“ incorporating an “ask a pharmacist” program into myhealthevet and secure messaging ”...

“Incorporating an “Ask A Pharmacist” program into MyHealtheVet and Secure

Messaging”Presented by: Eric Spahn, Pharm D, Veteran Healthcare

System of the Ozarks (VHSO)/VISN 16

Contributors: Lynn Sanders, Pharm D, Director, Pharmacist Re-Engineering, VACO PBMLuAnn Barron, RPH Pharmacy Program Manager, VACO PBMMaureen Layden, MD, MPH Director of the Medication Reconciliation Initiative, VACO PBM

2011 VA Pharmacy Informatics Conference (West Coast Edition)

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Healthcare literacy, medication adherence, adverse drug events, and access have contributed to a nationwide medication use crisis

Patients have limited “real time” access to comprehensive pharmacy services that mitigate this crisis by concentrating on safe, effective, and patient centered medication treatment management, review, and counseling

Patients have questions about their medications at home, after hours, and seek answers on the internet or in the non VA health care settings

Adverse drug events (ADE)s are the most common of all healthcare-associated adverse events and can occur when multiple changes to medication regimens take place in the context of poor patient education, inadequate medication resources, and lack of concise communication between the patient and provider

Face the Facts

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Description of Innovation

“Ask A Pharmacist” incorporated within the MyHealtheVet (MHV) Pharmacy Section will provide Veterans, families and their caregivers info on:– Their VA Pharmacy: The CMOP, VA Formulary, and Frequently Asked

Questions– Their Medications: From trusted sources– How to connect with their pharmacist directly through a triage group

within Secure Messaging (SM) called “Ask A Pharmacist”

Veteran Centered - this program will connect the patient to the pharmacy and the pharmacist to the healthcare team

Both Veterans and the VA benefit as Veterans are motivated to become “In-Person Authenticated” and healthcare teams to increase awareness of available resources within MHV

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Key Components

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1. Ask A Pharmacist Secure Messaging Triage GroupUtilize slocal triage group development within SM, in which messages sent to “Ask A Pharmacist VHSO" can be triaged from patient or primary care provider to pharmacy tech, then to staff pharmacist. In effect, this should provide less interruption to on-site patient care as well as a reasonable time frame for appropriate response and follow-up. (Can currently being incorporated at local sights)

2. Ask A Pharmacist Clinical Content Addition to Pharmacy Section of MHVMHV will host an Ask A Pharmacist site which will include a Frequently Ask Questions (FAQ) archive developed by a National Pharmacy Workgroup as well as links to internal and external medication resources, maintained by the workgroup and MHV. This component is currently being developed by various MHV and PBM representatives using the CAB content addition process.

Do you have a question for a Pharmacist..?“VA pharmacists are dedicated to your health and well-being. You can search our archive for answers to general questions about health and medications any time, day or night. VA pharmacists have prepared hundreds of answers to commonly asked questions. In addition, Veterans who have completed the In-Person Authentication Process (IPA) can submit specific questions for a prompt, personal response through SECURE MESSAGING!”

https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=spotlightArchive&contentPage=spotlight/November%202010/spotlight_sm_coming_soom.htm

Location In MyHealtheVet

Frequently Asked Questions

Send A Secure Message

Trusted Resources

Medications: Play It Safe

VA Pharmacy

Medications and Health

Ask A Pharmacist

View In MyHealtheVet



Trusted Resources


VA Pharmacy


Ask A Pharmacist




Trusted Resources


VA Pharmacy


Ask A Pharmacist

Links to resources within

content




Trusted Resources


VA Pharmacy


Ask A Pharmacist




Trusted Resources


VA Pharmacy


Ask A Pharmacist

Links to SM within content




Trusted Resources


VA Pharmacy


Ask A Pharmacist

Links to Medications: Play

It Safe within content




Trusted Resources


VA Pharmacy


Ask A Pharmacist

Link(s) to Secure Messaging



Trusted Resources


VA Pharmacy


Ask A Pharmacist

Secure Messaging: Ask A Pharmacist

The way to do this within current functionality would be as follows:1. Have the MHV coordinator activate the Pharmacy Staff at a VAMC whose

job it would be to respond to the Ask a Pharmacist messages. 2. Create a Triage Group called Ask a Pharmacist Portland or Ask a Pharmacist

VHSO, etc and put the pharmacy staff on this Group.3. Have a CAC run a Reminders Due Report on the patients at that site who

have gone through In-Person Authentication and choose the Option to save this report as an OE/RR List. Name the OE/RR list Ask A Pharmacist and be sure to make this list Public.

4. Associate the Ask a Pharmacist Triage Group with the Ask a Pharmacist OE/RR list.

5. Patients will now be able to select the Ask A Pharmacist triage group as a recipient of a New Message.

6. The CAC will have to periodically refresh this list as new patients go through In-Person Authentication.

David Douglas, MD – Facility Chief Health Informatics Officer – Portland VAMC, VISN 20

Secure Messaging: Ask A Pharmacist Setup

Secure Messaging: Ask A Pharmacist Setup

PATIENT A

PATIENT B

PATIENT B

Secure Messaging: Ask A Pharmacist Example

PATIENT B

PROVIDER

PATIENT A


PATIENT A

PATIENT A,


PATIENT A

Secure Messaging: Ask A Pharmacist Results

David Douglas, MD – Facility Chief Health Informatics Officer – Portland VAMC, VISN 20



Trusted Resources


VA Pharmacy


Ask A Pharmacist

Trusted Resources



Trusted Resources

Medications: Play It SafeVA Pharmacy


Ask A Pharmacist

Medications: Play It Safe!



