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HITSP Real World Sites Medication Management Webinar 8 September 10th, 2009 | 2:00 – 3:30 pm (Eastern). Moderator: Ken Majkowski , Surescripts Presenters: J. Marc Overhage , Regenstrief Institute Peter Kaufman , DrFirst. Learning Objectives. - PowerPoint PPT Presentation
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1enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
HITSP Real World SitesMedication Management
Webinar 8 September 10th, 2009 | 2:00 – 3:30 pm (Eastern)
Moderator: Ken Majkowski, Surescripts
Presenters: J. Marc Overhage, Regenstrief Institute Peter Kaufman, DrFirst
Slide 2HITSP – enabling healthcare interoperability 2009 Webinar Series
Learning Objectives
During this 90-minute webinar, participants will learn:
— Learn how the HITSP Medication Management Interoperability Specification is being used today by the Regenstrief Institute, DrFirst, and Surescripts
— Explore the value and limitations of external sources of medication history
— Learn how various standards are employed in the HITSP Medication Management transactions
— Discover how DrFirst and Regenstrief have employed HITSP in the real world in the areas of e-prescribing, patient eligibility, formulary and benefit inquiry, and medication reconciliation
Slide 3HITSP – enabling healthcare interoperability 2009 Webinar Series
Agenda
What is HITSP?
Surescripts case study
Regenstrief Institute case study
DrFirst case study
Overview of the 2009 Webinar Series
Questions?
Slide 4HITSP – enabling healthcare interoperability 2009 Webinar Series
Mission
To serve as a cooperative partnership between the public and
private sectors for the purpose of achieving a widely accepted
and useful set of standards specifically to enable and support
widespread interoperability among healthcare software applications,
as they will interact in a local, regional, and national health
information network for the United States.
Slide 5HITSP – enabling healthcare interoperability 2009 Webinar Series
HITSP is a volunteer-driven, consensus-based organization
that is funded through a contract from the Department of
Health and Human Services
— Created in 2005
HITSP develops Interoperability Specifications (IS) – documents
that harmonize and recommend the technical standards that are
necessary to assure the interoperability of electronic health records
— Production to date:13 IS and 60 related constructs
Overview
Slide 6HITSP – enabling healthcare interoperability 2009 Webinar Series
HITSP Stakeholders
Patients
Consumers
Employers
General
Practitioners
Outpatient
Providers
Government
Agencies
Hospitals
Review Boards
Practice
Guidelines
Residential
Care Providers
Standards
Developers
Specialists
Payers
Suppliers
Current Participation in HITSP:
800+ organizations 1,000+ individuals
Over 25,000 volunteer hours
Slide 7HITSP – enabling healthcare interoperability 2009 Webinar Series
HIT Standardization
HITSP members agreed that a standard is a
well-defined approach that supports a business
process and . . .
— has been agreed upon by a group of experts
— has been publicly vetted
— provides rules, guidelines, or characteristics
— helps to ensure that materials, products, processes and services are fit for their intended purpose
— is available in an accessible format
— is subject to an ongoing review and revision process
Standards Harmonization is required when a proliferation of
standards prevents progress rather than enabling it.
Slide 8HITSP – enabling healthcare interoperability 2009 Webinar Series
Released Accepted Recognized
Federal projects must use HITSP recognized standardsPer Executive Order 13410
Panel approved for submission to HHS
Secretary of HHS has accepted for a period
of testing
Secretary of HHS has recognized the IS for
immediate implementation
Status: Interoperability Specifications
Slide 9HITSP – enabling healthcare interoperability 2009 Webinar Series
IS 01Electronic Health Record (EHR) Laboratory Results Reporting
IS 02 Biosurveillance
IS 03 Consumer Empowerment
IS 04Emergency Responder Electronic Health Record (ER-EHR)
IS 05Consumer Empowerment and Access to Clinical Information via Media
IS 06 Quality
IS 07 Medication Management
HITSP Interoperability Specifications (IS)
Accepted
Recognized
Slide 10HITSP – enabling healthcare interoperability 2009 Webinar Series
IS 08 Personalized Healthcare
IS 09 Consultations and Transfers of Care
IS 10 Immunizations and Response Management
IS 11 Public Health Case Reporting
IS 12 Patient – Provider Secure Messaging
IS 77 Remote Monitoring
IS 107 EHR Centric
HITSP Interoperability Specifications (IS)
Released /Panel
Approved
Accepted
Slide 11HITSP – enabling healthcare interoperability 2009 Webinar Series
“Meaningful Use”
From existing Interoperability
Specifications, determine subset
required for “meaningful use” as
called for in the American Recovery
and Reinvestment Act (ARRA).
