1. Drug File Management for Multidivisional Sites using EHR Brian K. Johnston DPh Lieutenant, USPHS Clinical Application Coordinator Choctaw Nation Health Care Center Talihina, Oklahoma

2. Objectives:  Multiple Divisional Drug File vs. One Division Drug File  Formulary Management and Drug File Maintenance  Communication System for Formulary and EHR Changes

3. Choctaw Nation Health System  145,000 ft² 37 Bed Hospital located in Talihina, OK  6 Satellite Health Clinics  Mail Order/Refill Center (opening spring ’07)  ~100 Physicians and Mid-Levels  Multidivisional Database ran from Talihina’s Servers (EHR distributed by Citrix)

4. Multidivisional Drug File PPros: –E–Each Pharmacy maintains their own Drug File (pro & con) –C–Custom Formularies based on Provider’s preferences –O–Open Access for Pharmacist’s Product Substitutions

6. Multidivisional Drug File (cont.)  Cons: –Physician Order Entry & EHR –Lots of Rx Editing –Renewing Orders in EHR –Outpatient Medications & Change “link” in EHR –Maintenance/Design of EHR & Drug File

11. One Divisional Drug File (Filtered) PPros: –S–Standardization of Products –L–Limited Access to Drug File –E–Ease of Menu/Quick Order Creation in EHR –S–Solves Renewal Problem with Multidivisional Sites

15. One Divisional Drug File (cont.)  Cons: –Intense Formulary Management –May require an Acquisitioning Technician –Time require to convert all refills to single drug file –10-15% of Products Revolve –Rx Editing Required

16. Formulary Management  Managing Multiple NDC’s –Pharmacy Director determines Generic substitutions –STOP McKesson’s product substitution –Small price changes DO NOT validate product switching –Drug File may contain Duplicates, Not EHR

19. Drug File Maintenance  3 Pharmacists control Drug File (Staff Pharmacist, Inpatient Director and CAC)  All P&T changes available 1 st of following month  Constant design required

20. Formulary Communication System  P&T determines approved Product & Dosage Forms  Pharmacy Director in coordination with Providers sets the standard strengths available  Acquisitioning Tech sends approved products information to Drug File Guardians  Acquisitioning Tech distributes list of specific items to all facilities

21. Formulary Communication System (cont.)  Drug File Guardian creates products in RPMS & EHR  New Products available 1 st of following month after P&T meeting  All “tweaks” for products are emailed to Drug File Guardians

22. EHR Design/Development  Standardized View for Providers in EHR  “Global” Picture of Patient’s Records  Copying of Main Menus in EHR  Updating a sub-menu places items in all divisions  P&T Restrictions/Messages instantly seen by all facilities  Citrix Portal Access

27. ???Questions??? bkjohnston@cnhsa.com