# Presentation: 792697

## Overview of Technology Approaches of Medication Management in Long-Term Care

- Rachelle “Shelly” Spiro, RPh, FASCP
- President, Spiro Consulting

## Overview

- e-Prescribing and eMAR
- LTC e-Prescribing standards and pilots
- Summary

**Overview**

## 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

- 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

## 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.pdf 

- 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.pdf

## LTC EHR Standards

- 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

**LTC EHR Standards**

## CCHIT LTC Roadmap

| CCHIT Roadmap for Expansion of Certification
Feb 2, 2007  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- |
| Expansion Area | Jan-Jun
2007 | July-Dec
2007 | 2008 | 2009 | 2010 |
| 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_20070202.pdf

## e-Prescribing and eMARs

- 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

**e-Prescribing and eMARs**

## eMAR Standards

- Integration
- Hardware and software
- Further standards of eMAR and inventory management is needed
- REMOTE DISPENSING*

**eMAR Standards**

- *Covered in next presentation

## 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

- Source: http://www.iom.edu/Object.File/Master/35/943/medication%20errors%20new.pdf

## Grantee/Contractor Project Titles for e-Prescribing AHRQ Pilot Project

| Organization Name 	  | Project 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 KePRO  | A Practice-Based Pilot Site Test of Emerging E-prescribing Standards |
| RAND Corporation  | Test of Medicare’s Initial Electronic Prescribing Standards in the New Jersey E-prescribing Action Coalition |
| SureScripts, LLC  | Maximizing the Effectiveness of E-prescribing Between Physicians and Community Pharmacies |

## Purpose of LTC e-Prescribing Pilot

- Validate that the e-Prescribing and electronic Prior Authorization standards work in a LTC setting

**Purpose of LTC e-Prescribing Pilot**

## e-Prescribing in the LTC Setting

- 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

**e-Prescribing in the LTC Setting**

## Summary

- 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

**Summary**

## Thank you

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