e-collaboration for healthcare (telemedicine / e-prescription) fellowship week # 9 week 2 day 2 1 st...

E-collaboration for healthcare (Telemedicine / E-prescription)

Fellowship

Week

# 9

Week 2Day 2

1st of August, 2010ITI Smart Village

04/18/23 1Information Technology Institute

04/18/23 2

What is Medical Prescription?Definition / ErrorsWorkshop

What is e-prescription?TheoryProcessPractice

Why do we need e-prescription?LimitationsIssues

Conclusion – Assignment 02

1 hour 30 minutes

Week 1 - Agenda

Information Technology Institute

2 hours

2 hours 30 minutes

Medical prescriptionRx

04/18/23 Information Technology Institute 3

WorkshopDefinition / Errors

Medication Safety Pyramid

04/18/23 Information Technology Institute Slide 4

© 2005, Levinson Productivity Systems, P.C.www.ct-yankee.com

5

Prescribe

Generalpre·scribe (pr-skrb) v. pre·scribed, pre·scrib·ing,

pre·scribes 1. To set down as a rule or guide; enjoin. See Synonyms

at dictate.2. To order the use of (a medicine or other treatment).Medicine1. to write an order for a drug, treatment, or

procedure. 2. to recommend or encourage a course of action.

http://www.thefreedictionary.com/dictate

Paper Prescriptions


• ℞ Activity:“Role-play”Time: 30 mins.

3 people– Patient(illness)– Dr.: Write pres.– N: Criticize it

Prescription Symbl℞• Origin

– Latin word: recipe (take…)– Eye symbol of Heru (Horus)

A prescription ( ) is a health-care plan implemented by a ℞physician or other medical practitioner in the form of instructions for the health care for an individual patient.[1]

Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist.

Prescriber takes responsibility for the clinical care of the patientThe scope of meaning of the term "prescription" has broadened

to also include clinical assessments, laboratory tests, and imaging studies relevant to optimizing the safety or efficacy.


Medicine in ancient history



9

Medical Prescription

• Prescription order entry • Bar code scanner for re-supply • Web connections Electronic Medication Administration Records

(eMARs) Proprietary or HL7 – System at a minimum include the "Five Rights"

• Right Resident (patient)• Right Medication (drug)• Right Dosage • Right Route • Right Time

© 2005, Levinson Productivity Systems, P.C.www.ct-yankee.com 10

Prescription Abbreviations

• Link


11

Prescribing Practice

OHSU study finds computers greatly reduce prescription errors• prescriptions initially entered into a computer reduce errors

in the prescription by one-third and are five times less likely to require pharmacist clarification than handwritten prescriptions. The study was published in the November 2002 issue of Academic Emergency Medicine (www.aemj.org), published by Hanley & Belfus.

• "This new computer system is really the foundation for ongoing improvements in safe prescribing practice," said Kenneth E. Bizovi, M.D., assistant professor of emergency medicine in the OHSU School of Medicine, toxicologist and emergency physician.

http://www.innovations-report.com/html/reports/studies/report-14213.html


12

Medication Errors (USA - key facts)

• More than one million serious medication errors occur every year in U.S. hospitals. Such errors include administration of the wrong drug, drug overdoses, and overlooked drug interactions and allergies. They occur for many reasons, including illegible handwritten prescriptions and decimal point errors.

• Medication errors often have tragic consequences for patients. Many serious medication errors result in preventable adverse drug events (ADEs), approximately 20% of which are life-threatening. According to the 1999 Institute of Medicine report, To Err is Human, medication errors alone contribute to 7,000 deaths annually.

• Medication errors also result in tremendous financial costs. Over $7.5 billion per year nationwide in hospital costs alone. Beside, other malpractices.


13

Causes of Medication Errors

• "most medication errors occur as a result of multiple, compounding events rather than from a single act by a single individual. Medication errors invariably represent the collapse of a faulty system, not a faulty human being."– Reasons cited include: "Failed communication: handwriting and oral

communications, especially over the telephone, drugs with similar names, missing or misplaced zeroes and decimal points, confusion between metric and apothecary systems of measure, use of nonstandard abbreviations (TABLE 1), ambiguous or incomplete orders."

– The above problems are completely avoidable under a decent quality management system.

Prescription ErrorsHandwritten prescriptions kill about 25,000 people a year. (in the world, who pays for the consequences?)

