117 Pharmacy Re-Engineering PRE Update

1. 1 117 Pharmacy Re-Engineering (PRE) Update Eric Williamson (Project Manager) Lina Bertuzis (Lead Functional Analyst)

2. 2 Project Update Eric Williamson

3. 3 Project Update - Releases PRE V.0.5 pre-release Pharmacy Data Management patch allowing preparation time for overall v.0.5 implementation PRE V.0.5 Enhanced order checks using COTS drug database

4. 4 Project Update - Schedule Pre-release (completion dates) Stage III/Site testing (mid August 2008) National release (early September 2008) V.0.5 on track (completion dates) Coding (September 2008) Stage I testing (January 2009) Stage II testing (late March 2009) Stage III/Site testing (late May 2009) Complete to EPS (mid June 2009) National release (July 2009)

5. 5 Project Update - Testing Testing Process (4 Stages) Stage I: Internal (Team) Testing Stage II: Testing Services Stage III: Production Site Testing Stage IV: Final Review and Approval

6. 6 Project Update - Issues Major Issues and Risks Equipment Acquisition and Deployment Testing Preparation and Execution Technical and Business Process Documentation

7. 7 PRE V.0.5 Pre-Release Lina Bertuzis

8. 8 Background Information Preparation Work Needed for PRE V. 0.5 To implement Enhanced Order Checking Improve existing order checks Drug-Drug Interactions Duplicate Therapy (Class) Add Dosing Checks Interfacing with First DataBank (FDB) database and APIs Mapping required between VistA and FDB File review and setup activities

9. 9 Why A Pre-Release Mapping Activities (VistA to FDB) Drug Connection GCNSEQNo in VA Product File Local Medication Routes Dose Units File Review and Setup Local Possible Dosages Administration Schedule and Medication Instruction frequency Identify PreMix Solutions

10. 10 Pre-Release Patch Installation New Files Standard Medication Routes (#51.23) Dose Unit (#51.24) New Fields Drug File (#50) Local Possible Dosage multiple (#904) Numeric Dose (#5) Dose Unit (#4) Dosage Form File (#50.606) Exclude From Dosage Checks (#11)

11. 11 Pre-Release Patch Installation (cont.) New Fields (continued) Medication Routes file (#51.2) Standard Medication Route (#10) Standard Med Route Change Log (#7) Activity Date and Time (#.01) Person making change (#1) Old Value (#2) New Value (#3) IV Solution file (#52.7) PreMix (#18)

12. 12 Pre-Release Patch Installation (cont.) Menu Changes Enhanced Order Checks Setup Menu (New) Pharmacy Data Management Menu (Restructuring)

13. 13 Enhanced Order Checks Setup Menu

14. 14 Pre-Release Patch Installation (cont.) Post Init Initiate NTRT population of VUIDs for Standard Medication Route file Auto mapping of local Medication Routes file to Standard Auto population of numeric dose and dose unit for Local Possible Dosages MailMan message upon completion

15. 15 Medication Route Mapping

16. 16 Standard Medication Route Standard Medication Route file (#51.23) Created by Standards and Terminology Service (STS) Mapped to FDB dose route table by STS Approved by Pharmacy Benefits Management (PBM) Facilitate mapping of local medication route to FDB

17. 17 Standard Medication Route (cont’d) Initially exported as a Pharmacy Data Management (PDM) file No local editing allowed Updates via New Term Rapid Turnaround (NTRT) Change Requests Via VistA option (temporary) NTRT Website (permanent) Available with PRE V. 0.5 release

18. 18 Change Requests Request Change to Standard Medication Routes File option Request additions and/or modifications to standard medication route Request Information submitted Medication route to be added/modified Example of medication administered by route References/reason for request Sent to VHA OI SDD HDS NTRT Outlook mail group and requestor on VistA account To be reviewed by established committee

19. 19 Request Change To Standard Med Route

20. 20 Request Change To Standard Med Route

21. 21 Req Change To Standard Med Route

22. 22 Mapping Local to Standard Mapping Local to Standard Med Routes New STANDARD MEDICATION ROUTE field (#10) in MEDICATION ROUTES file (#51.2) Only required for local Medication Routes marked for ALL PACKAGES Map to ACTIVE Standard Medication Route No changes to Order Entry selection lists

