications and are to use e-prescribing functionality. For more information see Section Implementation and Deployment

14 Demo Patients have been appropriately setup in the system. Every site planning on participating in the e-prescribing project needs to verify that their demo patients have been setup in the standard format as recommended by the National Health Information Management group. See Section 8.0 for proper demo patient format. Other Recommendations to consider: Policies and Procedures for e-prescribing have been incorporated to the facility s documentation. Each site should update the policy and procedures to include the e-prescribing functionality while preparing for this new process. Contingency Plans have been established for times when e-prescribing is not available to transmit messages to a participating Surescripts Pharmacy. As with any Health Information Technology project the site should have a plan in place to prepare in times of outage that could potentially effect the electronic transmission of prescriptions from the local site to the IHS Central Server to the Surescripts network. Communicate this plan to all staff so that patient care activities are not delayed when outages occur. 3.2 Phase 2 Verification Phase After completing all tasks required to implement e-prescribing, site personnel will work with the Area CAC to complete and return the e-prescribing Readiness Assessment Form. This form is then sent to the National e-prescribing team who will work with the site, Area, and Regional Extension Center teams to establish WebEx sessions and a deployment plan specific to the site s needs. Each of the steps are verified in either a report format that is sent to the National team or via live WebEx sessions. 3.3 Phase 3 Staging Phase Once all tasks have been completed and verified, the site will move into the Staging Phase. At this point information pertaining to the site s deployment plan is updated in the National Deployment Project Management (PM) Plan. Once a site has been added to the PM plan it will start meeting with the National e-prescribing team via WebEx to: install and setup the local instance of Ensemble, assign additional RPMS menu access to staff, setup and configure mailman groups, configure EHR parameters, setup Auto-Finish (if not currently setup), and assist the site in configuring the e- Receipt. As installation and configuration requirements are occurring in the background, the local provider champion, site CAC, and other clinical staff will receive training on how to use e-prescribing functionality before they begin the testing process. Once the setup and training has been completed the local provider informaticist champion begins transmitting electronic prescriptions for demo patients only to Surescripts test pharmacies. 11 Implementation and Deployment

15 3.4 Phase 4 Production Phase When a site reaches Phase 4 of the e-prescribing deployment plan, its personnel will work with the National e-prescribing team to re-configure the database to communicate to the live IHS Central Ensemble Production Server. Once transitioned over to this server, sites will no longer be able to test electronic prescriptions on demo patients and are required to send electronic prescriptions for live patients only. After the transition, OIT will work with the local team to identify patients who will work with us and communicate back any issues that occurred with their e-prescribed medications. Once the site has confirmation the patients have successfully received their medications as prescribed, the provider informaticist can then use e-prescribing for all patients requesting the service. Once ready, the site can continue to deploy e-prescribing to the remaining providers who meet credentialing requirements. 12 Implementation and Deployment

16 Implementation and Deployment 13 e-prescribing Deployment Phases SITE e-rx PREP SITE + AREA + NATIONAL + REC VERIFICATION SITE + AREA + NATIONAL + REC e-rx STAGING SITE + AREA + NATIONAL + REC e-rx PRODUCTION IDENTIFY e-prescribing Site Team ü Provider ü Site CAC ü IT Personnel ü Pharmacy Informaticist ü Credentialing Officer ü Area CAC ü Area IT ü Area ISO Tag Site for Deployment (e-rx Team) Go-Live Site moved to Production Figure 3-1: e-prescribing Deployment Configure RPMS & Ensemble (e-rx Team) Testing on Production Provider Informaticist to test using 5 preselected patients TASK TO COMPLETE ü Drug File Complete ü EHR Patch 9 Installed ü Clinical Indication Medications in EHR ü Station Number Verification ü Collect Data for Surescripts Provider ID (SPI) ü Demo Patients Setup ü Policies and Procedures Updated for e-prescribing ü Contingency Plan ü QA Process TASK TO VERIFY ü EHR Patch 9 Installed ü Drug File Optimization ü Clinical Indication Medications in EHR ü Station Number Verification ü Collect Data for Surescripts Provider ID (SPI) ü Demo Patients Setup ü Policies and Procedures Updated for e-prescribing ü Contingency Plan in Place ü QA Process Verify Notification Group for Connection Issues (e-rx Team) Final Go-Live All Patients on e-rx NO EHR Team Training (e-rx Team) Additional Provider Training e-rx National team or Area?? YES Test on Staging Provider Informaticist (e-rx Team) e-prescribing (BEPR) Version 1.0

