EHR Parameters for Pharmacy

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Learning Objectives• Assess need to have a properly configured Information Management

system and use of uniform data to assure medication accuracy, timely access to patient information and patient safety.

• Explain the necessity to configure Information Management system in medication management to correlate to physical processes to assure that the system supports but does not supplant the process.

• Evaluate package parameters relating to medications and medication use in both outpatient and inpatient settings to function for useability and workflow including IHS specific options, a uniform print format for EHR, controlled substance orders, the PharmEd Button, inpatient user parameters, inpatient ward setup, Ward Groups, Unit Dose Parameters and MAR/MAR Labels. Determine best practices.

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Definition of Parameter

• A Parameter is a Quantity whose value is selected for the particular circumstances and in relation to which other variable quantities may be expressed.

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Definition of Parameter

• For RPMS-EHR, this means that a CAC can change behavior of a part of the software without having to perform a programming change simply by changing the value of a Parameter.

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Parameters:

• Provide a way to Control Configuration at the Local Level by non-programmers

• Allow for Flexibility and Customization of RPMS-EHR at each Site

• Allow for different Configuration for Divisions and Individual Users

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Parameter Structure

• The Structure of Parameters within RPMS-EHR is Hierarchical

• Parameters range from User at the top to Package at the bottom

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Hierarchy Levels

1 User2 Team (OE/RR)3 Device4 Location5 Service6 Division7 System8 Package

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Parameter Hierarchy

• How does the Hierarchy work?• A Package first Checks the Highest Level (e.g.

“User”) to see if a Value is set• The Package will continue to check each

succeeding Level until a Value is found• When a Value is found, the Package stops and

uses that Value for the Operation in question

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Parameter Hierarchy

• Note that not all Levels are available for all Parameters, but only those that make sense for that particular item.

ORWOR WRITE ORDERS LIST may be set for the following:

1 User USR [choose from NEW PERSON]

2 Location LOC [choose from HOSPITAL LOCATION]

2.3 Service SRV [choose from SERVICE/SECTION]

2.7 Division DIV [MEDSPHERE DEMO HOSPITAL]

3 System SYS [DEMO.MEDSPHERE.COM]

4 Package PKG [ORDER ENTRY/RESULTS REPORTING]

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Setting Parameters

• Most Parameters are set at the System or Division Level.

• For some Parameters, it may be necessary to use Location, Team or User.

• The “higher” the level used, the more effort required to maintain the Parameter (e.g. 1 Setting at System, vs. 30 at Location, vs. 300 at User).

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Setting Parameters

• Package levels should NOT be changed by the CAC.

• The Package Level should be considered the “Reference” Value.

• New Patches for a Package may sometimes reset the Package Level value which could have interesting consequences if was changed locally.

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Setting Parameters

• RPMS-EHR Parameters can be set in two ways:

• Using the RPMS menu option: General Parameter Tools

• Using various RPMS menus from:RPMS-EHR Configuration Master Menu

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Parameters – MedsCORE-EHR-BEH-MED

ACT Days of Medication ActivityDEA Print DEA on all PrescriptionsMAX Maximum Allowable Days SupplyMEC Medication Counseling ConfigurationOMD Outside Med Dosage FormORD Default Collation OrderREN Renewal Limit for Expired MedsSPL Med Tab Splitter Size

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Days of Medication Activity

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Print DEA on all Prescriptions

• Allows for local customization for DEA printing on all prescriptions instead of only on controlled prescriptions.

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Maximum Allowable Days Supply

• This controls the upper limit for days supply of a dispensed medication:• The range is 90-365 days.

