101 Secure Messaging – _The Die is Cast_ My HealtheVet Pharmacy by hcj

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									101 Secure Messaging – “The Die is Cast”
             My HealtheVet Pharmacy
   Electronic Patient/Pharmacist Communication
                             Presented by :
                         Howard Mun, Pharm D
   Ambulatory Care Clinical Pharmacist – Secure Messaging Pharmacist

                        Kazumi Cornell, RHIA
      My HealtheVet Coordinator – Secure Messaging Administrator
Please write any questions on
    the 3x5 cards provided
 – Room Director will collect the cards and
   we will attempt to respond (as time
   permits) to all questions

 – If we run out of time your questions and
   answers will be posted on the VA eHealth
   University (VeHU) website

                                              2
        Learning Objectives

• Provide an overview of My HealtheVet
  (MHV) pharmacy functionality
• Demonstrate the Veterans’ refill
  process
• Present an overview of Secure
  Messaging (SM)
• Demonstrate a typical message for
  prescription renewal


                                         3
My HealtheVet Overview

               3-Tier Access Model
               •Visitors
               •Registrants
               •In-Person Authenticated
               (IPA) Users



               June 2010:
               •Over 39 Million visits
               •One Million registered users
               (75% are VA Patients)
               •Nearly 200,000 In-Person
               Authentications
               •Over 15 Million Rx Refills
               (since Aug 2005)

                                               4
             My HealtheVet Pharmacy

The most requested Online Service from Veterans
                            Pharmacy:
                            •VA Prescription refills
                            •VA Prescription refill history
                            •Self-entered medications, herbals,
                            Over-the-Counter (OTC)
                            medications, and supplements
                            •My VA medication list
                            •My complete medications list (VA
                            and self-entered)

                            Over 15 Million VA prescription refill
                            request since it’s launch in Aug 2005

                            March 2010: Highest month ever
                            with nearly half a million
                            prescription refill requests
                                                                  5
VA Patient Main Screen




                         6
VA Patient Main Screen


                         Tool
                         Bar




                            7
VA Patient Main Screen




                          User
                         Log In




                              8
VA Patient Main Screen




                         Quick
                         Links




                            9
            VA Patient Main Screen




Featured
 Articles




                                     10
VA Pharmacy Refill (Patient
Views)




                              11
Refills Status




                 12
Refills Submit Date




                      13
Fill Date




            14
Refills Remaining




                    15
Prescription Number & NAME




                             16
Facility




           17
Select to Refill




                   18
VA Prescription Refill




                         19
Refill Successful




                    20
      Non-refillable Prescriptions




• Some pain medications and
  Narcotics
• Expired Medications
• Prescription Renewals


                                     21
        Options


• In person – wait in line
• Call the pharmacy – wait on hold
• Call the Health Care Team
  – Leave a message for the nurse,
    pharmacist, or provider
  – Play phone tag
• Send a SECURE MESSAGE
  through My HealtheVet
                                     22
           What is Secure Messaging?

• Web-based, electronic, bi-directional
  communication used for non-urgent, non-
  emergent health care questions and concerns
• Emergency – use facility policies
   For medical issues – call 9-1-1 or nearest
    emergency room
   For mental health or suicidal ideation – follow the
    facility’s suicide hotline protocol
• Secure Messaging is the only VHA approved
  method of electronic communication between
  our patients and health care professionals – it
  is NOT email
                                                          23
                   Secure Messaging differs from E-
                   mail
Secure Messaging                             E-Mail
Can only be sent to other Secure Messaging   Can be sent to anyone with an e-mail
participants                                 address
Messages are non-reputable because           Message authorship can be denied because
authorship is guaranteed                     authorship can be faked
Launched from My HealtheVet and              Requires the launch of a separate application
Computerized Patient Record System (CPRS)    or browser instance
and requires no special software
Messages can be made part of a patient’s     Totally separate from patient health records
health record
Does not require the users to have e-mail    Requires users to have e-mail service
service
All messages have an expiration period       By default, messages can sit in an in box
                                             indefinitely
Designed specifically to generate business   Does not lend itself to any sort of metrics
metrics                                      beyond system performance
Allows for triaging of messages prior to     Designed to have messages read by the
clinician involvement                        addressee only
Self-contained                               Requires an e-mail server that is usually
                                             shared with other systems                 24
         Benefits of Secure Messaging


• Promotes a partnership between the
  patient and their Health Care Team
• Provides a safe, alternative
  communication means that is convenient
  and flexible
• Reduces the need for telephone calls and
  waiting on hold
• May decrease unscheduled clinic walk-in
  visits
• Provides a timely response
                                      (~MHV)
                                               25
                Who will utilize Secure
                Messaging?