17 4.0 Drug File Optimization The following section provides a review of the drug file optimization process that is required to implement e-prescribing. If the site has not started this process please review Appendix A: which includes drug file reports using FileMan. These reports will assist in quickly identifying areas within the drug file that will require optimization prior to implementing e-prescribing. The following table gives a brief overview of the files that will require optimization: Pharmacy Drug Management Prompt DRUG GENERIC NAME VA CLASSIFICATION DEA, SPECIAL HDLG ORDER UNIT DISPENSE UNIT DISPENSE UNITS PER ORDER UNIT DISPENSE UNIT NCPDP CODE NDC National Drug File Additional information/guidance All sites moving towards e-prescribing will need to review the drug file names to ensure a standard naming convention that aligns with Generic Name (plus) Strength (plus) Dosage Form. It is also critical to avoid special characters within the drug name that can result in transmission errors. The VA Classification field controls the EHR medication order checks. This includes order checks for allergies & drug-drug interactions. This field will populate automatically when the pharmacist matches the drug to the National Drug File (NDF). Remember controlled substances are excluded from the E-Rx Meaningful Use (MU) report logic. This logic determines which Eligible Professionals (EP) will have to meet the 40% threshold. Therefore errors in the DEA, Special HDLG field could negatively impact EPs when reporting this specific E-Rx Measurement. The next three fields work together and impact Provider Order Entry. Pharmacy should always complete the documentation for these three fields based on the correct product information. See ORDER UNIT for more details. See ORDER UNIT for more details. National Council for Prescription Drug Programs (NCPDP) provides a standard for the exchange between prescribers, pharmacies, intermediaries, and payers. National Drug Code (NDC) is a unique number assigned to all prescription and over the counter medications approved by the FDA. Match each and every drug to the NDF to obtain VA Drug Class. This will allow allergy checking and Drug/Drug interactions to operate correctly. Without this code providers will not get the appropriate order checks, which can ultimately result in adverse patient outcomes. 14 Drug File Optimization

18 Pharmacy Drug Management Prompt Dosages Application Packages Orderable Item Management Additional information/guidance All medications in the RPMS drug file need to have appropriate dosages assigned to improve provider order entry, decrease medication errors, and to prevent any E-Rx transmission failures. Marking a drug O authorizes it to be ordered in an Outpatient (aka Ambulatory Setting) and processes it through the Outpatient Pharmacy Drug File or it can be E-Prescribed. Marking a drug X allows it to be ordered as a NON-VA Medication and is not necessary for e-prescribing functionality. Pharmacy should optimize the orderable item file to ensure that the orderable item matches the intended dispense drug that the patient will receive in the dispensing process. 4.1 e-prescribing Medication Quick Orders When completing the drug file optimization, sites should also consider the current state of their medication quick orders. Sites that have never used EHR to order medications will need to establish medication quick orders and menus for providers to use when ordering prescriptions. Multiple types of quick orders are currently available in RPMS. Each has a recommended namespace to differentiate one package from another. Sites looking to separate the e-prescribed medications from their normal onsite processed medications should follow the namespace of PSOX (i.e. PSOXZ ENALAPRIL 10MG TABLET PO DAILY). The same namespace can also be used for sites that have never setup medication quick orders and are currently in the process of establishing new ones to accommodate this implementation project. This is not a requirement but instead a best practice recommendation. Some sites may decide against changing the existing medication quick order namespaces to meet this recommendation. Regardless of the decision, the final naming structure will not impact the functionality of e-prescribing but instead offers a way to manage existing quick orders. Namespace RA LR PSO PSOX PSJ PSIV Department Radiology Lab Outpatient meds E-Prescribed meds Inpatient (Unit dose) meds IV meds 15 Drug File Optimization

