Product Effectiveness Benefits Realization Assessment of the Pharmacy Re-Engineering (PRE)...

Product Effectiveness Benefits Realization Assessment of the Pharmacy Re-Engineering (PRE) Medication Order Check Healthcare Application (MOCHA) software

Tom FaganPharmacy Benefits Management Clinical Informatics Instructor

VETERANS HEALTH ADMINISTRATION

Learning Objectives

• Understand the Mission of Pharmacy Benefits Management • Understand the Background on Pharmacy Re-Engineering

Project (PRE) including (MOCHA) Medication Order Check Healthcare Application

• Understand the reason and goals for Benefits Realization assessment of PRE including MOCHA by OHI PE Team

• Understand the data sources, methodology and rationale used in assessment

• Understand initial assessment findings and recommendations


Mission of Pharmacy Benefits Management

• To improve the health status of veterans by encouraging the appropriate use of medications in a comprehensive medical care setting.

• Functions– Drug Benefit Design– Evidence-Based Formulary Management– Utilization Management – Staff Education– Patient Safety


Clinical Informatics

• Application of Information Technology to deliver Healthcare Services


(PRE) Pharmacy Re-engineering Background

• Began in 2002• Multiple Increments Project Management• Main Goal to Improve VistA Pharmacy Package

– Respond to Patient Safety Issues– Medication cost reduction– Improved workflow and process


PRE Increments

• First Iteration

Increment 1 – PRE Foundational Enhancement Increment 2 – Pharmacy Enterprise Customization System (PECS) Increment 3 – Medication Order Check Healthcare Application (MOCHA v1.0 ) (Non-Dosing) Increment 4 – Medication Order Check Healthcare Application (MOCHA v2.0 ) (Dosing) Increment 5 – Pharmacy Enterprise Customization System Enhancements Increment 6 – Enhanced Order Checks


PRE Pharmacy Re-engineering Components

• MOCHA–Medication Order Check Healthcare

Application • PECS– Pharmacy Enterprise Customization System

• PPS– Pharmacy Product System


Accessing PECS

• Have your ADPAC assign you the following security key:

PSS_CUSTOM_TABLES_REQUESTOR

• Access PECS through this link:

https://vapreapp1.aac.va.gov:8443/ct/public/Welcome.action




MOCHA V1.0

• Medication Order Check Healthcare Application – MOCHA v1.0

• Rolled out during the summer of 2011• Delivers a valuable enhancement to medication order checks in

the Pharmacy and CPRS packages • Utilization of a clinical drug database vendor, First Databank (fdb)• Enhanced Therapeutic Classification (ETC) allows for multiple

classes per drug, thereby reducing the number of clinically inexact or inappropriate warnings


MOCHA V2.0

– MOCHA v2.0 (Dosing) Development• Introduces dosage order check functionality which will reduce medication

errors, adverse events, and potential deaths• Provides an extremely valuable tool to VA clinicians in CPRS, Inpatient

Pharmacy, and Outpatient Pharmacy• Version 2.0 consists of a maximum single dose check derived from the

patient’s age, weight, and body surface area (BSA)• Currently installed in six test site environments with a planned national

release of July 2012


Stated Benefits of PRE

• Increased Patient Safety • Increased Efficiency of Prescription and Order

Processing • Decreased Costs • Increased Satisfaction • Increased Regulatory Compliance


Goal for Assessment

• Office of Health Information (OHI) Product Effectiveness (PE) Benefits Realization (BR) Assessment

• One key question– Is VHA realizing the intended benefits from the PRE functionality, and

if not, what can be done to make needed improvements?


Measureable Goals

1. Patient Safety2. Increased Efficiency of Order Processing3. Decreased Costs 4. Increased Satisfaction5. Increased Regulatory Compliance


Data Sources

1. PBM Database ProClarity Cube2. HR Employee Cube3. Non-Formulary Request Processing Reports4. National Drug File support Group5. PBM Inventory Data6. PBM Order Check Analysis Worksheet 7. vaADERS8. Office of Information IT Patient Safety Office

Database:


Surveys

1. VHA National Survey of Pharmacists2. PE Customer Satisfaction Focus Groups3. VA All Employees Survey4. Survey of Healthcare Experiences of Patients


Methodology Overview of BR

• Product Effectiveness Mission – Independent Assessment and Analysis– Benefit Realization - evaluate benefits against a specific outcome

• Initial Measurement (now)• Post Implementation Performance (future)


Methodology Scope

• PRE Multiple Increments – Initial– Post Implementation


Rationale

• Measurements• Findings• Recommendations


Initial Assessment Findings

• Establish a Baseline before PRE upgrades


Initial Assessment Recommendations

• Patient Safety• Alert Fatigue• Staff Satisfaction


Major Recommendation

• Measurements on Annual Basis• Identify Trends due to upgrades


Recommendation Monitoring Details

1. Safety Metrics2. MOCHA3. Staff Satisfaction 4. Work Flow


Key Findings

1. Increased Patient Safety and Decreased Costs2. Increased Satisfaction Mixed

-MOCHA


ASHP 2009 Drug Drug Interaction (DDI) Survey

• Pharmacists • Identify Areas for Improvement• Knowledge Gap –no formal education on how to evaluate and

respond to order checks


Summary

• Benchmark Established• Increment Assessment

Is VHA realizing the intended benefits from PRE if not what can be done to make needed improvements?

Product Effectiveness Benefits Realization Assessment of the Pharmacy Re-Engineering (PRE)...

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