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Preparation of Template for Pharmacy in Excel

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Preparation of Template for Pharmacy in Excel document sample

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									       Using Technology to
          Support MTM

 Steven T. Simenson, BPharm, FAPhA
               Managing Partner
              Goodrich Pharmacies

 Kenneth P. Whittemore, Jr., RPh, MBA
Senior Vice President, Clinical Practice Integration
                   SureScripts
            Financial Disclosures

Steven T. Simenson, BPharm, FAPhA,
Goodrich Pharmacies
declares no conflicts of interest or financial interests in any product or service
mentioned in this program, including grants, employment, gifts, stock holdings,
or honoraria.



Kenneth P. Whittemore, Jr., RPh, MBA, SureScripts
is employed by SureScripts, LLC, where he is involved in the service described
in this program; he declares no conflicts of interest or financial interests in any
product or service mentioned in this program, including grants, employment,
gifts, stock holdings, or honoraria.
Electronic Medical Records
         and MTM

Steven T. Simenson, BPharm, FAPhA
         Managing Partner
        Goodrich Pharmacies
      Goodrich Pharmacy, Inc.

• 5 independent community pharmacies
• Suburban to suburban/rural demographics
• Professional 850 to 1400 sq ft pharmacies
• 3 in clinic, 1 stand alone next to clinic, and
  1 supermarket pharmacy
• Established in 1864; stores added in 1991,
  1997, 2002, and 2005
 Prelude to MTM in Our Practice
• 1980s: Generic substitution protocols for
  products with patent expirations
  – Save physician phone calls
  – With clinic remodeling gained direct phone access
    to physicians’ workspace and offices
• 1990s: Therapeutic substitution protocols for
  PBM formulary mandates
• We became indispensable resource for PAs
  and NPs as they entered clinic practice
  environment
    Pharmaceutical Care to MTM
            Timeline
• 1990s: Disease state management
    – APhA Project IMPACT
    – LIPID panel in-store monitoring
• Blood pressure monitoring for referred patients
• Diabetes and A1c monitoring
• Pharmacy student rotations
• Actively recruiting pharmaceutical care patients
  through physician referral
• On-site clinic medication therapy presentations to
  providers always with some MTM tie-in or focus
• Collaborative Practice Agreements
• Active MTM practice with Health Plan contracting
Early Pharmacy Technology and
  Pharmacist Documentation
• Paper Word and Excel forms, filed in folders
  in filing cabinets
• Encouraged pharmacy software companies
  to add Note fields to Patient Profiles
• Lipid, A1c, and other CLIA-waived testing
  devices appeared and were utilized
• First Pharmaceutical Care documentation
  and billing systems appeared and utilized
 Electronic Medical Record Access
and Contracted Pharmacist Services
• Refill approval per standing order
  criteria and payment for consultation
  – Refill request
     • Patient medication chart review
        –   Re-order medications
        –   Order labs
        –   Communicate with care team
        –   Document and communicate patient consultation
        –   Document immunizations
Sharing Patient Information
              • Electronic Medical
                Record Systems offer a
                clear illumination of
                patient records that
                pharmacists seldom see
              • Shared information may
                improve MTM
                assessments and patient
                outcomes
 Integration With Other Systems
• Different systems in other health care
  organizations and hospitals
• Lack of systems
• Long-term care systems
• Insurance changes mandate provider
  changes
• Importation and mail order systems
   Using EMR to Provide MTM
• Preparation … pre-appointment
  – Check most recent labs with known
    medications
    • Look at kidney (SCr & GFR), liver function
      (AST/ALT), electrolytes, lipids, A1c, TSH/T4
  – Check health care provider goals and plan
  – Check visit compliance
  – Prepare bulk of PMR and substantiate with
    patient at visit
MTM Medication Therapy Review
        With Patient
• Check EMR when necessary during MTM
  consult to answer new patient questions
• Check for problem resolution or problem
  status with patient (provider goals)
• Have draft MAP for discussion and
  questions with patient
           Post MTM Visit

• Communication to care pool or provider
  of interventions, recommendations, and
  referrals per Core Elements of MTM
  services
• Re-order medications
• Order labs if necessary
• Same-day feedback through provider
  work queue
     Benefits of Using EMR in
         Providing MTM
• More accurate and complete patient
  information to assess medication AND
  care goals
• Coordination with Physician Care Plan
• Timeliness addressing concerns and
  problems
• Pharmacist documentation in patient chart
      Benefits of Patient MTM

• Pharmacist confidence level in patient
  medical information
• Working in the same workflow patterns
  and system as other health care providers
• Better patient acceptance and closer
  working relationships with other health
  care providers
   Effectively and Appropriately
          Using the EMR
• System legal requirements and staff
  training
• Access terminal in private yet convenient
  area
• Signing on and OFF regularly
• All areas when “touched” are labeled with
  individual accessing
• Zero tolerance to breaches in security
  Current Barriers EMR Access

• Health system employee or external
  consultant/business partner
• Allies in system to help advocate access
• HIPAA and confidentiality issues
  – Timeliness and barriers of HIPAA request
  – Not read only…two-way communication
    necessary
    Current EMR Shortcomings
• Incomplete patient information
  – Multiple clinics and prescribers (specialists)
     • Competing EMR systems
  – OTCs
  – Herbals
  – Mail Order
  – Samples
  -- Changes by providers made when “On Call” and
     not documented
         Future Efficiencies

• Billing capabilities through EMR system for
  MTM
• Access and conversion to a single
  Universal Electronic Medical Record for all
  patients WITH appropriate pharmacist
  access and MTM documentation and
  charting capabilities
• Include billing capabilities
     MTM Future Technology