Handwritten instructions are not allowed under ISO 9000. The Leapfrog Group advocates Computer Physician Entry Order (CPEO) systems. "Assures that prescribers* enter hospital medication orders via a computer system that includes decision support software to reduce prescribing errors.“

Verbal order readback is a routine practice in the Armed Forces. This means that the person who receives a verbal instruction repeats it back to the person who gave it to assure that there was no confusion. "Verbal (including telephone orders) should be recorded whenever possible and immediately read back to the prescriber"




15

Avoidance of Prescription Errors

• Procedure at Citizens General Hospital in New Kensington, Pennsylvania– A robot reads bar-coded prescriptions and retrieves the medications.– Medications go into individual bar-coded bags.– Prior to administering the drug, the nurse scans both the bag and the

patient's bar-coded wristband to assure that they match.

• Anesthesiology– The anesthesiologist announces the name and dose of each drug she

administers, along with the patient's weight. Another (specific) member of the operating team should be responsible for double-checking the activity.


16

Corrective Action Systems

• Corrective action systems are mandatory centerpieces of ISO 9000-compliant systems.

• If there is a quality nonconformance (such as a medical mistake), the health care organization is required to:

(1) Define the problem (e.g. prescription error, wrong-site surgery)(2) Identify the root cause

• This does not mean blaming the personnel.

(3) Identify and implement a permanent solution.• Telling people to be "more careful" isn't one.

(4) Make the new method the standard for the process in question, e.g. by updating work instructions and procedures.

• Problem solving techniques


17

Handwritten Prescription Scenario

• Form (or not)• Physician Order by Doctor

– Medication– Investigation (lab)– Diet– Blood Transfusion

• Transportation• Drug request• Pharmacy• Dispencing

Delay

Delay

Delay

Delay

Miss communication

Miss communication

Miss communication

Miss communication

Nurse

Pharmacist

Porter

Early Years: Healthcare IT Interoperability

NCPDP: National Council for Prescription Drug Programs is an ANSI-accredited standards development organization representing all facets of pharmacy

Late 1970’s Pharmacies

started installing computer

systems and submitting computer generated claims to insurance companies

Late 1970’s Pharmacies

started installing computer

systems and submitting computer generated claims to insurance companies

1977 NCPDP was

formed to standardize insurance

forms – UCF adopted in

1978

1977 NCPDP was

formed to standardize insurance

forms – UCF adopted in

1978

1987 PCS

introduced electronic claims –

other PBMs followed

1987 PCS

introduced electronic claims –

other PBMs followed

1988 NCPDP

developed Telecom

Standard v1.0 and Pharmacy

software vendors and chains coded for electronic

claims

1988 NCPDP

developed Telecom

Standard v1.0 and Pharmacy

software vendors and chains coded for electronic

claims

1997 NCPDP

developed SCRIPT

Standard v1.0

1997 NCPDP

developed SCRIPT

Standard v1.0

© SureScripts-RxHub, 2009

E-prescription eRx


AssessmentDefinitionProcess


20

E-prescription Benefits• Legible, complete prescriptions eliminating handwriting errors and

decreasing pharmacy “callbacks”• Abbreviations and unclear decimal points are avoided• The wait to pick up prescriptions would be reduced• Fewer duplicated prescriptions• Timely notification of drug alerts and updates• Better use of generic or preferred drugs• E-prescribing interface with practice and drug management SW• It is a secure and HIPAA compliant process• It is the future clinical decision support, alerts &reminders; integrates

DS related to disease states & medications• Digital records improve data analysis of prescribing habits• It allows the ability to look up drug history, drug-drug interactions and

compliance


21

Computerized physician order entry (CPOE)

• What is Computerized Physician Order Entry? Computerized physician order entry (CPOE) systems are electronic

prescribing systems that intercept errors when they most commonly occur — at the time medications are ordered.

With CPOE, physicians enter orders into a computer rather than on paper. Orders are integrated with patient information, including laboratory and prescription data. The order is then automatically checked for potential errors or problems.

The Center for Information Technology Leadership’s 2003 Report on the Value of CPOE in Ambulatory Settings estimated that e-prescribing would save $29 billion annually from fewer medication errors; reduced overuse, misuse and adverse drug event related hospitalizations and more cost effective selection of generic or less expensive medications.


22

CPOE (cont.)

Specific benefits of CPOE include: • Prompts that warn against the possibility of drug interaction,

allergy or overdose; • Accurate, current information that helps physicians keep up

with new drugs as they are introduced into the market; • Drug-specific information that eliminates confusion among

drug names that sound alike; • Improved communication between physicians and

pharmacists; and • Reduced healthcare costs due to improved efficiencies.