19 Namespace GMRC OR Department Consults CPRS (Nursing Orders) To further assist in the development/optimization of medication quick orders a sample quick order is shown in Figure 4-1. It is not recommended that a site populates information pertaining to the outside pharmacy or other e-prescribing fields. By leaving these entries blank the provider is able to complete the fields while ordering the medication based on the patient s needs. NAME: PSOXZ CAPTOPRIL 25MG PO TID Replace DISPLAY TEXT: Captopril (Capoten) 25mg PO TID #90 May RF x 1 Replace VERIFY ORDER: YES// DESCRIPTION: No existing text Edit? NO// ENTRY ACTION: Medication: CAPTOPRIL TAB // Complex dose? NO// Dose: 25MG// Route: ORAL// Schedule: TID// Patient Instructions: FOR BLOOD PRESSURE Include Patient Instructions in Sig? YES// Chronic Med?YES// Dispense as Written?// Days Supply: 30// Quantity (TAB): 90// Refills (0-11): 1// Pick Up: ELECTRONIC// Pharmacy:// Surescripts Pharmacy Information Edit? No// (No) APSP REFILL REQUEST entry// Priority: ROUTINE// Comments: No existing text Edit? No// (No) Indication:// Indication ICD9:// Medication: CAPTOPRIL TAB 25MG Instructions: 25MG ORAL TID Patient Instructions: FOR BLOOD PRESSURE Days Supply: 30 Quantity (TAB): 90 Refills (0-11): 1 Pick Up: ELECTRONIC Priority: ROUTINE (P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO// Figure 4-1: Sample Quick Order in RPMS 16 Drug File Optimization

20 On the Medication Order dialog (Figure 4-2), character limitations exist for the prescription instructions (a combination of the Dosage, Route, and Schedule fields) and the Comments field. If the prescription is to be transmitted to an outside pharmacy, provider input cannot exceed 140 characters in the combined instructions or 210 characters in the Comments field. If the medication order exceeds the character limitations in either location the provider will not be able to accept the order. Figure 4-2: Medication Order dialog For most medications the character limits will not be an issue, however sites using complex dosing with multiple directions are likely to be problematic (i.e. sliding scale insulin regimens and prednisone tapers). Each site should work to standardize both of these regimens in order to prevent any issues with e-prescribing transmission failures. 17 Drug File Optimization

21 5.0 Medication Clinical Indication Every medication transmitted via e-prescribing will require a clinical indication. If the site did not configure the clinical indication for medications when EHR patch 6 was released, it must be done before attempting to send a medication through e-prescribing. The following information outlines the RPMS setup required to complete this e-prescribing task. DEMO IHS CLINIC RPMS-EHR Management Version 1.1 Order Entry Configuration DOC Delayed Orders Configuration... KEY Key Management... MNU Order Menu Management... OCX Order Check Configuration... PAR Order Parameters... PRN Print/Report Parameters... RPT Order Reports... Select: PAR Order Parameters DEMO IHS CLINIC RPMS-EHR Management Version 1.1 Order Parameters HLD IND MSC ORD RSN UOV VER Disable Hold/Unhold Actions in EHR Enable Clinical Indicator Prompt Miscellaneous Parameters Disable Ordering in EHR Edit DC Reasons Set Unsigned Orders View on Exit Enable/Disable Order Verify Actions Select: IND Enable Clinical Indicator Prompt DEMO IHS CLINIC RPMS-EHR Management Version 1.1 Enable Clinical Indicator Prompt Enable Clinical Indicator Prompt may be set for the following: 800 Division DIV [DEMO IHS CLINIC] 900 System SYS [DEMO.IHS.GOV] Enter selection: 900 System DEMO.IHS.GOV --- Setting Enable Clinical Indicator Prompt for System: DEMO.IHS.GOV ---- Select Package:? Package Value LAB SERVICE YES OUTPATIENT PHARMACY YES 18 Medication Clinical Indication

22 Figure 5-1: Medication Order dialog Once the Clinical indication has been turned on, the provider should select a diagnosis for each drug that is e-prescribed. Remember, this is turned on for the entire system. If the onsite pharmacy uses RPMS, the providers will need to select a diagnosis for every medication order, no matter where it is being filled. 19 Medication Clinical Indication

23 6.0 Surescripts Provider Identifier Number Before a provider can access e-prescribing and activate the electronic functionality from the EHR medication quick order, a unique SPI# must be assigned to the provider by Surescripts. A provider will not be able to obtain an SPI# until he or she has reached the Staging and Production phases as outlined in Section 3.0. Once the system is successfully connected to the e-prescribing network, the Credentialing Officer may use RPMS to request the provider s SPI# from Surescripts. Prior to making the request it is essential that the provider s RPMS profile is updated with the following information: NPI Number Address Fax Number These three items are required to request the SPI#. Without properly updating the provider s profile, the system will decline all request for SPI# until the information has successfully been updated for each provider credentialed to use the e-prescribing network. The following diagram demonstrates that the SPI# request uses the same electronic highway between the IHS e-prescribing network and the Surescripts network to accomplish this task. Figure 6-1: IHS RPMS/EHR e-prescribing PRODUCTION Network SPI# 20 Surescripts Provider Identifier Number