Effort began on April 7, 2009.
Slide 12HITSP – enabling healthcare interoperability 2009 Webinar Series
All based on previous HITSP work
CAP140 Exchange Administrative Benefits/Eligibility transactions specification
CAP141 Exchange Administrative Referral/Authorization Transactions Specifications
CAP142 Retrieve Communications Recipient
CAP143 Consumer Preferences and Consent Management
CAP146 Identification of communications Recipient Specifications
CAP117 Communicate Ambulatory and Long Term Care Prescription Specification
CAP118 Communicate Hospital Prescription Specification
CAP119 Communicate Structured Document Specification
CAP120 Communicate Unstructured Document Specification
CAP121 Communicate Clinical Referral Request Specification
CAP122 Retrieve medical Knowledge Specifications
CAP123 Retrieve existing data Specifications
CAP124 Establish Secure web access Specifications
CAP125 Retrieve Genomic Decision Support Specifications
CAP126 Communicate Lab Results Message Specifications
CAP127 Communication of Lab Results Document Specifications
CAP128 Communicate Imaging Information Specifications
CAP129 Communicate Quality Measure Data Specifications
CAP130 Communicate Quality Measure Specification Specifications
CAP131 Immunization Registry update Specifications
CAP132 Immunization Registry Query Specifications
CAP133 Communication of Immunization Summary Specifications
CAP135 Retrieve Pre-populated Form for Data Capture Specifications
CAP136 Emergency Alerting Specifications
CAP137 Send and Receive clinical data message Specifications
CAP138 Assign pseudo-identity SpecificationsEmergency CAP139 Communicate Resource Utilization Specifications
ADMINISTRATIVE and FINANCIAL
HITSP Capabilities
Immunization
Case Reporting and
Bio-surveillance
Medication Management
CLINICAL OPERATIONS
(Care Delivery, Emergency Responder
and Consumer Empowerment)
Exchange of Clinical Data
Exchange of Laboratory and Imaging Data
Quality Management
CLINICAL QUALITY AND
PUBLIC HEALTH
Slide 13HITSP – enabling healthcare interoperability 2009 Webinar Series
IS 01Electronic Health Record (EHR) Laboratory Results Reporting
IS 02 Biosurveillance
IS 03 Consumer Empowerment
IS 04Emergency Responder Electronic Health Record (ER-EHR)
IS 05Consumer Empowerment and Access to Clinical Information via Media
IS 06 Quality
IS 07 Medication Management
Today’s Focus . . .
Accepted
Recognized
14enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
Medication Management Real World Sites
Surescripts
Ken Majkowski, Pharm. D.Vice President, Clinical Affairs and Product Strategy, Surescripts
Slide 15HITSP – enabling healthcare interoperability 2009 Webinar Series
Definition of E-Prescribing
E-Prescribing supports a shift to a paperless and more informed way for payers, prescribers and pharmacists to communicate.
E-Prescribing occurs when a prescriber uses a computer or handheld device with software that enables him or her to:
— Electronically access that patient’s prescription benefit.
— With a patient’s consent, electronically access that patient’s prescription history.
— Electronically route the prescription to the patient’s choice of pharmacy. When the patient runs out of refills, his or her pharmacist can also electronically send a prescription renewal request to the physician’s office for approval.