23

E-prescription Scenarios

Electronic Medical Record - EMR



25

"Death by Decimal"

• Oprah Winfrey's "Outrageous Medical Mistakes" uses the phrase "death by decimal," which kills seven to ten thousand people a year.– Presumably out of the 25,000 total.– E.g. a patient gets 10 milligrams instead of 1.0 milligram.

• A total no-brainer and 100% preventable!– We are more careful with our money than many doctors are with their

prescriptions. We write, for example, "Twenty dollars and 30/100" on a check and it is impossible to mistake this for anything else.

– 100% preventable by a CPEO system.– Even preventable by requiring the pharmacist to reject any

prescription whose quantity is ambiguous.

26

Dec. 2003 Medicare

Prescription Drug & Improvement Medication Act

Dec. 2003 Medicare

Prescription Drug & Improvement Medication Act

Apr. 2007 CMS proposes

3 new e-prescribing standards;

effective 1/1/09

Apr. 2007 CMS proposes

3 new e-prescribing standards;

effective 1/1/09

Jul. 2006 IOM Report released:

Preventing Medication

Errors

Jul. 2006 IOM Report released:

Preventing Medication

Errors

Aug. 2007 E-prescribing

becomes legal in all 50 states plus

D.C.

Aug. 2007 E-prescribing

becomes legal in all 50 states plus

D.C.

Jun./Jul. 2008

DEA issues proposed rule to allowe-prescribing for controlled substances. Comments due 9/25/08.

Congress passes Medicare bill withe-prescribing incentives (MIPPA)

RxHub and SureScripts merge

Jun./Jul. 2008

DEA issues proposed rule to allowe-prescribing for controlled substances. Comments due 9/25/08.

Congress passes Medicare bill withe-prescribing incentives (MIPPA)

RxHub and SureScripts merge

2001 RxHub and SureScripts

both founded

2001 RxHub and SureScripts

both founded

Oct./Nov. 2008CMS

Holds seminal e-prescribing conference

Extends fax exemption until 1/1/2012

Issues regulation on e-prescribing incentives for Medicare Part D

Oct./Nov. 2008CMS

Holds seminal e-prescribing conference

Extends fax exemption until 1/1/2012

Issues regulation on e-prescribing incentives for Medicare Part D

2002/2003 RxHub and SureScripts

begin network operations

2002/2003 RxHub and SureScripts

begin network operations

2005 Katrina

proves need for electronicmedication

records

2005 Katrina

proves need for electronicmedication

records

Timeline of Key E-Prescribing Events


National E-Prescribing Infrastructure


Patient uniquely identified in MPI.Request for patient information sent to payer & pharmacy.

Patient

1 2 5

Provides Patient: Eligibility Benefit & Formulary Medication Claims History

Certified Payer

Collects Patient: Consent Name Date of Birth Gender Zip

Certified Clinician Application

Electronic

E-Prescribing: How it works

3

Certified Pharmacy

Processes:

Validates Information Received with Patient4

E-Prescriptions Medication Pharmacy History

3

Reviews Benefit and Selects Therapy

Pharmacy Selected by Patient

E-Prescription Generated

More complete medication history

No illegible handwriting

Reduces pharmacy callbacks

6

Reduces time spent on renewals

E-Refills/Renewals

Displays economic alternatives

More convenient for patients

E-Prescribing Benefits


E-Prescribing Services

Patient compliance with prescribed regimens

Therapeutic interventions

Drug-drug and drug-allergy interactions

Adverse drug reactions

Duplicate therapy

Person Index: Access to more than 200M patients identified using demographic elements

Patient Eligibility: Patient eligibility, benefit and coverage, and formularies for authorized clinicians at point of care. Patient eligibility also available to pharmacists at the point of dispensing

Patient Medication History: Drug history for all patient coverages and includes original prescription and refills. Data can indicate:

Information is available for outpatient, inpatient and emergency departments Patient Prescriptions: Electronic delivery of prescriptions between

prescribers and pharmacies and refills between pharmacies and prescribers.


Case Study: Henry Ford Medical Group

• Over 370,000 prescriptions changed/ cancelled due to drug to drug interaction warnings

• Over 27,000 prescriptions changed/ cancelled due to drug/allergy warnings

• A 24% reduction in incidence of patients with prescription claims for severely contraindicated medications (warfarinand erythromycin, insulin and propranolol, lithium and thiazides, etc.)