24 7.0 Prerequisites for requesting an SPI# A VA FileMan report (Figure 7-1) has been provided to assist the site in identifying fields in the New Person file needing optimization before the site connects to the e-prescribing network. The report has been setup to identify those users with the parameter Authorized to write Med orders set to YES. If the local IT or CAC has not assigned this parameter to providers writing prescriptions, the provider will not be able to order medications through EHR and the report will not capture all potential providers needing updates. Before attempting to run this report, coordinate the necessary changes to this parameter for all providers using e-prescribing. Select VA FileMan Option: SEarch File Entries OUTPUT FROM WHAT FILE: NEW PERSON// -A- SEARCH FOR NEW PERSON FIELD: INACTIVE DATE -A- CONDITION: NULL -B- SEARCH FOR NEW PERSON FIELD: AUTHORIZED TO WRITE MED ORDERS -B- CONDITION: = EQUALS -B- EQUALS: YES -C- SEARCH FOR NEW PERSON FIELD: IF: A+B INACTIVE DATE NULL and AUTHORIZED TO WRITE MED ORDERS EQUALS "1" (YES) OR: STORE RESULTS OF SEARCH IN TEMPLATE: SORT BY: NAME// START WITH NAME: FIRST// FIRST PRINT FIELD: NAME;L40 THEN PRINT FIELD: NPI;L11 THEN PRINT FIELD: DEA#;10 THEN PRINT FIELD: FAX NUMBER;L11 THEN PRINT FIELD: OFFICE PHONE;L11 THEN PRINT FIELD: ADDRESS;L25 THEN PRINT FIELD: Heading (S/C): NEW PERSON SEARCH// STORE PRINT LOGIC IN TEMPLATE: DEVICE:HOME;300;99999 Figure 7-1: VA FileMan report example Use the final report to identify any of the required data elements missing from the provider s profile while preparing the site for e-prescribing implementation. Inactivate providers no longer at the facility. 21 Prerequisites for requesting an SPI#

25 Note: If any of the data elements are missing at the time of transition to the e-prescribing network, the SPI# request will not work as designed and will ultimately delay e-prescribing implementation. The prerequisite data elements to request an SPI# are: a valid address, a fax number, and an NPI number. I/T/U sites are currently unable to transmit controlled substances while using the e-prescribing network. However, providers are encouraged to document all medication orders through EHR. In order to document a narcotic in EHR a prescriber is required to have a DEA number within their RPMS profile. In New Person file or the AVA Add/Edit Provider menu, type the provider , fax number, and valid DEA number if the provider has a valid DEA number. Use the NPI menu to enter in a new NPI number for providers who currently don t have the NPI documented on their profile. RPMS Menu AVA Add/Edit Providers Menu SPI Required Fields Provider NPI FAX NUMBER ADDRESS In VA FileMan, review the Institution File and verify that the site has a physical address populated at the street address 1, street address 2, city, state, and zip fields. If the facility has a Facility DEA number it must be recorded in the Institution File. RPMS File INSTITUTION Required Fields STREET ADDR. 1 (cannot be a P.O. Box) STREET ADDR. 2 (if applicable) CITY STATE ZIP FACILITY DEA NUMBER (if applicable) 22 Prerequisites for requesting an SPI#

26 In VA FileMan review the Location File, the site needs to populate the primary phone number in the following format RPMS File Required Fields Format LOCATION PHONE MAILING ADDRESS- STREET MAILING ADDRESS-CITY MAILING ADDRESS-STATE MAILING ADDRESS-ZIP 23 Prerequisites for requesting an SPI#