Prescription Benefit
Prescription History
Prescription Routing
Slide 16HITSP – enabling healthcare interoperability 2009 Webinar Series
Provides electronic delivery of patient prescription history from payers and pharmacies to prescribers
Prescription History Data:
Date Range of History
Drug Name (Brand/Generic)
Oldest Fill Date, Most Recent Fill Date
Number of Fills, Days Supply, Quantity Dispensed
Pharmacies/Prescribers
Slide 17HITSP – enabling healthcare interoperability 2009 Webinar Series
Surescripts National Progress Report Summary
Adoption 2006 2007 2008 Q2 2009
Prescription Benefit
33M 37M 79M9% patient visits
66M
Prescription History
4M 7M 16M1.8% patient visits
24M
Prescription Routing
11M 29M 68M4% eligible Rxs
78M
Total Message Volume
69M 107M 242M 303M
Opportunity:
According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons.According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)
Slide 18HITSP – enabling healthcare interoperability 2009 Webinar Series
Opportunity:
Adoption 2006 2007 2008 Q2 2009
Prescribers 16K 36K 74K 126K 21% prescribers
Payer Member Records
160M 200M 230M 222M
Community Pharmacies
34K 41K 47K 50K82% pharmacies
Mail Order Facilities
3 3 6 6
According to the August 2008 National Ambulatory Medical Care Summary, an estimated 902 million patient visits were made to office-based physicians in 2006; an average of about 306.6 visits for every 100 persons.According to NACDS, 1.57 billion new prescriptions and renewals eligible for electronic routing in 2008 in the U.S. (Note: Those 1.57 billion prescriptions do not include controlled substances as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions because they do not require communication between a physician and a pharmacist.)
Surescripts National Progress Report Summary, continued
Slide 19HITSP – enabling healthcare interoperability 2009 Webinar Series
Medication History for Hospitals
Provides clinicians access to up-to-date medicationhistory for patients they are treating in an inpatient setting
Person search
Dispensed claims medication history
Slide 20HITSP – enabling healthcare interoperability 2009 Webinar Series
Medication History for Hospitals, continued
Delivered to the acute care setting via strategic distribution partners:
— DrFirst
— Emerging Health
— GE Healthcare
— Healthcare Systems
— InterMedHx
HL7 Interface
— ADT
— RDS
— ORU
— Regenstrief
— Siemens
— Standard Register
— others
Slide 21HITSP – enabling healthcare interoperability 2009 Webinar Series
Value Drivers – Disaster Relief
In response to the lessons learned in the aftermath of Hurricane Katrina, a collaborative of public and private organizations launched ICERx.org (In Case of Emergency Prescription Database).
This online resource allows authorized physicians and pharmacists to get evacuees’ medication records
Prescription history information is pooled from a variety of sources, including Surescripts, payers and state Medicaid programs.
This information allows health care professionals to safely renew prescriptions for evacuees and help coordinate care, while avoiding harmful prescription errors and potential drug interactions.
For more information, visit www.icerx.org.
Slide 22HITSP – enabling healthcare interoperability 2009 Webinar Series
Additional External Medication History Sources
State Medicaid Programs
Enterprise Medication History Databases
Pharmacy Benefits Managers (PBMs)
Health Plans
Pharmacies
Personal Health Records (PHRs)
Others
Slide 23HITSP – enabling healthcare interoperability 2009 Webinar Series
For More Information
The E-Prescribing Resource Centerwww.surescripts.com
A Comprehensive Resource Center for Payers, Prescribers and Pharmacists
http://www.surescripts.com/news-sign-up.html
24enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
Medication Management Real World Sites
Regenstrief Institute
J. Marc Overhage, M.D., Ph.D.Director of Medical Informatics and Research Scientist, Regenstrief Institute
Slide 25HITSP – enabling healthcare interoperability 2009 Webinar Series
Background
Slide 26HITSP – enabling healthcare interoperability 2009 Webinar Series
Regenstrief – Solutions and Problems Solved
Incomplete medication histories
Fragmented patient data
Difficult to obtain electronic formularies
Difficult to maintain pharmacy data
Providers without an Electronic Medical Record (EMR)
Slide 27HITSP – enabling healthcare interoperability 2009 Webinar Series
ePrescribing— Provide a comprehensive medication history (greater starter set)
— Incorporate allergies and other clinical data
— Incorporate formulary decision support
— Capture prescriptions written
Medication Management— Provide a comprehensive medication history
— Incorporate allergies and other clinical data
— Incorporate formulary decision support
Regenstrief – Use Cases
Slide 28HITSP – enabling healthcare interoperability 2009 Webinar Series
E-Prescribing Flowchart
DispensingDatabases
PBMDatabases
ClaimsDatabase
FormularyDatabases
Provider’sAppointment
System
PrescribingDatabases
MedicationHistory
Patient Matching
• Merge Sources• Merge providers• Aggregate• De-duplicate Records• Age Records• Compute MPRs
• Matching prescription and dispensing data
• Provide views of merged data
• Allergy checking• Clinical decision support
Formulary Prescription Records
HL7 Appointment
Surescripts
Slide 29HITSP – enabling healthcare interoperability 2009 Webinar Series
E-Prescribing Flowchart, continued
Surescripts
PrescribingDatabases
Prescription
HITSP T43 Med OrderNCPDP SCRIPT Std.
