1. Strategic Planning Review and Setup RXM Expunge PRIORITY EVENT 257/327

2.  Review of the RXM Expunge options  What reports will be run and why  Clean up process: RXM and PHA  Discussion about expected timelines and resources

3.  Drug manufacturers will utilize old NDC numbers for new drug entries.  The new drug is entered into the drug list by the FSV as a new item  The FSV may not have deemed the original drug entry as obsolete, thus creating an overlap of information  This will cause a combination of information, potentially causing problems during Interaction and Conflict checking

4.  Optimize Drug Interaction Checking  Optimize the ePrescribing Interface  Insert question: Where are you in the process of implementing ePrescribing? ◦ Live ◦ Not Live/In-Process ◦ Not Live/Planning stage ◦ Not on current radar

5.  Will detect recycled drugs during an FSV update  Will run Integrity reports for RXM and PHA to review Generic descriptions in your database against the FSV raw data file (PE 257)  Will run Integrity reports for RXM to review Trade descriptions in your database against the FSV raw data file and associated GPC (PE 327)

6.  Hospital will run their scheduled FSV load  MEDITECH will open a task and run their utility reports to identify numeric generic mnemonics in RXM and PHA  Hospital will run PHA Generic Integrity, RXM Generic Integrity, and RXM Trade Name Integrity reports ◦ MAGIC or C/S – 5.66 reports are available ◦ MAGIC or C/S – earlier than 5.66, programming will provide reports

7.  All 3 reports will review drugs (including retail entries in PHA) between what is in your database versus the raw data on FSV file ◦ Follow the steps provided by MEDITECH. Each report will have certain criteria to streamline what is on each report. ◦ There will be thousands of hits – Do NOT be overwhelmed ◦ Many entries on each report will be “false positives”. Take enough time to go through each list thoroughly in Test so that a proper evaluation can be made

8.  Evaluation of the reports will outline how many errors reside in your dictionaries.  Logically, the trend has been…. The longer you have been Live with RXM, the more recycled NDC numbers that exist.  Insert Question: Are you currently using RXM functions in your Live environment? ◦ Yes, currently utilize Medication Reconciliation ◦ No ◦ System is in Live, but not being used

9.  If you are not Live or Live but stagnant, then a complete expunge can be made in RXM  PHA Generic cleanup will still need to be completed  If you are Live….

10.  Manual Cleanup ◦ After reviewing the reports the hospital chooses to make RXM edits on their own  Automated/Full Expunge ◦ Completely expunge the whole RXM Drug dictionary ◦ NOTE: Drugs on a patient’s record will be inactivated and de-indexed  Automated/Almost Full Expunge ◦ Expunge all RXM Drugs not associated to a patient’s record ◦ Can also include other groups from expunging: User Defaults, RXM Order Sets, Favorite Sets, and Procedures ◦ All drugs not expunged will stay in their current active state

11.  Full Expunge ◦ Since all drugs will be inactivated and de-indexed you will need to reload the RXM Drug dictionary with the next FSV load ◦ Alternative workflow process will need to take place once complete as drugs on patient profiles will be inactive.  Medication Reconciliation should be reviewed upon entry into facility  Scripts should only be affected during renewal

12.  Almost Full Expunge ◦ You will need to reload the remaining RXM Drugs with the next FSV load ◦ Manual cleanup will take place for all drugs not expunged ◦ Workflow should not be affected after completion  Drugs on patient’s home medication list or previously written as scripts won’t be expunged

13.  Create a custom report to download the entire RXM Drug dictionary with fields to assist in the process (recommended to include GPC code)  Integrity reports that you reviewed before making the decision to expunge should be used to clean up drug descriptions.  Trade Names and Generic Names may need to be optimized/updated for consistency. Create a style guide and stick to it.  If you run the Almost Full Automated expunge you will need to manually edit the Drugs not expunged. Report is provided by Meditech, run manually. Steps to clean up drugs should follow Best Practice so that they stay linked to FSV.  Strings will need to be added back to expunged drugs  Evaluate Favorites Lists, User Defaults, Procedures and RXM Order Sets

14.  Manual Expunge: No downtime should be warranted  Almost Fully Automated Expunge: Downtime should only last a few hours while the expunge takes place. FSV reload should not justify downtime.  Fully Automated Expunge : Downtime should last a couple of days as you will need to account for the expunge and the FSV load, file and RXM parameter connection

15.  The process should be evaluated in Test and Live  The complete cleanup is not necessary to be completed in Test (although recommended) but needs to be diligently evaluated

16.  Recommended to have a Pharmacy Informatics Analyst to run this project. ◦ Must be able to comprehend and evaluate drug data on Integrity reports ◦ Must be able to make edits in PHA Drug and RXM Drug dictionaries ◦ Must be able to review and edit PHA and RXM supporting dictionaries ◦ Must be able to enter RXM Drug strings

17.  Typically this process takes 12-13 weeks for 1 FTE. Will be 1.25-1.5 FTE if additional pharmacy resources are needed or may extend timeline  MEDITECH will open a master PHA task to follow through the process step by step ◦ Change Control will be necessary before each step ◦ Programming resources will need to be allocated/scheduled by the RXM Specialist. Allow a few days notice before you want to run the expunge, especially if there is downtime associated.

18.  When planning resources for the expunge, you may want to also consider…. ◦ Optimization in PHA for CPOE ◦ Drug strings for CPOE ◦ Setting up Dose Range Checking

19.  Medispan only: Issue with the Generic Mnemonic repopulating with a numeric value causing the description field to be nil. Need to change the FSV Generic parameter to pull from BOTH instead of KDC ONLY  Micromedex only: Issue where the Control Schedules loads as a nil value. MEDITECH needs to run a loop to correct the issue.

20.  FSV Process needs to be kept up-to-date each month/quarter. ◦ The FSV will not review drugs retroactively for recycled NDC on previous updates ◦ Should run and review all reports after PHA Load, PHA File and RXM Parameter Link  RXM Drug Activation: If you do a full expunge you will be prompted when attempting to reactivate a de-indexed drug ◦ Message will appear “NDC has been recycled, reactivation is not recommended. Continue?” ◦ Do not activate. Find diff drug w/same GPC code

21.  Prepare for your ePrescribing Interface Implementation  Take some time to optimize your RXM Drug Strings and Pharmacy databases for CPOE

22. William Salemi Regional Director  Bill has 20 years experience in Healthcare IT as a Project Manager, IT Director and Subject Matter Expert as well as several years experience as a Certified Pharmacy Technician. Currently as Director at Infinity HIT, Bill specializes on the implementation and optimization of the Pharmacy databases, ePrescribing and MEDITECH’s Advanced Clinical Applications.  wsalemi@infinityhit.com wsalemi@infinityhit.com  Mobile: 508-838-7293