27 8.0 Demo Patients and e-prescribing A site moving towards e-prescribing must understand the necessity for configuring demo patients as recommended. Once a site gains access to the e-prescribing network it will work directly with the IHS Central Network and the Surescripts Network. While on the e-prescribing Staging Network the site may test the e-prescribing functionality by sending prescriptions for a demo patient. As the site transitions from the Staging Network to the e-prescribing Production Network, providers may send electronic prescriptions for live patients only. Configuration rules exist for each of the network (Staging and Production) Central Servers to ensure that these requirements are followed; however, some sites have patients with the last name of demo or the same four characters in their name, which could cause issues when transmitting prescriptions. This will be addressed at a site as it moves into phase 2 of the deployment plan. If a site does not comply with the following recommendations, issues can arise and the site could be delayed in the deployment process or even disconnected from the e-prescribing Network until further actions can be taken to ensure these recommendations are in place. Create each demo patient used for testing with these characteristics. Last name= Demo First name = Patient SSN = 00000nnnn (where nnnn are any numbers - the leading 5 zeros are the key) 24 Demo Patients and e-prescribing

28 20BDrug File Optimization Reports & Report Objectives 25 Appendix A: Drug File Optimization Reports & Report Objectives FileMan access is not always granted; be very careful when using it. To print reports, the minimum permission of search only must be granted. Otherwise, the local IT must assist in printing the reports. A.1 Drug File Name and DEA Special Handling Code All sites moving towards E-Prescribing will need to review the drug file names to ensure a standard naming convention that aligns with Generic Name (plus) Strength (plus) Dosage Form. It is also critical to avoid special characters within the drug name that can result in transmission errors. Controlled substances are excluded from the E-Rx MU report logic. The MU report determines which EPs will have to meet the 40% threshold for the E-Prescribing measurement. Therefore errors in the DEA, Special HDLG field could negatively impact EPs when reporting this specific E-Rx Measurement. 1. Start at the VA FileMan Option screen: Enter or Edit File Entries Print File Entries Search File Entries Modify File Attributes Inquire to File Entries Utility Functions... Data Dictionary Utilities... Transfer Entries Other Options... Select VA FileMan Option: SEARCH FILE ENTRIES 2. At the Select VA FileMan Option prompt, type SEARCH FILE ENTRIES e-prescribing (BEPR) Version 1.0

29 20BDrug File Optimization Reports & Report Objectives Answer each of the following prompts in the order and manner prescribed: VA FileMan Search Prompt User Input Explanation OUTPUT FROM WHAT FILE: DRUG <Enter> This report focuses on the Drug File (File #50). -A- SEARCH FOR DRUG FIELD: INACTIVE DATE <Enter> Exclude any drug that has been inactivated in the system. -A- CONDITION: NULL <Enter> Adding NULL excludes any inactive drug that has been populated. -B- SEARCH FOR DRUG FIELD: <Enter> No other requirements are needed for this particular report; press Enter at this prompt. STORE RESULTS OF SEARCH IN TEMPLATE: <Enter> These results will not be stored; press Enter at this prompt. SORT BY: GENERIC NAME <Enter> Sort the report by Generic Name. START WITH GENERIC NAME: <Enter> The default is FIRST; press Enter at this prompt. FIRST PRINT FIELD: GENERIC NAME <Enter> The first field (column) of the report will contain the Generic Drug Name. THEN PRINT FIELD: NUMBER <Enter> The next field of the report will contain the drug s IEN Number, which is unique to each drug and is useful for quickly locating the drugs that need to be modified. THEN PRINT FIELD: DEA, SPECIAL HDLG <Enter> The next field of the report will contain the drug s DEA Special Handling Code. THEN PRINT FIELD: <Enter> Press Enter at this prompt to stop adding fields. Heading (S/C): <Enter> The default is DRUG SEARCH; press Enter at this prompt. e-prescribing (BEPR) Version 1.0

30 20BDrug File Optimization Reports & Report Objectives 27 VA FileMan Search Prompt User Input Explanation DEVICE: HOME;180;99999 <Enter> Before printing the report, turn on session logging (session logging will be discussed in class). Once session logging has been turned on type: HOME;180;99999: HOME indicates that the final report will print to the home screen. 180 indicates that there are 180 characters across the screen indicates that the screen will scroll until it hits the 99,999 row which should allow the entire report to be captured without having to press Enter between each screen. NOTE: Before printing the report, check the telnet settings to verify that the columns are set to 180 columns or more. A process commonly called session logging is used to capture report details. Different telnet session use different terminology including capture to file, transfer to file, session logging, etc. Please work with the local IT department for additional information on session logging reports. Turn on session logging (or equivalent) to record the report. When prompted to save the file, save it in My Documents or on the desktop so that it easy to find. 4. Once the report is complete: a. Turn off session logging. b. Open Microsoft Excel. c. Using the data import tool, import the saved.txt file that was created. d. Review for drug file clean-up. e-prescribing (BEPR) Version 1.0