23. 23 Mapping Local to Standard (cont’d) Options for mapping Find Unmapped Local Medication Routes Map Local Medication Route to Standard Medication Route File Enter/Edit

24. 24 Mapping Local to Standard (cont’d) All three options Allow for mapping of a local medication route marked for ‘All Packages’ to an active standard route FDB route is displayed when selecting an active standard medication route User can bypass route without mapping

25. 25 Find Unmapped Local Med Routes Find Unmapped Local Medication Routes Loops through every unmapped local medication route and presents each route to user for mapping Redisplays the mapping after mapping At completion or if the user “^” to exit loop, the software rechecks status of mapping Displays status of mapping to user

26. 26 Find Unmapped Local Med Routes

27. 27 Find Unmapped Local Med Routes

28. 28 Find Unmapped Local Med Routes

29. 29 Mapping Local to Standard (cont’d) Next two options also Display mapping for a route already mapped Allow remapping Redisplay the mapping after remapping If no mapping occurs, warning message displayed

30. 30 Map Local Medication Route Map Local Medication Route to Standard Allows individual selection of a local medication route marked for ALL PACKAGES Only used for mapping to a standard route

31. 31 Map Local Med Route to Standard

32. 32 Medication Route File Enter/Edit If a local medication route is not marked for ALL PACKAGES user will not be asked to map to standard Allows deletion of mapping

33. 33 Dosage Form File Enter/Edit Modified to not allow entry of a new Medication Route Will still be able to associate existing local medication route with a Dosage Form

34. 34 Mapping Local to Standard Mapping Reports Medication Route Mapping Report Medication Route Mapping History Report

35. 35 Medication Route Mapping Report Allows printing of all local medication routes or unmapped local medication routes Only displays local medication routes marked for ALL PACKAGES Report Display Information: Local Medication Route Outpatient Expansion for Local Medication Route

36. 36 Medication Route Mapping Report Report Display Information (cont) Standard Medication Route FDB Route Totals for local medication routes and/or unmapped local medication routes Alphabetical display 132 column format Output to screen or printer

37. 37 Medication Route Mapping Report

38. 38 Medication Route Mapping Report

39. 39 Medication Route Mapping Report

40. 40 Medication Route Mapping Report

41. 41 Medication Route Mapping Report

42. 42 Med Route Mapping History Report Medication Route Mapping History Report Tracks mapping changes between local medication routes and standard medication routes Allows printing for all local medication routes with mapping changes or a single local medication route Can specify timeframe

43. 43 Med Route Mapping History Report Output to screen or printer Report Display Information Local Medication Route Date/Time change occurred User who made mapping change Old Value New Value

44. 44 Med Route Mapping History Report

45. 45 Med Route Mapping History Report

46. 46 Med Route Mapping History Report

47. 47 Med Route Mapping History Report

48. 48 Dose Unit Mapping

49. 49 New VistA Dose Unit File Dose Unit File (#51.24) New VistA file Mapped to FDB dose unit table Facilitate mapping of local possible dosage unit to FDB Being analyzed by STS for standardization (for PRE V. 1.0) No local editing allowed Exported as PDM file Updates via PDM patch Change Requests Via VistA option

50. 50 Change Requests Request Change to Dose Unit Option Request additions and/or modifications to dose unit Request Information submitted Dose Unit to be added/modified References/reason for request Sent to VA OIT VHIT PS DOSE UNIT REQ Outlook mail group and requestor on VistA account To be reviewed by established committee

51. 51 Request Change to Dose Unit Option

52. 52 Request Change to Dose Unit Option

53. 53 Dosage Form File (#50.606) New field added to exclude dosage form from dosage checks Initial data population with Pre-Release patch To be managed by NDF manager nationally Future data updates via NDF data update patches

54. 54 Local Possible Dosages Two new fields added to DRUG file (#50) within LOCAL POSSIBLE DOSAGES multiple (#904) UNITS - points to New Dose Unit File NUMERIC DOSE - numeric representation of dosage based on unit defined

55. 55 Local Possible Dosages Population of two new fields Will not be done for Supply items Drug associated with a dosage form excluded from dosing checks Auto population During post init based on established business rules

56. 56 Options for Population Find Unmapped Local Possible Dosages Map Local Possible Dosages Drug Enter/Edit Enter/Edit Dosages

