1. Department of Veterans Affairs Consolidated Mail Outpatient Pharmacy August 3, 2011 Bob Gale R.Ph., MBA Medication Image Library Pharmacist Department of Veterans Affairs Consolidated Mail Outpatient Pharmacy CMOP Medication Image Library (MIL) 1

2.  The Idea for MIL  Impact  Goals  Program Development  Standardization  Roll-Out  Summary  Questions 2 MEDICATION IMAGE LIBRARY(MIL): AGENDA

3.  VA T21 Initiatives  “ Enhance the Veteran’s Experience and Access to Health Care”.  “Increase Veteran client satisfaction with health, education, training…”  Interactive VA Point of Service (VPS) KIOSKS 3 THE IDEA FOR MIL: SUPPORTING OUR VETERANS

4.  Improve Veteran Learning Environment  Medication Reconciliation Directive  Image Standardization  Decrease Workload Across VA  Future: Medication Image on RX Label 4

5. 1. Catalogue Existing Images 2. Include All VA Products 3. Centralized 4. Standardized 5. Up to Date 6. Accurate and Verified 5

6. 6

7. 7

8. 8

9. 1. Catalogue Existing Images 2. Include All VA Products 3. Centralized 4. Standardized 5. Up to Date 6. Accurate and Verified 9

10. 10

11.  Listed Colors:  Sky Blue  Light Blue  Medium Blue  Gray-Blue  Colors Listed in Existing CMOP Image Database:  Sky Blue  Light Blue  Medium Blue  Gray-Blue 11

12. 1. Catalogue Existing Images 2. Include All VA Products 3. Centralized 4. Standardized 5. Up to Date 6. Accurate and Verified 12

13.  Define Technician and Pharmacist Roles  Ability to Track NDC Progress through Program  Ability to Retrieve All Images for an NDC  Move Image to Editing Program and Back.  Confirm Data and Image  Centrally Store Verified NDC Data and Images

14. 1. Retrieve Image and Data by NDC 2. Review, Edit, and Confirm Images 3. Review, Edit, and Confirm Data 4. Verify Image and Data 5. Store Verified Image and Data 14

15.  FDA Data Standard Manual (DSM)  Standards:  Color  Scoring  Shape  Size  Imprint Recording  Image Format  NLM, NIH and FDA Patient Safety Initiative  Recommendations:  Image Size  Photographing and Image Editing 15

16.  Based on FDA Standards and NLM/NIH/FDA Recommendations  Colors  Shapes  Scoring  Size  Recording of Markings  Medication Imaging and Editing 16

17. 17

18. 18

19.  Based on Numbering System  Number of Equal Pieces that a Solid Dosage Form can be Divided.  Solid Capsule or Tablet – Score Value = 1  1 Score Line – Score Value = 2  2 Parallel Score Lines – Score Value = 3  3 Parallel Score Lines or Two Intersecting Lines - Score Value = 4 19

20.  Based on FDA Standards and NLM/NIH/FDA Recommendations  Colors  Shapes  Scoring  Size  Recording of Markings  Medication Imaging 20

21. MIL STANDARDS: LAYOUT 21

22. MIL PHASE I: EXISTING IMAGES  Editing Existing Image Database 1. Review 109,000 NDC Images and Data 2. Priority – NDC’s used by CMOP 3. CMOP’s - Continue Taking Own Photos 4. Roll-Out of Image and Data Standards 22

23. MIL PROGRAM: LOG IN 23

24. 24

25. 25

26. MIL PROGRAM: SELECT NDC 26

27. MIL PROGRAM: NDC STATUS 27

28. MIL PROGRAM: TECH REVIEW 28 12 3 4 5 6 7 8

29. MIL PROGRAM: IMAGE REVIEW 29

30. MIL PROGRAM: IMAGE REVIEW 30

31. MIL PROGRAM: SELECT FOR EDIT 31

32. MIL PROGRAM: IMAGE EDITING 32

33. EDITING: BEFORE AND AFTER 33 AFTER BEFORE

34. MIL PROGRAM: NEW IMAGE 34

35. MIL PROGRAM: DATA REVIEW 35

36. MIL PROGRAM: DATA EDITING 36 SHAPE: TEAR COLOR: PINK FRONT IMPRINT: DV BACK IMPRINT: NVR SCORE: 1 DRUG ID: TEAR/PINK/SCORE1/TABLET/DV;NVR

37. 37

38. MIL PROGRAM: RPH REVIEW 38

39. MIL PROGRAM: RPH VERIFY 39 1 2 3

40. MIL PHASE II: PHOTOGRAPHING  Photographing Phase 1. Begin Photographing Medication 2. Customer Image Requests 3. Maintain and Expand Library 40

41. DATA AND IMAGE USE  FUTURE:  Kiosks  Labels  NOW:  CMOP Prescription Filling and Verification Process  VAMC – CMOP National Web Application 41

42. CMOP: CANISTER REPLENISHMENT 42

43. CMOP: RETURN TO STOCK 43

44. CMOP: PRESCRIPTION LABELING 44

45. CMOP: RPH VERIFICATION 45

46. DATA AND IMAGE USE  FUTURE:  Kiosks  Prescription Labels  NOW:  CMOP Prescription Filling and Verification Process  VAMC – CMOP National Web Application 46

47. VAMC: CMOP NATIONAL WEB APPLICATION 47

48.  Medication Image Library  Veteran Education and Reconciliation  CMOP Image Standardization  Central, Standard Image Data Base 48

49.  Bob Gale  Robert.Gale@va.gov Robert.Gale@va.gov  1-708-786-7820 49