31 20BDrug File Optimization Reports & Report Objectives 28 A.1.1 The final report imported into Excel should look like this: GENERIC NAME NUMBER DEA SPECIAL HDLG ACETAMINOPHEN 325MG TAB 263 9P ACETAMINOPHEN/CODEINE NO.3 TAB AB AEROCHAMBER ATORVASTATIN 10MG TAB CALCIUM CARBONATE 500MG (CA++) CHLORDIAZEPOXIDE 25MG CAP LAPBZ MORPHINE SULFATE 15MG *SR* TA AP Drug File Name and DEA Special Handling Code Report Objective Review this report for the following requirements: Drug Name: Standardize the drug name: Remove any internal naming conventions (i.e. ORX or other internal names). All drugs to be E-Prescribed must be in the recommended format: Generic Name + Dose + Dosage Form ex: LISINOPRIL 10MG TABLET Remove Special Characters from drug file name:! # $ % & ( ) * +, -. / : ; [ \ ] ^ _ { } ~ NOTE: Sites using special characters to block Scriptpro or other automation should contact the company to see if other changes can be made to the configuration other than using the character symbol to block the prescription. DEA SPECIAL HDLG: Review active drugs for the appropriate code. e-prescribing (BEPR) Version 1.0

32 20BDrug File Optimization Reports & Report Objectives 29 Verify that all controlled substances have been set up correctly. Fill in any blanks. A.2 Units Report 1. Start at the VA FileMan Option screen: Enter or Edit File Entries Print File Entries Search File Entries Modify File Attributes Inquire to File Entries Utility Functions... Data Dictionary Utilities... Transfer Entries Other Options... Select VA FileMan Option: SEARCH FILE ENTRIES 2. At the Select VA FileMan Option prompt, type SEARCH FILE ENTRIES 3. Answer each of the following prompts in the order and manner prescribed: VA FileMan Search Prompt User Input Explanation OUTPUT FROM WHAT FILE: DRUG <Enter> This report focuses on the Drug File (File #50). -A- SEARCH FOR DRUG FIELD: INACTIVE DATE <Enter> Exclude any drug that has been inactivated in the system. -A- CONDITION: NULL <Enter> Adding NULL excludes any inactive drug that has been populated. -B- SEARCH FOR DRUG FIELD: <Enter> No other requirements are needed for this particular report; press Enter at this prompt. IF: A// <Enter> Press Enter at this prompt. STORE RESULTS OF SEARCH IN TEMPLATE: <Enter> These results will not be stored; press Enter at this prompt. e-prescribing (BEPR) Version 1.0

33 20BDrug File Optimization Reports & Report Objectives 30 VA FileMan Search Prompt User Input Explanation SORT BY: GENERIC NAME <Enter> Sort the report by Generic Name. START WITH GENERIC NAME: <Enter> The default is FIRST; press Enter at this prompt. FIRST PRINT FIELD: GENERIC NAME;L50 <Enter> The first field (column) of the report will contain the Generic Drug Name. THEN PRINT FIELD: NUMBER;L10 <Enter> The next field will contain the drug s IEN Number, which is unique to each drug and is useful for quickly locating the drugs that need to be modified. THEN PRINT FIELD: THEN PRINT FIELD: THEN PRINT FIELD: THEN PRINT FIELD: ORDER UNIT;L5 <Enter> DISPENSE UNIT;L10 <Enter> DISPENSE UNITS PER ORDER UNIT;L5 <Enter> DISPENSE UNIT NCPDP CODE;L5 <Enter> The next field will contain the drug s ordering unit (how the drug is supplied from the manufacturer). The next field will contain the smallest unit that can be dispensed (the dose of the order unit; e.g., tab, cap, ml, gm.). The next field will contain a number indicating the quantity of dispense units per order unit? Normally we see: 1000 tabs in one bottle: Dispense units per order unit = tabs in one bottle: Dispense units per order unit = 30 NCPDP provides a standard for the exchange between prescribers, pharmacies, intermediaries, payers. E-Prescribing requirement for new prescription Request, change of new prescription, cancel of prescription, refill/renewals request/response or resupply in long term care. e-prescribing (BEPR) Version 1.0