57. 57 Options for Population (cont’d) All four options Allow for editing of the Numeric Dose and Dose Unit fields for a local possible dosage Exclude the following drugs: Marked as a supply item Associated with a Dosage Form excluded from dosage checks Has no local possible dosages defined

58. 58 Options for Population (cont’d) System displays to user: Drug name Strength and unit (if data exists) Local possible Dosage Numeric Dose and Dose Unit (if data exists) If strength of Drug does not match VA Product strength, a warning is displayed to the user and respective strengths displayed User can bypass prompts without entering data

59. 59 Options for Population (cont’d) New options also Redisplay entered/modified data If user “^” will be asked if they want to continue

60. 60 Find Unmapped Dosages Find Unmapped Local Possible Dosages Loops through drugs that have local possible dosages eligible for dosage checks that do not have either Numeric Dose or Units entered Excludes the following additional drugs: Inactive Not matched to NDF At completion or if the user “^” to exit loop, the software rechecks status of data population

61. 61 Find Unmapped Dosages (cont’d)

62. 62 Find Unmapped Dosages (cont’d)

63. 63 Find Unmapped Dosages (cont’d)

64. 64 Map Local Possible Dosages Allows selection of an individual drug Displays warning message for excluded drugs No local possible dosages defined Supply item Associated with dosage form excluded from dosage checks Displays warning message and/or information, but allows population of fields for drugs that are Inactive Not matched to NDF

65. 65 Map Local Possible Dosages

66. 66 Map Local Possible Dosages

67. 67 Drug Enter/Edit Modified to allow editing of the Numeric Dose and Dose Unit fields when Entering/Editing a new drug Matching a drug to NDF Rematching a drug to NDF Fields not shown for editing if drug: Supply Item Associated with Dosage Form excluded from dosage checks

68. 68 Enter/Edit Dosages Modified to allow editing of the Numeric Dose and Dose Unit fields Fields not shown for editing if drug: Supply Item Associated with Dosage Form excluded from dosage checks

69. 69 Reports Strength Mismatch Report Review Dosages Report Local Possible Dosages Report

70. 70 Strength Mismatch Report Displays dosage information For DRUG file (#50) entries that have a different strength than what the VA product match has Information Displayed: Local drug IEN Drug Name Inactive Date Strength and Units Application Package Use Possible Dosage Fields (Dispense Units Per Dose, Dose, Package, Outpatient Expansion) Local Possible Dosage Fields (Local Possible Dosage, Package, Numeric Dose, Dose Unit) Strength mismatch warning and strength comparisons

71. 71 Strength Mismatch Report

72. 72 Strength Mismatch Report

73. 73 Review Dosages Report Modified to displayed Numeric Dose and Dose Unit fields for a Local Possible Dosage If strength of Drug does not match VA Product strength, a warning is displayed to the user and respective strengths displayed

74. 74 Local Possible Dosages Report Allows printing of all drugs with local possible dosages eligible for dosage checks or for drugs with just missing data in the Numeric Dose and Dose Unit fields Excludes drugs that are: Supply Items Associated with Dosage Form excluded from dosage checks Inactivated Not matched to NDF

75. 75 Local Possible Dosages Report 132 column format Information displayed: IEN of local drug Drug Name Strength and Units Application Package Use Local Possible Dosage data (Local possible dosage, Package, Numeric Dose, Dose Unit) Strength mismatch warning and information

76. 76 Local Possible Dosages Report

77. 77 Local Possible Dosages Report

78. 78 Frequency Review

79. 79 Administration Schedule Frequency Administration Schedule File Report Allows for printing of all Administration Schedules or those without a frequency Only those schedules that have a ‘PSJ’ in the package prefix will be included 80 or 132 column format

80. 80 Administration Schedule Frequency Display Information: Administration Schedule Standard administration times Outpatient Expansion Other Language Expansion Ward(s) Ward(s) Administration Times Schedule Type Frequency (in Minutes)

81. 81 Administration Schedule File Report

82. 82 Administration Schedule File Report

83. 83 Medication Instruction Frequency Medication Instruction File Report Allows for printing of all Medication Instructions or those without a frequency 80 or 132 column format Information Displayed: Name Synonym Expansion Other Language Expansion Plural Intended Use Frequency (In Minutes)