Opted in Providers                              Clinical Staff
       MD                                        Health Tech
      ARNP                                           LPN
        PA                                          Nurse
    Specialists                                  Pharmacist
                                                Social Worker
                             My HealtheVet
                             registered VA
                            patients with In-
                                 Person
                            Authentication


          Triage Staff                                     Secure
 Program Support Assistant (PSA)                          Messaging
 Others on the Health Care Team                           Administra
                                                             tor
                                                                  26
New Message Notification




                           27
Secure Messaging




                   28
    Secure Messaging – Prescription
    Renewal
(Triage – Assign– Reply – Complete)




                                      29
View & Assign




                30
Inbox – Message Assigned




                           31
         Objectives

• Pharmacist’s involvement in Secure
  Messaging.
• Pharmacist’s process in Secure
  Messaging.
• Review of collected data from pilot.
• Benefits and challenges for pharmacist
  involvement.
• Future recommendations for utilizing
  pharmacy staff in Secure Messaging.
                                           32
           Pharmacist’s Involvement

• Three primary functions:
   Address drug information related
   questions.
     Ex. Drug-drug/drug-herbal/drug-food interactions.


   Address prescription processing issues.
     Ex. Renewals, refills, medication clarification, mail
      processing.


   Triage and clarify any medication related
   questions for providers to address.
     Ex. Potential reported adverse reaction, overuse of
      medication.
                                                              33
                          Pharmacists pilot workflow
                          chart


                  • Receipt of e-mail in Outlook. (non-descriptive e-mail)
Receipt of e-
mail in Outlook




                  • Assessment of questions from patient.
   Review         • Formulation of answer to resolve patients concerns.


                  • Respond to patient’s request or clarification by Secure Message.
  Secure
 Message to       • Inform patient next steps in clarifying medication related concerns.
  patient




                  • If there is need for the provider to address issue, forward original
  Triage to
 provider to
                    Secure Message from patient and pharmacists return response.
  address




                                                                                           34
Access Secure
Messaging
through
Computerized
Patient Record
System (CPRS)



                 35
Secure Messaging




                   36
Assigned Member – Action
Taken




Good day Pharmacist.

I received several prescriptions yesterday (03 MAR 10). Please note that: Cholesterol med; 80 MG TAB is no refill remaining, Aspirin 25 MG
TAB is one refill remaining, and Generic meds 300 MG CAP is one refill remaining.

I appreciate that the one refill remaining on the two meds that are good for 90 and 60 days respectfully, I just thought that since you needed
to seek permission to put one on refill that the balance might be “rolled over” at the same time.

Pharmacist, I appreciate your customer service. I write to you because I know that when I do, the job will get done.

Respectfully,
Veteran Patient




                                                                                                                  SM PHARMACIST
                                                                                                                  SM ADMINISTRATOR
                                                                                                                  SM PROGRAM ASST
                                                                                                                  SM NURSE
                                                                                                                  SM PHARMACIST
                                                                                                                  SM PROVIDER




                                                                                                                                                 37
Reply




        38
Completing the Message




                         39
         Pharmacist Pilot involvement


• Involvement in Secure Messaging pilot
  project on April 2008 for primary care.
• Pilot included one Primary Care
  Pharmacist.