34 20BDrug File Optimization Reports & Report Objectives 31 VA FileMan Search Prompt User Input Explanation THEN PRINT FIELD: NDC;L15 <Enter> Format only for proper functioning with POS & NDF Matching. It may be necessary to use leading zeros to get the correct format. Sites without a pharmacy, still need to populate the NDC field. To acquire an NDC, search the FDA NDC file: eryndctn.cfm This site will also display common quantities usable to complete the order unit, dispense unit, and dispense units per order unit. Search the internet for those that are not on the FDA site. THEN PRINT FIELD: <Enter> Press Enter at this prompt to stop adding fields. Heading (S/C): <Enter> The default is DRUG SEARCH; press Enter at this prompt. e-prescribing (BEPR) Version 1.0

35 20BDrug File Optimization Reports & Report Objectives 32 VA FileMan Search Prompt User Input Explanation DEVICE: 4. Once the report is complete: a. Turn off session logging. b. Open Microsoft Excel. HOME;180;99999 <Enter> c. Using the data import tool, import the saved.txt file that was created. d. Review for drug file clean-up. Before printing the report, turn on session logging (session logging will be discussed in class). Once session logging has been turned on type: HOME;180;99999: HOME indicates that the final report will print to the home screen. 180 indicates that there are 180 characters across the screen indicates that the screen will scroll until it hits the 99,999 row which should allow the entire report to be captured without having to press Enter between each screen. NOTE: Before printing the report, check the telnet settings to verify that the columns are set to 180 columns or more. A process commonly called session logging is used to capture report details. Different telnet session use different terminology including capture to file, transfer to file, session logging, etc. Please work with the local IT department for additional information on session logging reports. Turn on session logging (or equivalent) to record the report. When prompted to save the file, save it in My Documents or on the desktop so that it easy to find. e-prescribing (BEPR) Version 1.0

36 20BDrug File Optimization Reports & Report Objectives 33 A.2.1 The final report imported into Excel should look like this: GENERIC NAME NUMBER ORDER UNIT DISPENSE UNIT DISPENSE UNITS PER ORDER UNIT UNIT NCPDP CODE ACETAMINOPHEN 325MG TAB 263 BT TAB 1000 U ACETAMINOPHEN/CODEINE NO.3 TAB NDC BT TAB 1000 U AEROCHAMBER EA EACH ATORVASTATIN 10MG TAB BT TAB 30 CALCIUM CARBONATE 500MG (CA++) Units Report Objectives: Review this report for the following requirements: Sites with Onsite Pharmacy: For all drugs: Review the drug file for accuracy. Update missing information. Update drug file to match shelf stock. Sites without Onsite Pharmacy: BT TAB 1000 For all drugs: Review the drug file for accuracy. Update missing information. Look up NDC numbers and common quantities (order unit, dispense unit, and dispense units per order unit) at: Note: It may be necessary to try both generic and brand name to pull up a list of drugs e-prescribing (BEPR) Version 1.0

37 20BDrug File Optimization Reports & Report Objectives 34 A.3 NDF Report The web site will help identify additional 0 in order to comply with the format when populating NDC numbers If the information is not found on the FDA web site, use other web searches to complete the task. 1. Start at the VA FileMan Option screen: Enter or Edit File Entries Print File Entries Search File Entries Modify File Attributes Inquire to File Entries Utility Functions... Data Dictionary Utilities... Transfer Entries Other Options... Select VA FileMan Option: SEARCH FILE ENTRIES 2. At the Select VA FileMan Option prompt, type SEARCH FILE ENTRIES 3. Answer each of the following prompts in the order and manner prescribed: VA FileMan Search Prompt User Input Explanation OUTPUT FROM WHAT FILE: DRUG <Enter> This report focuses on the Drug File (File #50). -A- SEARCH FOR DRUG FIELD: INACTIVE DATE <Enter> Exclude any drug that has been inactivated in the system. -A- CONDITION: NULL <Enter> Adding NULL excludes any inactive drug that has been populated. -B- SEARCH FOR DRUG FIELD: <Enter> No other requirements are needed for this particular report; press Enter at this prompt. IF: A// <Enter> Press Enter at this prompt. STORE RESULTS OF SEARCH IN TEMPLATE: <Enter> These results will not be stored; press Enter at this prompt. e-prescribing (BEPR) Version 1.0