Update Prescribing Database
Slide 30HITSP – enabling healthcare interoperability 2009 Webinar Series
Constructs
— C 26 : Nonrepudiation of Origin
— C 38 : Patient Level Quality Data Document
— C 44 : Secure Web Connection
— C 80: Clinical Document and Message Terminology
Transactions
— T 16: Consistent Time
— T 17: Secured Communication Channel
— T 31: Document Reliable Interchange
— T 68: Patient Health Plan Authorization Request and Response
Transaction Packages
— TP13: Sharing of documents
— TP20: Access Control Transaction Package
— T 15: Collect and Communicate Security Audit Trail Transaction
— TP 43: Medication Orders Transaction Package
— TP 46: Medication Formulary and Benefits Information Transaction Package
HITSP Constructs Used
Slide 31HITSP – enabling healthcare interoperability 2009 Webinar Series
Solution & Benefits
More complete medication histories for more patients
Data from multiple sources enriched the clinical context (laboratory results, allergies, diagnoses)
More formularies available
Patients cared for by providers without Electronic Medical Records (EMRs) still received the benefit of clinical decision support
Slide 32HITSP – enabling healthcare interoperability 2009 Webinar Series
Successes
Reduced number of adverse drug events
Improved therapeutic monitoring
Improved formulary adherence lower patient costs
Improved provider satisfaction
Slide 33HITSP – enabling healthcare interoperability 2009 Webinar Series
For More Information
www.regenstrief.org
34enabling healthcare interoperability
2009 Webinar Series
Sponsored by the HITSP Education, Communications and Outreach Committee
Medication Management Real World Sites
DrFirst
Peter N. Kaufman, M.D.Chief Medical Officer, DrFirst, Inc.
Slide 35HITSP – enabling healthcare interoperability 2009 Webinar Series
Impact of E-Prescriptions on Physician Office Workflow
Improve efficiency - Increase staff productivity
Improve patient safety, quality of care, and satisfaction
Minimize time spent phoning/faxing to clarify prescriptions and authorize renewal requests
Minimize time spent phoning and faxing to ensure formulary compliance
Minimize chart pulls - Reduce time to find prescribing information
Simplifying staff workflow, allowing completion of refill authorizations in seconds, not hours
Remotely check patient medications and allergies – and prescribe
Slide 36HITSP – enabling healthcare interoperability 2009 Webinar Series
Information Available in the E-Prescribing Workflow via HITSP and SDO
Technical Standards
Patient Demographics (HL-7, CCD)
Eligibility (X12 270/271)
Medication History (NCPDP SCRIPT)
— Pharmacies
— Payors
Formulary and Benefits (tiers, co-pays, substitution) (NCPDP SCRIPT)
Renewal Requests (NCPDP SCRIPT)
New Prescription (retail and mail order) (NCPDP SCRIPT)
Slide 37HITSP – enabling healthcare interoperability 2009 Webinar Series
Workflow: example
Staff confirms on arrival:
— Demographics
— Pharmacy - ask patient
— Medication History List - pull down through Surescripts and confirm with patient
Prescriber:
— Reviews current medication list
— Insurance eligibility is displayed
— Formulary alerts, substitution, co-pay etc. present when medication is chosen
— Clinical alerts present during prescribing, if applicable
Slide 38HITSP – enabling healthcare interoperability 2009 Webinar Series
Standards Not Yet in Wide Use for E-Prescriptions
Allergies (CCD)
Diagnoses (CCD)
Prior authorization (NCPDP SCRIPT)
RxNorm (to supplement/replace NDC codes)
Structured and codified SIG (NCPDP SCRIPT)
Slide 39HITSP – enabling healthcare interoperability 2009 Webinar Series
Remember . . .