• A 48% reduction in incidence of pregnant women who had prescription claims for severely contraindicated medications during pregnancy (coumadin, heparin, oral diabeticagents, etc.)


Case Study: Henry Ford Medical Group

• HAP/HFMG initial capital investment of $1.6 million plus annual operating costs averaging $590,000 reaps total savings of more than $1.9 million in total for 2005 and 2006

• Future estimated savings through 2009 will average $4 million per year• Based on the 2005 and 2006 realized improvement in generic use rate, the five

year Return On Investment is now estimated to be over $14M• Key sources of cost reduction benefit are:

– GUR Improvement – totaling $1.5 million for 2005 & 2006and estimated at $3 million/year for 2007-2009

– Administrative savings – totaling $700,000 for 2005 & 2006and estimated at $560,000/year for 2007-2009

– Estimated impact of reduced adverse drug events (ADEs) – totaling $540,000 for 2005 and 2006 and $540,000/year for 2007-2009


Henry Ford Health System

• Care design teams, each with a project manager, prepare and implement changes that will be rolled out through the system. The e-prescribing project demonstrates decreased paper costs, reduced adverse drug events and errors and increased prescription of generics.


**Percent of prescriptions processed by these mail order pharmacies

Progress Report

* Patient eligibility, formulary and medication history requests. National Center for Health Statistics estimates 964 million patient visits per year.

Starting at “0” in 2003…vs. estimates for full year 2008:

Member Records 200 million (66%)

E-Prescriptions 100 million (6%)

E-Prescribing Retail Pharmacies 45,000 (79%)

Patient Visits* 70 million (14%)

E-Prescribing Mail Order Pharmacies** 6 of the Top 10 (70%)

E-Prescribers 85,000 (15%)


E-Prescribing Community Successes

Patient Safety Improved

Patient Quality of Care Improved

National Infrastructure Demonstrated

Drug Duplication and Interaction Identified

Workflow Efficiency Gained


Interoperability Readiness

All industry stakeholders involved

National infrastructure established and secure

Transaction standards approved and in use for more than 6 years

Technology partners are certified on transactions and data usage

Return On Investment can be measured


Next Steps

Focus on driving e-prescribing adoption and utilization (Currently at 7%)

Focus on “break-even”

Future may hold other uses for this network(Lab, Medical Eligibility, Radiology, etc.)


E-Prescribing Lessons for InteroperabilityCollaboration among all stakeholders is essentialBusiness model requires stakeholders who receive

value to pay for itContractual framework aligned with stakeholder

accountabilityNever underestimate the importance of standardsStandards don’t replace the need for policy and

processPrivacy and security is paramount


For More Information

• Prescribers– GetRxConnected.com– RxSuccess.com– A Clinician’s Guide to ePrescribing

• Pharmacists– SureScripts.com

• Policymakers– SureScripts.com/Safe-Rx

• Consumers– LearnAboutEPrescriptions.com

• Media– SureScriptsRxHub.com/mediaguide

• All– TheCIMM.org

To subscribe to our daily newsletter,please visit:

www.surescripts.com/Surescripts/newsletter-signup.aspx

To subscribe to our daily newsletter,please visit:

www.surescripts.com/Surescripts/newsletter-signup.aspx


39

Conclusions

What can we do?• India: Ipad $35 we can also adopt it. • Raise Physicians awareness on: online stuff like:

– http://www.drugs.com/– http://www.rxlist.com

• Find out the most applicable free tool that can be disseminated in the hospitals and clinics

Assignment (02)Search for an e-prescription tool (free)

1- You have to check people’s reviews about it.2- You have to download it and try it out, check YouTube tutorials.3- Write your opinion about it in 1 to 2 pages max.

oCan we use it in our hospitals clinics?oHow can we spread it? (plan)oTo facilitate this: What decisions would you take if you were the minister of health (MOH)?

4- Deadline (Saturday 7th August, 2010) Send by email to: [email protected] Subject of the email has to be (Assignment 02: Your Name)

Good Luck 04/18/23 Information Technology Institute Slide 40

Thanks

HI Fellowship ProgramR&D Department

Information Technology Institute


Amena [email protected]

e-collaboration for healthcare (telemedicine / e-prescription) fellowship week # 9 week 2 day 2 1 st...

Documents

term prescription

minutes slide

medical prescription

levinson productivity

ohsu school of medicine

individual patient

emergency physician

definition errors workshop