7th Annual Pharmacy Informatics Conference Impact on Pharmacy of Patient Facing Apps Eric Spahn, Pharm D Clinical Analyst, PBM Clinical Informatics Rob Silverman, PharmD Program Manager, PBM Clinical Informatics April 3, 2014

The Pharmacy “Environmental Scan” 7th Annual Pharmacy Informatics Conference The Pharmacy “Environmental Scan” Rob Silverman, PharmD Program Manager, PBM Clinical Informatics April 3, 2014

What is the “Pharmacy Environmental Scan”? It’s a spreadsheet It’s an attempt to get the big picture of all medication-related development efforts across the VA, since PBM is, by definition, the business owner or designated subject matter expert(s). It’s comprised of data from multiple sources: New Service Requests Existing projects in PMAS Field Development Projects, including Class 3 to Class 1 Conversion Candidates Mobile Application Projects Innovations Projects

Additional information re: New Service Requests PBM maintains a weekly log of those New Service Requests (NSRs) that we are tracking with a pharmacy-related interest. https://vaww.cmopnational.va.gov/cmop/PBM/pre/NSR/default.aspx

How did the Environmental Scan get compiled, and… Where can I find the Environmental Scan information now? Original source content was provided by the New Service Request tracking sheet, with additions for the other types of projects provided by: National Alliance for Patient Medication Information Standardization (NAPMIS) 2010 White Paper report produced their environmental scan on patient med info/medication reconciliation projects being proposed or in development AIM: Applied Informatics Management team, formerly Health Systems Portfolio Management, and RDM: Requirements Development & Management Now it is hosted by AIM, and will be on a SharePoint site, http://vaww.esm.infoshare.va.gov/sites/hps/HPS-PBM-Collaboration/Shared%20Documents/Comprehensive%20Environmental%20Scan.xlsx Note: This is currently a restricted-access site, not yet open to all authenticated users within the VA Intranet.

Discussing some of the Mobile Apps… Immunization Mobile App Officially “Mobile Workflow Immunization Campaign App” Initial implementation (Phase 1) for influenza vaccine only Warfarin Monitor (formerly Coumadin Clinic) Safe Women's Prescribing App

Discussing some of the Field Development Projects… Non-VA Medications as Outside Prescriptions NSR 20081118 Waiver Requests for sites to install Multiple TIU and CPRS based local solutions Unapproved abbreviations TIU Data Objects and Health Summary components by “Drug Class” Any project that modifies Class 1 nationally released routines will be evaluated as part of VistA Standardization, aka Gold Disk project.

Some of the problems that the Environmental Scan aims to address… Pharmacy Benefits Management (PBM) needs to be aware of any medication-related projects Example: innovation efforts related to management of remote prescriptions at other VA’s PBM needs to manage the participation of subject matter experts for all of the identified projects The Essential Medication Information Standards Directive defines medication information standards for sharing, management and review across all app development projects, (mobile, web and print) for both patient and staff facing information recognizes PBM as the primary subject matter expert on any medication related project A central repository of projects assists us in having a bird’s-eye view PBM needs to connect various discussions about a single project Often, the New Service Request name/title is the only common thread between discussions Funding Prioritization Development

Health Recon/Med Review App Potential workflow impact of the patient-facing app on the team-facing activities… VPS Kiosk Patient entry and update of medication list Provider can then use the update during the clinic visit Health Recon/Med Review App Same workflow model … patient can update list; provider can use list during clinic visit

What’s next? If you recognize a medication-related project that is NOT on the Environmental Scan, please notify PBM or AIM and it will be evaluated for addition The Scan will be reviewed on a regular basis by PBM/AIM

VA Pharmacy & MyHealtheVet

…Access to Care “A significant contribution to health reform by the pharmacy profession may be to increase access to patient care services,” - 2011 USPHS Report to USSG In order to meet the growing health care demands in the United States, pharmacists must continue to expand access to patient care services.

MHV Statistics VA Blue Button Rx Refill Ask A Pharmacist Latest Releases VA Open Notes Up and Coming Features VA CCD Rx Refill New User Interface User statistics Ask A Pharmacist New Feature: Rx Tracker Secure Messaging statistics My Medications Mobile App Development Enhancements to MHV Pharmacy View/Edit My Medications Add A Medication Add A Medication Effect My Medication Journal Sharing My Medications Output

What's NEW with My HealtheVet? My HealtheVet Release 12.8 – March 22, 2014 Secure Message Reassignment enhancement allows a message sent to one triage group to be reassigned to ANY other health care team member or triage group to a VA facility outside of the facility in which the message originated Secure Messaging Attachments (first version) allows for attachments to be added to Secure Messages from Patients My HealtheVet Release 12.7.1 – February 22, 2014 Rx Refill sort change now displays the medication name before (on top of) the Rx number to allow alphabetical sorting. Change made to the Rx Refill page and Prescription Refill History page My HealtheVet Release 12.7 – January 25, 2014 Secure Message reassignment enhancements allows a message sent to one triage group to be reassigned to ANY other health care team member or triage group within a facility