Having a feature is not the same as
having a usable feature
Slide 40HITSP – enabling healthcare interoperability 2009 Webinar Series
How Physicians Realize the Benefits of True Electronic Prescribing
Improves efficiency
— Minimizes time spent phoning and faxing to clarify prescriptions, authorize renewal requests and ensuring formulary compliance
Inbound calls decreased from 36% to 18.5% of RX filled; outbound calls were reduced by more than 50%
Increases staff productivity
— Simplifies staff workflow, allowing completion of refill authorizations in seconds, not hours
— Enables remote access to patient medications and allergies
— Re-allocate staff time to other activities
Slide 41HITSP – enabling healthcare interoperability 2009 Webinar Series
Improves quality of care
— Improves safety and quality of care: drug/drug drug/allergy, drug/diagnosis and dose checking, medication history
— Reduces errors due to misread prescriptions and medications with similar sounding names
Increases patient satisfaction
— Decreases pharmacy wait times while improving safety
— Formulary compliance can reduce co-pays
How Physicians Realize the Benefits of True Electronic Prescribing, continued
Slide 42HITSP – enabling healthcare interoperability 2009 Webinar Series
Peter N. Kaufman, MDCMO, DrFirst
3206 Tower Oaks Blvd. #310Rockville, MD 20854Cell: 301-806-8004
For More Information
Slide 43HITSP – enabling healthcare interoperability 2009 Webinar Series
Webinar 1 Advances in Sharing Information in Healthcare IT
Thursday, January 15, 2009 — 2:00-3:30 pm Eastern
Webinar 7 HITSP eTown Hall II with Dr. John Halamka
Thursday, August 27, 2009 — 2:00-3:30 pm Eastern
Webinar 2 Personalized Healthcare Interoperability Specification (IS 08)
Thursday, February 12, 2009 — 2:00-3:30 pm Eastern
Webinar 8 Medication Management Real World Sites
Thursday, September 10, 2009 — 2:00-3:30 pm Eastern
Webinar 3 Consultations and Transfers of Care Interoperability Specification (IS 09)
Thursday, March 12, 2009 — 2:00-3:30 pm Eastern
Webinar 9 HITSP EHR Centric Interoperability Specification
Thursday, October 8, 2009 — 2:00-3:30 pm Eastern
Webinar 4 NHIN Real World Sites
Thursday, April 16, 2009 — 2:00-3:30 pm Eastern
Webinar 10 Security, Privacy, and Infrastructure
Thursday, November 12, 2009 — 2:00-3:30 pm Eastern
Webinar 5 HITSP eTown Hall I with Dr. John Halamka
Thursday, June 18, 2009 — 2:00-3:30 pm Eastern
Webinar 11 Quality Measures Real World Sites
Tuesday, December 8, 2009 — 2:00-3:30 pm Eastern
Webinar 6 Health Information Exchange (HIEs) in the Real World
Thursday, July 9, 2009 — 2:00-3:30 pm Eastern
NOTE:Recent schedule changes reflect HITSP’s response to new efforts in HIT based on the ARRA Stimulus bill provisions. Further changes are possible due to priority changes and availability of speakers.
The 2009 Webinar Serieswww.HITSP.org/webinars
Slide 44HITSP – enabling healthcare interoperability 2009 Webinar Series
Questions Welcomed
Slide 45HITSP – enabling healthcare interoperability 2009 Webinar Series
View the Complete Set of HITSP Deliverableswww.HITSP.org
Slide 46HITSP – enabling healthcare interoperability 2009 Webinar Series
Use or specify recognized HITSP Interoperability Specifications in your HIT
efforts and in your Requests for Proposals (RFPs)
Ask for CCHIT certification
Leverage Health Information Exchanges to promote HITSP specifications to
make connections easier in the future
Ask . . . Is there a HITSP standard we could be using?
Get involved in HITSP . . . Help shape the standards
Implementation feedback to HITSP is welcome
How YOU can become involved
Slide 47HITSP – enabling healthcare interoperability 2009 Webinar Series
Allyn Clemons, HIMSS Theresa Wisdom, [email protected] [email protected]
Re: HITSP Technical Committees
Michelle Deane, ANSI [email protected]
Re: HITSP, its Board and Coordinating Committees
Join HITSP in developing a safe and secure
health information network
for the United States
Visit www.hitsp.org or contact:
Slide 48HITSP – enabling healthcare interoperability 2009 Webinar Series
Sponsor Strategic Partners
www.HITSP.org