Transcript ITI e-collaboration Week 2 Day 2

Fellowship
Week
#9
E-collaboration for healthcare
(Telemedicine / E-prescription)
1st of August, 2010
ITI Smart Village
4/6/2017
Information Technology Institute
Week 2
Day 2
1
Week 1 - Agenda
What is Medical Prescription?
Definition / Errors
Workshop
1 hour 30 minutes
What is e-prescription?
Theory
Process
Practice
2 hours
Why do we need e-prescription?
Limitations
Issues
2 hours 30 minutes
Conclusion – Assignment 02
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Medical prescription
Rx
Workshop
Definition / Errors
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Medication Safety Pyramid
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Prescribe
General
pre·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).
Medicine
1. to write an order for a drug, treatment, or
procedure.
2. to recommend or encourage a course of action.
© 2005, Levinson Productivity
Systems, P.C.
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Paper Prescriptions
• ℞ Activity:
“Role-play”
Time: 30 mins.
3 people
– Patient(illness)
– Dr.: Write pres.
– N: Criticize it
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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 patient
The 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.
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Slide 7
Medicine in ancient history
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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
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© 2005, Levinson Productivity
Systems, P.C.
www.ct-yankee.com
Prescription Abbreviations
•
Link
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www.ct-yankee.com
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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
© 2005, Levinson Productivity
Systems, P.C.
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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 lifethreatening. 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.
© 2005, Levinson Productivity
Systems, P.C.
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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.
© 2005, Levinson Productivity
Systems, P.C.
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Prescription Errors
Handwritten 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"
© 2005, Levinson Productivity Systems, P.C.
www.ct-yankee.com
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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.
© 2005, Levinson Productivity
Systems, P.C.
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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 
© 2005, Levinson Productivity
Systems, P.C.
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Handwritten Prescription Scenario
•
•
Form (or not)
Physician Order by Doctor
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–
–
–
•
•
•
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Nurse
Medication
Investigation (lab)
Diet
Blood Transfusion
Porter
Pharmacist
Transportation Delay Miss communication
Drug request Delay Miss communication
Pharmacy Delay Miss communication
Dispencing Delay Miss communication
© 2005, Levinson Productivity
Systems, P.C.
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Early Years: Healthcare IT Interoperability
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
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
1997
NCPDP
developed
SCRIPT
Standard v1.0
NCPDP: National Council for Prescription Drug Programs is an ANSIaccredited standards development organization representing all facets
of pharmacy
© SureScripts-RxHub, 2009
E-prescription
eRx
Assessment
Definition
Process
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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
© 2005,
Levinson Productivity
interactions
and compliance 20
Systems, P.C.
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 eprescribing 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.
© 2005, Levinson Productivity
Systems, P.C.
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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.
© 2005, Levinson Productivity
Systems, P.C.
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E-prescription Scenarios
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Systems, P.C.
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Electronic Medical Record - EMR
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Slide 24
"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.
© 2005, Levinson Productivity
Systems, P.C.
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Timeline of Key E-Prescribing Events
Jun./Jul. 2008
 DEA issues proposed rule to allow
Apr. 2007
2002/2003
Dec. 2003
RxHub and
SureScripts
begin network
operations
Medicare
Prescription Drug
& Improvement
Medication Act
CMS proposes
3 new
e-prescribing
standards;
effective 1/1/09
e-prescribing for controlled substances.
Comments due 9/25/08.
 Congress passes Medicare bill with
e-prescribing incentives (MIPPA)
 RxHub and SureScripts merge
2001
2005
Jul. 2006
Aug. 2007
Oct./Nov. 2008
RxHub and
SureScripts
both founded
Katrina
proves need
for electronic
medication
records
IOM Report
released:
Preventing
Medication
Errors
E-prescribing
becomes
legal in all 50
states plus
D.C.
CMS
 Holds seminal e-prescribing
conference
 Extends fax exemption until
1/1/2012
 Issues regulation on e-prescribing
incentives for Medicare Part D
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© SureScripts-RxHub, 2009
National E-Prescribing Infrastructure
© SureScripts-RxHub, 2009
E-Prescribing: How it works
Certified Clinician Application
Patient
Collects Patient:
 Consent
 Name
 Date of Birth
 Gender
 Zip
4  Validates Information Received with Patient
 Reviews Benefit and Selects Therapy
 Pharmacy Selected by Patient
 E-Prescription Generated
E-Prescribing Benefits
1
2
5
Patient uniquely
identified in MPI.
Request for patient
information sent to
payer & pharmacy.
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Electronic
 More complete medication
history
 Displays economic
alternatives
 No illegible handwriting
 Reduces pharmacy
callbacks
 More convenient for patients
3
3
Certified Payer
Provides Patient:
 Eligibility
 Benefit & Formulary
 Medication Claims History
 Reduces time spent on
renewals
Certified Pharmacy
Processes:
 Medication Pharmacy History
 E-Prescriptions
 E-Refills/Renewals
© SureScripts-RxHub, 2009
E-Prescribing Services

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:

Patient compliance with prescribed regimens

Therapeutic interventions

Drug-drug and drug-allergy interactions

Adverse drug reactions

Duplicate therapy
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.
© SureScripts-RxHub, 2009
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 (warfarin
and 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 diabetic
agents, etc.)
© SureScripts-RxHub, 2009
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 & 2006
and estimated at $3 million/year for 2007-2009
– Administrative savings – totaling $700,000 for 2005 & 2006
and 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
© SureScripts-RxHub, 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 eprescribing project demonstrates decreased
paper costs, reduced adverse drug events and
errors and increased prescription of generics.
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Slide 32
Progress Report
Starting at “0” in 2003…vs. estimates for full year 2008:
Member Records
200 million (66%)
Patient Visits*
70 million (14%)
E-Prescribers
85,000 (15%)
E-Prescribing Retail Pharmacies
45,000 (79%)
E-Prescribing Mail Order Pharmacies**
6 of the Top 10 (70%)
E-Prescriptions
100 million (6%)
* Patient eligibility, formulary and medication history requests. National Center for Health Statistics estimates 964 million
patient visits per year.
**Percent of prescriptions processed by these mail order pharmacies
© SureScripts-RxHub, 2009
E-Prescribing Community Successes
Patient Safety Improved
Patient Quality of Care Improved
National Infrastructure Demonstrated
Drug Duplication and Interaction
Identified
Workflow Efficiency Gained
© SureScripts-RxHub, 2009
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
© SureScripts-RxHub, 2009
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.)
© SureScripts-RxHub, 2009
E-Prescribing Lessons for Interoperability
Collaboration among all stakeholders is essential
Business model requires stakeholders who receive
value to pay for it
Contractual framework aligned with stakeholder
accountability
Never underestimate the importance of standards
Standards don’t replace the need for policy and
process
Privacy and security is paramount
© SureScripts-RxHub, 2009
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
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
© 2005, Levinson Productivity
Systems, P.C.
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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]
5- Subject of the email has to be (Assignment 02: Your Name)
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Information Technology Institute
Slide 40
Thanks
Amena Safwat
[email protected]
HI Fellowship Program
R&D Department
Information Technology Institute
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