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Medication Counseling Configuration

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Medication Counseling Configuration

DCMP Default Comprehension ValueDCTM Default Counsel TimeEDTX Edit Disclaimer TextELST Education TopicsHL Hospital Location for VisitPLST POV ListDPOV Default POVPNL POV Narrative Text

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Medication Counseling Configuration

Default Comprehension Value Default Counsel Time

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Medication Counseling Configuration

Edit Disclaimer Text Education Topics

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Medication Counseling Configuration

Hospital Location for Visit POV List

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Medication Counseling Configuration

Default POV POV Narrative Text

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Outside Med Dosage Form

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Default Collation OrderControls the default collation order for the medication list. May be one or more of the following values: C = Chronic med status E = Expiration date F = Last fill date I = Issue date M = Medication name N = Rx # P = Provider name R = Refills remaining S = Status

To reverse the collation order, use the lowercase equivalent.

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Default Collation Order

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Renewal Limit for Expired Meds

• This is the maximum number of days following the expiration of a prescription that it may still be renewed:• Typically set to between 90-120 days.

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Parameters – OrderingCORE-EHR-BEH-ORD-PAR

HLD Disable Hold/Unhold Actions in EHRIND Enable Clinical Indicator PromptMSC Miscellaneous ParametersORD Disable Ordering in EHRRSN Edit DC ReasonsUOV Set Unsigned Orders View on ExitVER Enable/Disable Order Verify Actions

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Enable Clinical Indicator Prompt

• Places a prompt for providers to enter a clinical indication for medication orders.

• Required to be turned on for e-prescribing.• EHR Patch 9:

• Requires a coded diagnosis• Pull in problem list and POVs for providers to

select from• Renew, copy, and change pre-populates with

clinical indication of new order

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Clinical Indication prompt

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Ordering - Miscellaneous ParametersCORE-EHR-BEH-ORD-PAR-MSC

Active Orders Context Hours 24Allow Clerks to act on Med Orders NOAllow Clerks to act on Outside Med OrdersAuto Unflag YESConfirm Provider YES (Exclude ORES)Default ProviderError Days 7New Orders Default Sign & ReleaseRestrict Requestor YES (ORELSE & OREMAS)Review on Patient Movement NOShow Lab # YESShow Status Description YESSignature Default Action Release w/o SignatureSigned on Chart Default NO

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Parameters - Order ChecksCORE-EHR-BEH-ORD-OCX

CON Creatinine Date Range for Contrast Media OrdersCTH CT Scanner Height LimitCTW CT Scanner Weight LimitDAN Set Clinical Danger LevelDBG Enable/Disable Debug Message LoggingDPL Lab Duplicate Order RangeDPO Orderable Item Duplicate Order RangeDPR Radiology Duplicate Order RangeEDT Mark Order Checks Editable by UserENA Enable/Disable an Order CheckGLU Creatinine Date Range for Glucophage-Lab ResultsLCL Edit Local TermsMRH MRI Scanner Height LimitMRW MRI Scanner Weight LimitPLY Number of Medications for PolypharmacyUSR Order Checks a User Can Receive

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Parameters – NotificationsCORE-EHR-NOT

DET Determine RecipientsDIS Display Notifications a User Can ReceiveERA Erase NotificationsFLG Flag Orderable Items to Send NotificationsFWD Forward NotificationsPAR Notification ParametersPRC Enable/Disable NotificationsREC Display Patient Alerts and Alert RecipientsSYS Enable/Disable Notification SystemUNV Set Delays for Unverified OrdersURG Set Urgency for Notifications

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Parameters – ReportsCORE-EHR-BEH-RPT

FMT Print FormatsHSM Health Summary Configuration ...PAR Report Parameters ...SYS System Display ParametersUSR User Display Parameters

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EHR Patch 9: Auto-finish & e-Prescribing Parameters

• BEHORX PRINT LABEL• Optional

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EHR Patch 9: Auto-finish and e-Prescribing Parameters

• BEHORX PRINT FORMATSDefinition Template Type Site Specific Template Formats

Prescription Controlled PC:RX CII (Site Name) Prescription (CII)

Prescription Non-Controlled PN:RX NON-CII (Site Name) Prescription (NON-CII)

Order Control OC:ORDER CII (Site Name) Order for Signature (CII)

Order Non-Control ON:ORDER NON-CII (Site Name) Order for Signature (NON-CII)

