Pharmacy PSG Sponsored Training September 2014 Pharmacy Workflow Changes with EHRp13/APSP 1017

Pharmacy PSG Sponsored Training September 2014

Pharmacy Workflow Changes with EHRp13/APSP 1017

Pharmacy Workflow Changes 2

Presenter

CDR Katie Johnson, Pharm DNPAIHB EHR Integrated Care Coordinator

Pharmacy PSG Chair


Pharmacy Package Changes

• Removal of POV function:• Paperless refill, Suspense POV, All Rx POV.

• Removal of POV in Pharm Ed button.• BCMA (Bar Code Med Administration).• RxNorm mapping to Drug file.• SNOMED Route mapping.• Discharge medication prompt.


REFILL, SUSPENSE, AND WORKFLOW


Refills and POVs

• No more Paperless Refill function:• Medication will be refilled in Pharmacy Package.• Visit “shell” created.• Primary Provider will be added manually.• POVs will need to be added manually from EHR

GUI using the new Integrated Problem List.


EHR Integrated Problem List

• The only way to add a POV to a visit is to choose something on the Integrated Problem List (IPL).


EHR IPL


Medication Refill POV

• Recommended SNOMED equivalent for V68.1 Med Refill code = Dispensing Medication 373784005.

• Recommend making a Pharmacy SNOMED Picklist with this code on it.


Example Pharmacy Picklist


Workflow Considerations

• “Routine” refills.• IVR refills – batch POV entry vs. POV as you

go.• CMOP – Running reports and entering POVs

after CMOP fills prescription (work in progress).

• All Rx POV.


Sample Pharmacy EHR layout


Additional Considerations

• IPL Conversion to SNOMED.• Coordinate with EHR Team and Medical Staff.• Pharmacy will often be the first contact

patients have with the clinic post patch installation.

• Pharmacy will play a role in IPL conversion.• Problems must be converted before they can

be used as POV.


IPL Problems preceded by an asterisk (*) are not converted


PHARM ED BUTTON


Removal of POV from Pharm Ed Button


Removal of POV from Pharm Ed Button

• Options to deal with Pharm Ed Button:• Local decision – discuss with EHR Team and

Coding Department.• Option 1: Pharmacy enter POV through IPL and

Coding complete visits.• Option 2: Coding enter POV and complete visit.


Pharm Ed Button

• If Pharmacy is entering POV for dispensing only visits from IPL:• Recommended SNOMED = Dispensing

Medication Education 409021006.• Add to a Pharmacy Picklist.


Coding Workflow Considerations

• ACRX Auto-Complete Pharmacy Education Only Visits in PCC DE:• This menu option automatically completes visits

that were only pharmacy dispensing visits.• No longer functional since dependent on V-

codes.• Coders will have to complete these visits

manually.


ENHANCEMENTS COMING


Relief in EHRp14/APSP1018

• Refill and Suspend functions will automatically:• Create Pharmacy Visit.• Stuff person processing med as primary provider.• Add generic POV.


Relief in EHRp14/APSP1018

• Pharm Ed Button:• Parameters delivered to map ICD and SNOMED

codes to the Pharm Ed button.• ACRX Report restored for coding.• Basically, functionality restored.


OTHER PHARMACY PACKAGE UPDATES

Drug FileMed Route FileDischarge Med Prompt


RxNorm MappingThis option will update a drug file entry RXNorm field using the Apelon Tool or alternatively by data entry.

Do you want to update the Drug File RXNorm data using the Apelon Tool? Y// ES

Enter DRUG file entry: LISINOPRIL 1 LISINOPRIL 10MG TAB UD CV800 51079-0982-20 2 LISINOPRIL 10MG TAB** CV800 -523032 00006-0106-82 DEMO PHARMACY 3 LISINOPRIL 2.5MG TAB UD CV800 00143-1266-10 4 LISINOPRIL 20MG TAB** CV800 -515471 00006-0207-82 DEMO PHARMACY 5 LISINOPRIL 40MG TAB UD CV800 INPATIENT USE ONLY 51709-0984-20

Press <RETURN> to see more, ‘^’ to exit this list, ORCHOOSE 1-5: 2 LISINOPRIL 10MG TAB** CV800 -523032 00006-0106-82 DEMO PHARMACY

Using local DRUG file NDC data for Apelon query...LISINOPRIL 10MG TAB** CV800 -523032 00006-0106-82Querying Apelon site...ENTRY UPDATED – RXCUI field set to: 314076


RxNorm Mapping (NDF rematch)< Enter "Y" for yes, "N" for no >

Is this a match ? Y

You have just VERIFIED this match and MERGED the entry.

Resetting Possible Dosages..

Press Return to continue:Querying Apelon site...ENTRY UPDATED – RXCUI field set to: 314076Just a reminder...you are editing LISINOPRIL 10 MG TAB**.

Strength from National Drug File match => 10 MGStrength currently in the Drug File => 10 MG

Strength => 10 Unit => MG


Route Mapping to SNOMEDNAME: INHALATION ORAL//ABBREVIATION: INHL ORAL//PACKAGE USE: ALL PACKAGES//OUTPATIENT EXPANSION:OTHER LANGUAGE EXPANSION:IV FLAG:PROMPT FOR INJ. SITE IN BCMA:DSPLY ON IVP/IVPB TAB IN BCMA?:Snomed:

STANDARD MEDICATION ROUTE: INHALATION INHALATIONQuerying Apelon site...SNOMED Added 243132000

Local Route: 'INHALATION ORAL' has been mapped toStnd Route: 'INHALATION' FDB Route: 'INHALATION'


Discharge Med prompt


Discharge Med promptSUBSTITUTION: //DISCHARGE MEDICATION (In-House Inpatient/ER only): Yes// ??

Choose from:1 YES2 NO

Enter YES if this is a discharge medication from the In-House Inpatient unit or In-House Emergency Department.This should ONLY be entered for In-House discharge medications and not external discharge medication from other hospitals or emergency departments,

DISCHARGE MEDICATION (In-House Inpatient/ER only): Yes//

Documents

Pharmacy PSG Sponsored Training September 2014 Pharmacy Workflow Changes with EHRp13/APSP 1017