1. BCMA @ HSCQC, January 9, 2012 BAR CODED MEDICATION ADMINISTRATION (BCMA) UM-CareLink BCMA Solution Implementation Projects Project A: Bi-directional interface activation Project B: Implement bar code medication scanning

2. Medication Use Process Errors and Bar Code Scanning

3. Impact and Prevalence of BCMA Poon, et al. : Observed 14,041 medication administrations and reviewed 3082 order transcriptions. 11.5% error rate without BCMA vs. a 6.8% error rate when BCMA used — a 41.4% relative reduction in errors (P<0.001). T The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). Morriss results in the neonatal ICU: A total of 92 398 medication doses were administered to 958 subjects. The BCMA system reduced the risk of targeted, preventable ADEs by 47%, controlling for the number of medication doses/subject/day. 2011 ASHP survey of 1401 hospitals: 50% of hospitals have adopted BCMA and 66% of hospitals > 600 beds have adopted BCMA.

4. 4 UM-CareLink Pharmacy Verification Signal Only Medication Order Messages Open Loop CURRENT STATE: Cannot Scan

5. UM-CareLink Pharmacy Verification & Dispensed Product Information Medication Order Messages Closed Loop PROJECT A: Activate Interface

6. 6 PROJECT B: Implement Scanning Image from: http://www.stjohns.com/news/images/mercymeds.jpg

7. Success Factors Fix known interface issues Address UMCL 5.5 upgrade/Windows7 dependencies Overcome internal resource competition Identify and assign necessary specialists Productive vendor relationships Enterprise-wide commitment to BCMA

8. Projects A & B: Incremental Budget Needs Original Capital $1.95M Funds RemainingEquipment to PurchaseAvailable $300K MCIT$200K Scanners$100K MCIT $150K Nursing$150K Nursing Additional Incremental (New) Costs Estimates* $210K + $250K - $100K = $360K Labor MCIT $20K + $200K - $150K = $70K Labor Nursing $50K + $25K = $75K Labor Pharmacy $60K + $0 = $60K Server/Hardware $80K + $60K = $140K Vendor Services * Pending refinement and finalization of actual additional capital request +$705K

9. High level time-line & sequence BCMA Project A, Interface: 7 Months BCMA Project B: Nurse Scanning Roll-out 6 Months Feb ‘12 Sep Nov Apr ‘13 UM-CareLink 5.5 Upgrade Jan ‘12 Sep Jan ‘13 Pilot

10. Trade-offs – BCMA in 2012 means deferring these: + WORx pharmacy system upgrade + eMAR interface to TheraDOC + Rx IV room bar-code scanning system + Now & Then CPOE ( 600mg now & then 300mg BID ) + Insulin CPOE enhancements + Controlled substance CPOE enhancements + Restricting use of “as directed” in CPOE

11. We have the capacity for BCMA in 2012 + Nursing staff ready to support project + Pharmacy staff ready to support project + Medication-use system IT experts ready + Plan for Quality Assurance & Interface engineers BCMA would continue alongside UM-CareLink 5.5 Upgrade & along with building up the MiChart pharmacy team.