• I know what I think I would optimally
  like for MTM technology
• I think I know what we need for MTM
• Universal access to EMRs for all
  pharmacists
• Ken? How and when will we get
  there?
Using Technology to Support MTM:
A Future Vision for Interoperability


       Ken Whittemore, Jr., RPh, MBA
  Senior Vice President, Clinical Practice Integration
                     SureScripts
           In the Beginning…
• It came down to money
  – No one liked the inefficiencies and inaccuracies
    associated with paper billing
  – So following widespread community pharmacy
    practice automation came:
     • Pin-fed computer-printed claim forms
     • Tape and diskette billing
     • And then the “Holy Grail”…
         Online, real-time claims adjudication
  Fast Forward About 5 Years…
• Some in the profession began to ask:
  – “What other community pharmacy processes can
    we automate?”
  – One answer was: “How about the prescribing
    process itself?”
     • Paper-based, somewhat prone to error, inefficient, and
       costly
• This made good sense to many in the
  profession
  – So down that road went most of the same players
    who had automated the community pharmacy
    billing process
Why Did Automating the Prescribing
     Process Make Sense?
 E-Prescribing in the Early Days
• Electronic prescriptions
• Refill renewal requests and responses
• And their lesser-known cousins
  – Change and cancel messages
  – Prescription fill messages
And Not Much Happened Until…
• 2001
  – RxHub formed by the three largest PBMs (at that
    time)
  – SureScripts formed by NACDS and NCPA
• Both were created to automate and improve
  the prescribing and medication-use
  processes
  – Since then, their roles and emphases have
    diverged
    Which Brings Us to Today

• Over time, new needs were realized and
  are now being met
  – Medication history (Rx History)
  – Eligibility verification
  – Formulary information/lookup
While We Were Focused on Our Piece of the
Health Care Pie, Other Forces Were at Work
    Demand                                 Supply
•   Clinical history for physician    •   Community pharmacy
    EMR/E-Rx                              prescription history
•   Better information for pay-for-   •   Clinical laboratory orders and
    performance                           results
•   Acute care medication             •   Payer clinical claims
    reconciliation                        information
•   Regional Health Information       •   PBM prescription history
    Organization (RHIO)               •   Physician-entered EMR
    collaboration                         information
•   Federal and state health          •   Patient-entered family history
    information technology policy
•   Clinical history for consumer
    personal health record (PHR)
 Eventually, the Professions Began
Thinking in Terms of “Interoperability”
 • Many different types of health care
   information
 • Being shared electronically by a wide variety
   of caregivers
 • When appropriate to facilitate the provision of
   care to their patients
    Leading to the Notion of a
    National Health Information Network
    (NHIN)                                     Lab
                                                     Rx           Hospital
                                                          Radiology        Payer
                                                                                           RHIO



    NHIN Ingredients
•   Conceptual design
•   System architecture
•   Standards
•   Certification
•   Security and privacy
•   Patient matching
•   Authentication                                        NHIN
•   End user applications
•   Pilot programs
•   Business model
•   Adoption programs                          Application Vendors
•   Best practices                      (E-Rx, EMR, HIS, PBHR, PHR, etc.)
•   Incentives alignment
                                                                                           Member
                            Physician
                                                Nurse             Patient
                                                                                Employee
                                    Lab Tech         Pharmacist
                                                                       Family
Community Pharmacy Is More Prepared
  for Interoperability Than Are Others
        Ingredients       Pharmacy           Other Verticals

  Conceptual design                                  
  System architecture                                         
  Standards                                  
  Certification             
  Security and privacy              
  Patient matching          
  Authentication            
  End user applications             
  Pilot programs            
  Business model            
  Adoption programs         
  Best practices            
  Incentives alignment      
     Pharmacy Health Information Exchange:
         Stakeholders and Infrastructure
                                           Inpatient
Pharmacy     In-store              HIS
                                           Pharmacy                                               Practice
Rx History    Clinics                                                                    EMR
                                                                                                 Management
                                           Emergency
 MTM &
                                           Department                                            Electronic
Care Mgmt
                                                                                                 Prescribing
Pharmacies                                 Hospitals
                                                                                                 Physicians

                                                                                                      Patients
                                                                                                       Home Care
                                                                                                       Monitoring

                                                                                                       Intelligent
                                                                                           PHR
                                                                                                         Dosing




                                                                                          Payers / PBMs
                                                                                         Payer-based
                                                                                                            P4P
                                                                                         Health Rec.

                                                                          Prescription    Formulary     Predictive
                                                              RHIOs         History       & Guides      Modeling

                                                            Integration
                              Government                     Platform

                                                  Patient   Information
                        CDC       DEA
                                                 Locators     Policies
    Pharmacy Health Information Exchange
           As It Is Now Unfolding
                                             Inpatient
Pharmacy     In-store              HIS
                                             Pharmacy                                               Practice
Rx History    Clinics                                                                      EMR
                                                                                                   Management
                                             Emergency
 MTM &
                                             Department                                            Electronic
Care Mgmt
                                                                                                   Prescribing
                                           Hospitals
Pharmacies
                                                                   $                               Physicians

                                                                                                        Patients
                                                                                                         Home Care
                                                                                                         Monitoring

                                                                                                         Intelligent
                                                                                             PHR
                                                                                                           Dosing




                                                          $                                 Payers / PBMs
                                                                                           Payer-based
                                                                                                             P4P
                                                                                           Health Rec.


                                         $
                                                                            Prescription    Formulary     Predictive
                                                                RHIOs         History       & Guides      Modeling

                                                              Integration
                              Government                       Platform

                                                    Patient   Information
                        CDC       DEA
                                                   Locators     Policies
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