        2008:               2010:

      4 providers         8 providers


                                            40
               Puget Sound VA Pilot Results


       Summary of Secure Messages (4/08-6/10)

TOTAL Secure Messages received
                                     58
   for pharmacist to address

  AVERAGE of Secure Messages
received per day for pharmacist to   0.3
             address

   NUMBER of unique patients
                                     26
 requesting pharmacist services


  AVERAGE of responses from
pharmacist to address each single    1.2
    patient Secure Message

                                                41
               Puget Sound VA Pilot Results


   Types of pharmacy service requests (4/08-6/10)

     Renewal/refill medication
        processing related               46
       questions/concerns

    Drug information questions           8


 Forwarding of question/concerns
                                         22
     for provider to address


    Complicated questions not
appropriate to address over Secure       6
            Messaging

* Requests were separated by category.              42
                             Puget Sound VA Pilot: Time results



                  • Receipt of e-mail in Outlook. (non-descriptive e-mail)
                                                                                         10-15
Receipt of e-
mail in Outlook
                                                                                        seconds


                  • Assessment of questions from patient.
                  • Formulation of answer to resolve patients concerns.                1-3 minutes
   Review




                  • Respond to patient’s request or clarification by Secure Message.
  Secure
                  • Inform patient next steps in clarifying medication related         1-2 minutes
 Message to         concerns.
  patient




                  • If there is need for the provider to address issue, forward          10-15
  Triage to         original e-mail from patient and pharmacists return response.       seconds
 provider to
  address




                                                                                                     43
         Patient Satisfaction


• Responses from patients:
  “I appreciate your customer service. I
   write to you because I know that when I
   do, the job will get done.”
  “I have been high maintenance these last
   few weeks, and I want to thank you for
   your kindness and assistance.”
  “THANK YOU Mr. ___. You are truly a gift
   from God. “


                                              44
         Challenges encountered


• Complex medication related questions.
  – E.g. Tracking of narcotic prescriptions.
• Inefficient use of Secure Messaging.
  – E.g. Multiple Secure Messages for
    responses and clarifications.
• Time sensitive responses.
  – E.g. Urgent medication related side
    effects.


                                               45
         Benefits of pharmacist
         involvement


• For provider and team:

  – Assists in clarifying/resolving medication
    issues.
  – Convenient and time saving.
  – Research specific pharmacy profile/mail
    issues.
  – Integration of pharmacists into the patient
    centered medical home model.
                                                  46
         Benefits of pharmacist
         involvement


• For pharmacy:

  – Flexibility for pharmacists to address
    patient questions when convenient.
  – Reduce pharmacy phone calls.
  – Alternative form of communication.
  – Ensure accuracy of pharmacy profile
    information.


                                             47
        Future Recommendations


• Templated responses regarding
  general drug information or
  refill/renewal information.
• Communicate
  shortages/warnings/recalls of
  medications to patients.
• Involvement of pharmacy technician.
• Categorizing questions for triaging to
  pharmacy or other staff.
                                           48
        Example of redirected workload




                                   Triage to
Refill/renewal     Pharmacy
                                  Pharmacist
                 technician to
  question                       to address if
                    address
                                  appropriate


 Drug order                        Triage to
                   Pharmacy
                                  Pharmacist
 clarification   technician to
                                 to address if
   question         address
                                  appropriate




                                                 49
         Future Direction of Secure
         Messaging



• Enrollment of CBOC pharmacist to
  participate in Secure Messaging
  program.
• Interest from diabetes and pharmacist
  run anticoagulation services for
  possible integration into their current
  practice.
• Access for other primary care
  pharmacists and team members to
  Secure Messaging.                         50
        Struggles & Concerns

• Finding time to meet with all team
  members
• Delays in implementation or staging
  patients
• Secure Messaging notifications through
  outlook
• Taking on the additional work load
• Escalated messages

                                           51
         Successes


• Proactive communication
• Confidentiality/HIPPA
• Concise and abbreviated
• Improve prioritization and organization
• Manage the work load rather than the
  work load managing you
• Optimizes space needs


                                            52
         Lessons Learned

• Clinicians using Secure Messaging
  – Overall view Secure Messaging favorably
  – Improved communication with patient
  – Secure Messaging workload is
    manageable


• Patients
  – Feel that sensitive information is
    communicated within a comfortable
    setting
  – Proactively responsible for health care
                                              53
Questions???




               54

								
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