Trusted Resources


VA Pharmacy


Ask A Pharmacist

VA Pharmacy



Trusted Resources


VA Pharmacy


Ask A Pharmacist


Our colleagues agreed!

Strategic Goals Improve patient care

– Safety: Communicating the right information from VA resources and trusted external resources

– Quality: Activates patients to participate in shared and informed decisions about their medications

– Access: Provides asynchronous communication determined by the Veteran, family, or caregiver

Increase satisfaction across many stakeholders– Veteran, family, or caregiver– Their healthcare team

Improve Workflow– Decreases phone calls, visits, and time waiting at the pharmacy

window.– Assists in prescription processing questions as well as other

medication related topics

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Strategic Goals (cont)

Address multiple unmet needs― Use MyHealtheVet (MHV) as a provider of an "Ask the

Pharmacist" Program ― Give Veterans a chance to “Ask Pharmacists” questions about

medications and health concerns through a pharmacy archive and/or secure messaging

― Provide both general and patient-specific drug information to our Veteran in one venue: MHV

Help meet organizational requirements― VA Medication Reconciliation Directive― Joint Commission― Meaningful Use

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Success Metrics

Process Metrics– Site usage statistics– Deployment across the VA

Outcome Metrics– Decrease calls and visits to clinic and pharmacy– Decrease medication misadventure-related encounters

Satisfaction– Patient, caregiver, and family– Staff

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Impacts

Stakeholders– The Veteran, family, and caregiver– Patient Aligned Care Teams(PACT)s, pharmacy, clinic, and

support staff– MyHealtheVet, VA Pharmacy Benefits Management,

National Medication Reconciliation Initiative

Current Support– Pharmacy Benefits Management

VA Medication Reconciliation InitiativeClinical Pharmacy

– MyHealtheVet– Daily Plan

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Approach

Assemble a stakeholder and subject matter workgroup– Develop business requirements for each task and

functionality – Draw mock ups, use cases, and describe potential

scenarios– Plan for unintended consequences and comply fully with

VA patient information security standards

Submit request for proposal to contracting per VA policy

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Team and Environment

Levels of support– Veteran Healthcare System of the Ozarks (VHSO)

Patient Satisfaction Surveys (SHEP) – Meets or exceeds National and VISN statistics

VISN 16 Veterans Rank 3rd in nation for online utilization of MHV Ask a Pharmacist VHSO has 297 associated, 266 opted in

– Enabled “Ask A Pharmacist” Secure Messaging Triage Group spread Portland VAMC VISN 20

– MyHealtheVet Clinical Advisory Board (CAB) content addition approval since 2008

Subject Matter and Stakeholder Workgroup– Pharmacists, providers, nurses, clinical application coordinators,

patient safety, quality & performance, and informational technologists– Program office and field representatives

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Implementation Resources needed

– FTEE Program Analyst– FTEE Program Manager– Contracting for Prototype Development and Testing

Pre-Work: Local Pharmacist Secure Messaging Triage Group Roll Out – This pre-work is ongoing now within our facility (VHSO) and

Portland VAMC

Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet – Assemble candidate pilot groups– Identify project plan, key milestones, and communication

strategies with leadership 41

Timeline

Definition of Above Steps: Pre Work: Local Pharmacist Secure Messaging Triage Group Roll Out

• Step 1: Pre-work “Ask A Pharmacist” Secure Messaging Triage Group Roll Out• Step 2: Completions of requirements and supporting documents

Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet • Step 3: Contracting process• Step 4: Prototype Development• Step 5: Integration MHV applications• Step 6: Complete Testing

InnovationPre-Work

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Budget Narrative

Pre-Work: Local Pharmacist Secure Messaging Triage Group Roll Out ― Clinical Application Coordinator/MHV Coordinator

development and implementation― Local projected costs based on 1hr/mo is ~$2000/yr

Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet – The cost of developing and deploying the software to support

the business requirements $150,000– The cost of the supporting pilot implementation $100,000– After the pilots have been deployed, operations and

maintenance costs for spreading throughout the VA $50,000 per fiscal year

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Challenges and Risks

Challenges & Risks Lack of full incorporation

with MHV business architecture

Poor usage by patients, family, and caregivers

Lack of seamless integration with existing VA facility workflow

Mitigation Ongoing and effective

collaboration with MyHealtheVet

Broad-based outreach campaign

Ongoing and iterative feedback with key stakeholders in the field

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Measures of Success Ask: Veterans deserve access to comprehensive pharmacy services to help

promote full participation in the successful management of their medication treatment plans

A Pharmacist: The most accessible healthcare profession will participate and promote multidisciplinary team based care via their Pharmacist

On MHV: The most patient friendly platform in the VA: MHV promotes internal sites and services as well as In-Person-Authentication (IPA) while reducing patients waiting on the phone or at the pharmacy window

Our colleagues agreed, ranked this 13th out of 4700 ideas, added positive comments like: “Great Idea!” “Possibilities are endless!” “Connects the patient to the pharmacist” “Helps with pharmacy and MHV integration”

We’ll know we are successful when we hear one Veteran say to another, “Its easy, I just went on “Ask a Pharmacist” and found

the answer I was looking for”. 45

Questions

“ incorporating an “ask a pharmacist” program into myhealthevet and secure messaging ”...

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