Receipt Controlled RC:RECEIPT CII (Site Name) Receipt (CII)

Receipt Non-Controlled RN:RECEIPT NON-CII (Site Name) Receipt (NON-CII)

Label Controlled LC:LABEL CII Cannot configure at this time

Label Non-Controlled LN:LABEL NON-CII Cannot configure at this time

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EHR Patch 9: Auto-finish and e-Prescribing Parameters

• BEHORX PRINT FORMAT TYPETemplate Type Site Specific Template Formats Default Printer

PC:RX CII Demo Prescription (CII) CLIN 1

PN:RX NON-CII Demo Prescription (NON-CII) CLIN 1

OC:ORDER CII Demo Order for Signature (CII) CLIN 2

ON:ORDER NON-CII Demo Order for Signature (NON-CII) CLIN 2

RC:RECEIPT CII Demo Receipt (CII) CLIN 3

RN:RECEIPT NON-CII Demo Receipt (NON-CII) CLIN 3

LC:LABEL CII Cannot configure at this time DINOLB 1

LN:LABEL NON-CII Cannot configure at this time DINOLB 2

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EHR Patch 9: Auto-finish & e-Prescribing Parameters

• APSP AUTO RX DIV• Sets Pharmacy Division to divisions setup in

Outpatient Site File• Must be done before APSP AUTO RX

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EHR Patch 9: Auto-finish & e-Prescribing Parameters

• APSP AUTO RXAPSP Auto RX Setting

Meaning

Internal Patients fill prescriptions written by in-house providers at only in-house pharmacies: In-house options for Clinic, Mail, Window retained CII order for signature queued to print

Internal/External Patients fill prescriptions written by in-house providers at in-house and outside pharmacies: In-house options for Clinic, Mail, Window retained – CII order for signature queued to print. Prior to Surescripts® set up/deployment, enables the “Outside Pharmacy – Print” functionality – Auto-finishes medications upon signature and queues prescription for printing. After Surescripts® set up/deployment, enables the “Outside Pharmacy – eRx functionality – Auto finishes medications upon signature, transmits and queues receipt for printing

External No in-house pharmacy: All medication orders auto-finish upon signature Prior to Surescripts® set up/deployment, enables the Outside Pharmacy – Print” functionality – Auto finishes medication upon signature and queues prescription for printing. After Surescripts® set up/deployment, enables the “Outside Pharmacy – eRx functionality – Auto finishes medications upon signature, transmits, and queues receipt for printing

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EHR Patch 9: Auto-finish & e-Prescribing Parameters

• APSP AUTO RX SCHEDULE RESTRICT• Not editable

• APSP AUTO RX ERX OF CII• Not editable

• APSP AUTO RX ADD PRV COMMENT• Set to NO

• APSP AUTO RX DEF PT STATUS• Set to OUTPATIENT

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EHR Patch 9 – New Printing Functionality

• “Smart logic” is used to determine which order requires a print job and if so which type based on:• Status (Active or Pending)• Pick up location • Type of drug (Controlled or not)

• “Queues” the print jobs for printing.• Formats may be defaulted to specific templates.• Formats may be defaulted to specific printers at

the User, Location, Division and System level .

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Queue PrintFacility type

Pick up location Status after signing

CII? Print format Icon

Internal ClinicMailWindow

ClinicWindow

PendingPendingPending

PendingPending

NoNoNo

YesYes

N/AN/AN/A

CII Order for SigCII Order for Sig

External Clinic

Outside Pharmacy – eRx

Outside Pharmacy - Print

Active

Active

Active

NoYes

No

NoYes

N/APrescription (CII)

Prescription (Non CII)

Prescription (Non CII)Prescription (CII)

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Queue PrintFacility type

Pick up location Status after signing

CII? Print format Icon

Internal/ External

ClinicMailWindow

PendingPendingPending

NoNoNo

N/AN/AN/A

ClinicWindow

PendingPending

YesYes

CII Order for SigCII Order for Sig

Outside Pharmacy – eRx

Outside Pharmacy - Print

Active

Active

No

NoYes

Prescription (Non CII)