84. 84 Medication Instruction File Report

85. 85 Medication Instruction File Report

86. 86 Identify PreMixes

87. 87 Identify PreMix Solutions Flag IV solutions as PreMixes Identify for order check inclusion Option modifications/adds Added PreMix field for editing in: Drug Enter/Edit Primary Solution file Mark PreMix solution (new) IV Solution Report (new)

88. 88 Mark PreMix Solution Allow marking of IV Solution as a Premix Fields presented for Editing: Print Name Print Name {2} Generic Drug Volume Inactivation Date Used in IV Fluid Order Entry PreMix

89. 89 Mark PreMix Solution

90. 90 IV Solution Report Option to print all IV Solutions or those only marked as PreMixes Display Information: Print Name Print Name {2} Volume Synonyms Generic Drug Pharmacy Orderable Item Inactivation Date Used in IV Fluid Order Entry Premix Flag

91. 91 IV Solution Report

92. 92 IV Solution Report

93. 93 PRE V.0.5 Enhanced Order Checks What’s coming

94. 94 Enhanced Order Checks Build a HeV component to utilize services provided by a commercial drug database to support Legacy VistA order check changes Create/Modify APIs in M environment to support order check enhancements

95. 95 Order Checks – Data Flow When a HealtheVet VistA application (i.e. Outpatient Pharmacy) requests and order check to be performed, an XML message is sent from VistA to FDB via VistAlink. The PRE V. 0.5 application PEPS services will receive; validate the format and triage the request before sending on to FDB Drug Information Framework (DIF) which will perform the requested order check(s) and return the results. When a HealtheVet VistA application (i.e. Outpatient Pharmacy) requests and order check to be performed, an XML message is sent from VistA to FDB via VistAlink. The PRE V. 0.5 application PEPS services will receive; validate the format and triage the request before sending on to FDB Drug Information Framework (DIF) which will perform the requested order check(s) and return the results.

96. 96 Enhance Existing Order Checks Drug-Drug Interactions Short description of drug interaction clinical effects Detailed professional drug interaction monograph (optional) Display Changes Enter/Edit Local Drug Interaction & Edit Drug Interaction Severity options no longer available Request Changes to Enhanced Order Checks Database option

97. 97 Enhance Existing Order Checks Duplicate Therapy (Class) Utilize FDB’s Enhanced Therapeutic Classification (ETC) System Allows for multiple classes per drug Each therapeutic class assigned Duplication Allowance No longer processed in pairs Display changes

98. 98 Enhance Existing Order Checks Duplicate Drug Display changes Removed from Inpatient Medications Allergy/ADR Provide consistent displays between Outpatient Pharmacy & Inpatient Medications Allow user to take action after display for Inpatient Medications application

99. 99 New Order Checks Dosing Order Checks Single Maximum Dosage Check Daily Dose Range Check General Dosing Information for a Drug Incorporate dosing checks in Outpatient Pharmacy verification options New intervention types to accommodate dosing checks

100. 100 New Order Checks CPRS Order Checks Incorporate in Pharmacy backdoor Aminoglycoside Ordered Glucophage Lab Results Dangerous Meds for Patient >64

101. 101 Enhanced Order Checks Plus… Allow user to take action after order check display for Inpatient Medications (PSI-07-080) Order Check Display Sequence Changes Consistency between Outpatient Pharmacy & Inpatient Medication (PSI-07-080) Display changes between Remote and Local Order Checks for consistency Ability to perform order checks on PreMix solutions (PSI-06-012)

102. 102 Enhanced Order Checks Plus… Error Handling Messages at system, drug and order level when order checks cannot be performed Priority message when FDB link is down Provide option to check connectivity to FDB database Placing Intervention Menu hidden action on additional ListMan order screens

103. 103 Enhanced Order Checks Plus… Identify Recently Discontinued/Expired Orders Identify D/C and Hold Action on Profile User notifications for Standard Medication Route and Dose Unit file changes

104. 104 Customization GUI Application for Customization Ability to customize FDB standard reference tables used in enhanced order checks Provide facility users access to request custom changes and to view information Ability to accept/process custom requests Provide designated users ability to review and then to approve/reject customization requests Ability to manage queries and reports Provide method via FTP to update local/regional instances of FDB standard and custom tables

105. 105 Questions?