What's COMING with My HealtheVet? Rx Tracker Phase I, MHV release 12.9 (June 2014) Modify existing MHV Pharmacy RX History and RX Refill pages to allow Track Deliveries.  This will include other RXs in the package but will not include images. Phase II, MHV  release 12.10 (Sept 2014) Add new MHV Pharmacy RX Tracking page to allow for Track Deliveries.  This will include images and other requirements not addressed. My Medications Aiming for MHV 12.10 (Sept 2014) Blue Button User Interface redesign Aiming for MHV v12.9 (June 2014)

Changes to MHV Pharmacy Landing Page Current September 2014

September 2014 Select the new Track My Deliveries icon on the new Pharmacy landing page of My HealtheVet which takes you to a new ‘VA Deliveries Summary’ page This page shows all your VA prescriptions filled by a VA Mail Order Pharmacy and mailed in the last 45 days. A prescription sent by a VA Mail Order Pharmacy today, will not display until the next day or two. Select a prescription record to track from the VA Prescription Tracking Summary table by clicking the Track Delivery button under the Prescription Tracking column June 2014

Rx Refill Current

Rx Refill June 2014

Prescription History Current

Prescription History June 2014

Prescription Delivery Details September 2014 HYDROXYZINE 25MG CAP June 2014

Carrier Tracking Information Page June 2014

What's COMING with My HealtheVet? Rx Tracker Phase I, MHV release 12.9 (June 2014) Modify existing MHV Pharmacy RX History and RX Refill pages to allow Track Deliveries.  This will include other RXs in the package but will not include images. Phase II, MHV  release 12.10 (Sept 2014) Add new MHV Pharmacy RX Tracking page to allow for Track Deliveries.  This will include images and other requirements not addressed. My Medications Aiming for MHV 12.10 (Sept 2014) Blue Button User Interface redesign Aiming for MHV v12.9 (June 2014)

Changes to MHV Pharmacy Landing Page Current September 2014

My Medications Current MHV Pharmacy: **New Medications MHV Pharmacy: Pulls VA pharmacy medications from VistA View VA medications Enter/View Self-Entered medications and supplements Current MHV Pharmacy: Medications & Supplements VA Medications **New MHV Pharmacy: My Medications ** Includes link to MHV Pharmacy – RX Refill to request Medication Refills

Enhanced Features MHV Pharmacy: My Medications View/annotate Non-VA medications VA entered (limited fields) View/annotate VA Medication (limited fields) View and Record when a medication is taken and amount taken View and Record medication effects Display VA medication images Display patient centric label image for reference Display dosage strength and frequency of medications Recording of patient self discontinued medication View Self-Entered Allergies on Medication List (Basic MHV Account holders) View Self-Entered and VA Allergies and Adverse Reactions on Medication List (Premium and Advanced MHV Account holders)

Enhanced Features (cont.) MHV Pharmacy: My Medications Enhanced instructional text On screen via hover text and explanatory text Downloadable Patient Educational Materials Maintain history of past pharmacy prescribers Provides field for patient to document if taking medication as prescribed or differently.

MRP My Medications: Add a Self-Entered Medication

MRP My Medications: Medication Effects

MHV Pharmacy: Add Medication Effect Entry Page

MRP My Medications: My Medications Output and Secure Messaging…??

What's COMING with My HealtheVet? Rx Tracker Phase I, MHV release 12.9 (June 2014) Modify existing MHV Pharmacy RX History and RX Refill pages to allow Track Deliveries.  This will include other RXs in the package but will not include images. Phase II, MHV  release 12.10 (Sept 2014) Add new MHV Pharmacy RX Tracking page to allow for Track Deliveries.  This will include images and other requirements not addressed. My Medications Aiming for MHV 12.10 (Sept 2014) Blue Button User Interface redesign Aiming for MHV v12.9 (June 2014)

Difference between VA Blue Button and VA CCD?

Ask A Pharmacist and Secure Messaging

Pharmacy– Secure Messaging Stats SQL Query into MHV Database using Triage_Group_Name like '%pharmacist%' Date Stations Triage groups Active Patients Inbound messages in February February 2012 22 26 15158 682 February 2014 42 84 92066 1853

Ask A Pharmacist Mobile App Development Currently gathering requirements for future development Key requirements: My HealtheVet Pharmacy Services Pill Identifier Trusted Medication Resources Sending Secure Messages About VA Pharmacies