1. Spiro Consulting Overview of Technology Approaches of Medication Management in Long-Term Care Rachelle “Shelly” Spiro, RPh, FASCP President, Spiro Consulting 1

2. Spiro Consulting LTC Electronic Health Record (EHR) Standards e-Prescribing and eMAR LTC e-Prescribing standards and pilots Summary 2 Overview

3. Spiro Consulting HHS-ASPE Study to Access Business Case for LTC HIT Types of Health Information Technology (HIT) applications and functionalities in Post Acute Care (PAC) and Long-Term Care (LTC) Based on stakeholder description and technical expert panel (TEP) input Exhibit A-1 summarizes the types of HIT applications, functionalities, and the applicable PAC/LTC setting in which the applications are used 3 Source: U.S. Department of Health and Human Service (HHS) Assistant Secretary for Planning and Evaluation (ASPE) Office of Disability, Aging and Long-Term Care Policy EVALUATION DESIGN OF THE BUSINESS CASE OF HEALTH INFORMATION TECHNOLOGY IN LONG-TERM CARE http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf

4. Spiro Consulting 4 Source: U.S. Department of Health and Human Service Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy EVALUATION DESIGN OF THE BUSINESS CASE OF HEALTH INFORMATION TECHNOLOGY IN LONG-TERM CARE http://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdfhttp://aspe.hhs.gov/daltcp/reports/2006/BCfinal.pdf

5. Spiro Consulting E-prescribing ◦ CMS-AHRQ LTC e-prescribing pilot ◦ Modifications to NCPDP SCRIPT standard HL7 Continuity of Care Document (CCD) ◦ Standard for the exchange of clinical documents ◦ Replaces MDS HL7 EHR System (EHR-S) Functional Model ◦ The standard for the functions needed in an EHR-S 5 LTC EHR Standards

6. Spiro Consulting CCHIT LTC Roadmap 6 CCHIT Roadmap for Expansion of Certification Feb 2, 2007 Expansio n Area Jan-Jun 2007 July-Dec 2007 200820092010 Care Settings Long Term Care Further discussions Begin Development------ - Launch? TBD Launch TBD Proposed for August 2009 Source: http://www.ahima.org/infocenter/whitepapers/documents/Public _Comment_Expanding_CCHIT_Certification_Roadmap_200702 02.pdf http://www.ahima.org/infocenter/whitepapers/documents/Public _Comment_Expanding_CCHIT_Certification_Roadmap_200702 02.pdf

7. Spiro Consulting e-Prescribing ◦ Prescription order entry ◦ Bar code scanner for re-supply ◦ Web connections ◦ NCPDP Script ◦ HL7 Electronic Medication Administration Records (eMARs) ◦ Proprietary or HL7 ◦ System at a minimum include the “Five Rights”  Right Resident  Right Medication  Right Dosage  Right Route  Right Time 7 e-Prescribing and eMARs

8. Spiro Consulting Pharmacy versus facility driven Integration Hardware and software Further standards of eMAR and inventory management is needed REMOTE DISPENSING* 8 eMAR Standards *Covered in next presentation

9. Spiro Consulting Reduction in Adverse Drug Events Theoretically an integrated eMAR and EHR would help reduce adverse drug events (ADE) and medication errors July 2006 the Institute of Medicine’s report on “Preventing Medication Errors” concluded that of the 1.6 million nursing home population in the U.S., 800,000 preventable ADEs could occur each year 9 Source: http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdfhttp://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf

10. Spiro Consulting Grantee/Contractor Project Titles for e-Prescribing AHRQ Pilot Project 10 Organization NameProject Name Achieve Healthcare Information Technologies, LP LTC E-prescribing Standards Pilot Site Study Brigham and Women’s Hospital Electronic Prescribing Using a Community Utility: The e-Prescribing Gateway Ohio KePROA Practice-Based Pilot Site Test of Emerging E- prescribing Standards RAND CorporationTest of Medicare’s Initial Electronic Prescribing Standards in the New Jersey E-prescribing Action Coalition SureScripts, LLCMaximizing the Effectiveness of E-prescribing Between Physicians and Community Pharmacies

11. Spiro Consulting To study the effects of the electronic prescribing standards in long-term care on cost, quality and safety Validate that the e-Prescribing and electronic Prior Authorization standards work in a LTC setting 11 Purpose of LTC e-Prescribing Pilot

12. Spiro Consulting Three way communication: prescriber, nurse, pharmacy Resident is not a patient ◦ SCRIPT adjustments for unit/room/bed, resident, facility information Medications are delivered ◦ Communicate admission and discharge information to the pharmacy (new census message) Medication “chart” orders are open-ended ◦ Orders need to be cancelled or discontinued Facility needs to know the medication was actually dispensed Resupply requests represent 80% of LTC orders ◦ Resupply message 12 e-Prescribing in the LTC Setting

13. Spiro Consulting LTC industry is working on EHR-S standards LTC setting e-Prescribing can be supported with some technical modifications to the standards Additional research should be done on electronic prior authorization (e-PA) Further standards of eMAR and inventory management is needed These efforts are ways the industry is improving medication safety in the LTC setting 13 Summary

14. Spiro Consulting Thank you Shelly Spiro President, Spiro Consulting 1200 First Street, Suite 1632 Alexandria, VA 22314 703-599-5051 www.spiroconsulting.net 14