Prescription (Non CII)Prescription (CII)

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Queue Print

After signing, the meds that have print jobs are highlighted and the Queue Print button is active

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Queue Print

Click the Queue Print button and the print jobs are displayed, associated with pre-defined templates for each format and default printer (user may change)

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Rx Print Format (Template) editor

Set up:1. Design mode> Desktop Properties> Custom Menus2. Add Menu item “Rx Template Editor”3. Add the following in Action (lightening bolt)

$(BEHRXGENERATORSERVICE.RXGENERATOR.edittemplates)

4. Click Apply and Ok5. Make sure you have BEH Rx Generator Service checked

under “required services”6. Only place on EHR GUI templates of those who are

responsible for editing Prescription formats (ie. CAC, pharmacy Ad Pac)

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Rx Print Format (Template) Editor

Design Mode Rx Template Editor

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Rx Print Format (Template) Editor

• Template type (format)• Prescription (Non-CII)• Prescription (CII)• Order for signature (CII)• Order for signature (Non-CII)• Receipt (Non-CII)• Receipt (CII)

• Template• Default template for each

template type delivered with EHRp9

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Rx Print Format (Template) Editor

Importing template:1. Save the files to a local

drive2. Open Rx template editor3. Select template type4. Click Import5. Change the name if

desired, click OK

The files are .ptxml files6. Click “active on”7. Select Yesterday at 6:00

am, then OK8. Now you may edit the

template9. Click OK to store

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Rx Print Format (Template) Editor• Active on – set activation date

(usually Yesterday at 6:00am)• Preview – Display preview of current

template • Import – import template• Export – export template• Add Free Text – you may add as

many as you like. May include header info for format, alternate signature lines, etc.

• Mark Inactive – inactivates template so users cannot select

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*** Tip ***To Copy a template - export, save and import:- Change to a local name on imports. - Set “active on” to Yesterday at 6:00 am.- Make changes then click OK

Highly recommend using the copy process and creating local templatesrather than editing nationally delivered default templates ***

Rx Print Format (Template) Editor

• Change font • Set fields for inclusion,

change print labels, and set columns in the Fields section

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Rx Printer Configuration

In RPMS set the BEHORX PRINT FORMATS parameter• Associates the Format

type with the Format (Template)

• May set at User, Class, Location, Division and System level

• Most commonly will be set at System or Division level

Select Format Type: ?? Instance values are (Commonly set format types) : PC:RX CII PN:RX NON-CII OC:ORDER CII ON:ORDER NON-CII RC:RECEIPT CII RN:RECEIPT NON-CII LC:LABEL CII LN:LABEL NON-CII

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Rx Printer Configuration

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Rx Printer Configuration

Populate the BEHORX PRINT FORMAT TYPEThis associates the Format type:

Order for signature (CII)Prescription (CII)Prescription (Non-CII)Receipt (Non-CII) with a default printer. • Set at User, Location, Division or System level• In RPMS or in EHR Printer Preferences tool

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Rx Printer Preferences EditorSet up:1. Design mode> Desktop Properties> Custom Menus2. Add Menu item “Rx Printer Config”3. Add the following in Action (lightening bolt)

$(BEHRXGENERATORSERVICE.RXGENERATOR.EditPrinterPreferences)

4. Click Apply and Ok5. Make sure you have BEH Rx Generator Service checked

under “required services”6. Users will only be able to set their own defaults7. Assign the BEHORX PRINT key for CAC/IT staff who will set

Location, Division, System settings

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Rx Printer Preferences Editor

Design Mode Printer Preferences

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Rx Printer Preferences Editor

Use dropdown to select level, template type, printer settings.Click APPY to store the parameter.To remove a parameter level, bring up the level and click REMOVE

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Rx Printer Preferences EditorRPMS display parameterBEHORX PRINT FORMAT TYPE

RPMS enter/edit parameterBEHORX PRINT FORMAT TYPE

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Questions and Discussion

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