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Louis Cheung, Clinical Systems Application Pharmacist, Peninsula Health - Exploring what is needed to Facilitate System Interface between two Vendors: Cerner Powerchart with iPharmacy
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Louis Cheung, Clinical Systems Application Pharmacist, Peninsula Health - Exploring what is needed to Facilitate System Interface between two Vendors: Cerner Powerchart with iPharmacy

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Louis Cheung delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and …

Louis Cheung delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems.

For more information, please visit http://www.healthcareconferences.com.au/emed14

Published in Health & Medicine
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  • 1. System Interface Between Two Vendors: Cerner Powerchart with CSC iPharmacy Louis Cheung, Peninsula Health SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 2. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Peninsula Health - background
  • 3. Major public health care provider serving metro and rural areas on Victoria’s Mornington Peninsula (catchment area of approx. 850 sq. kms) SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Peninsula Health - background Measure 2011-2012 Staff (EFT) Medical 373 Nursing 1517 Allied Health 328 Other 1168 Total 3386 Structure Facilities Acute (incl. Maternity), Sub- acute (incl. residential care), Mental Health and Community Health Beds 878 (Acute -527, Mental Health – 74, Rehabilitation, Aged and Palliative Care – 277) Theatres 8 Throughput Admissions(Overnight/Day) 75,345 Community Occasions of Care 235,467 Babies Born 2675 Emergency Visits 79,311 Operations 15,121
  • 4. Development of e-MR at Peninsula Health – Background/Timelines 2007 2002 October 2009 June 2011 June 2012 August 2013 Oct 2014 Investigated other clinical solutions. Business case developed Orion implementation: e- results viewing, Dis Summ, Dis meds &e-prescribing (sub-acute) Announced as Lead Agency (with Austin Health) to implement HealthSMART Clinicals using CernerFirst Go-Live of Stage 1, Phase A Final Go-Live of Stage 1, Phase A First Go-Live of Stage 1, Phase B Final Go-Live of Stage 1 Phase B Proposed EDIS Go-Live November 2011 SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 5. Clinical system at Peninsula Health – 2013 SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Cerner Millenium iPM Synapse Dorevitch Radiology PAS Pathology Pharmacy iPharmacy
  • 6. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Why interface? Marianne Lisby, Lars Peter Nielsen, and Jan Mainz. Errors in the medication process: frequency, type, and potential clinical consequences Int J Qual Health Care (2005) 17 (1): 15-22
  • 7. Dispensing Inventory Control Purchasing PBS Claim Reports Prescribe in Cerner Powerchart Clinical review & product assignment in Cerner’s PharmNet e-Rx (inpatient & discharge) Decisionsupport iPharmacy X Integration between two vendors SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE ACK
  • 8. Medication Process Workflow SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 9. Boy accepts dare… SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE "The Simpsons Movie" Copyright © Fox Network
  • 10. Boy loses control of his skateboard… SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE "The Simpsons Movie" Copyright © Fox Network
  • 11. On admission SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE • Bart’s details are entered into iPM • Weight and allergies are documented • Pathology and radiology tests are ordered
  • 12. Document home medication and Admission medication reconciliation SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE • Home medications are documented electronically • Home medications are reconciled on admission and inpatient medications charted on the same screen
  • 13. Clinical ordering SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE • Inpatient medications are ordered
  • 14. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Inpatient eRx • Cerner Powerchart will differentiate between imprest and non-imprest items • Only verified items will send an eRx message
  • 15. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Discern report to replace inpatient eRx • PH has developed a discern analytics report + Excel macro to filter all non-imprest orders regardless of verification status
  • 16. Doctor rounds SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 17. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Discharge reconciliation • Home and inpatient medications are electronically converted and reconciled in Cerner Powerchart iPharmacy
  • 18. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Refilling the prescription in PharmNet Refill • These discharge orders appear in PharmNet Retail ready to be ‘refilled’ • Select a dispensing pharmacy
  • 19. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Refilling the prescription in PharmNet • Pick the product off the shelf then select that product in the PharmNet product window
  • 20. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Refilling the prescription in PharmNet • Check that the order (quantity, SIG) is OK to be sent to iPharmacy
  • 21. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Refilling the prescription in PharmNet • Repeat for other eRx orders
  • 22. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Dispensing the prescription in iPharmacy • Open iPharmacy 5.7.1002 build 6 or later version • Click on Dispensing > e-Rx orders
  • 23. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Dispensing the prescription in iPharmacy • Search for patient UR and select appropriate eRx orders
  • 24. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Dispensing the prescription in iPharmacy • Check that the orders are OK to be dispensed and click ‘Process’
  • 25. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Dispensing the prescription in iPharmacy • iPharmacy will do a patient entitlement and financial values check
  • 26. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Dispensing the prescription in iPharmacy
  • 27. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Records of dispensing in Powerchart • Right click the discharge prescription order in Powerchart > click ‘Order Info’ > History tab
  • 28. Difference between inpatient and discharge eRx Data Inpatient Discharge Application Med Manager Retail Product Automatic Manual Verification/Refill Automatic Manual SIG translation No Yes Quantity Automatic (system) Automatic (doctor) Other Cartfill reports SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE • Pilot wards for discharge eRx: ED, ESSU, ESW
  • 29. Build Design SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 30. e-Chinese Whispers Cerner PharmNet CSC iPharmacy HSS IE PH IE SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Testing, testing and more testing…
  • 31. Devil is in the details Prescriber • Name, alias, PBS prescriber # Patient • Name, Medicare, concession, address, etc Order details • Product, Order ID, dispense ID, SIG, quantity, UOM PBS data • PBS restriction, streamline, authority codes, reg 24 SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 32. Where’s Wally? MSH|^~&|CERNERPHARM|FH|PHIE|FH|20140307191711||ORM^O01|Q77776745T80839191|P|2.3.1 PID|1||0000000^^^FH^MR~~ERROR^^^AUSHIC^PEN~~30026770712^^^AUSHIC^MC||Dummy^Fred^John^^^^CURRENT~Dummy^Fred^Tester^^^^A||19 210101000000|M||8|Kkljklk.^3 Frankston-Dandenong Rd^Frankston^VIC^3199^Australia^4~10 Olive St^^Overseas^VIC^8888^Overseas^3~Po Box 25 Bruce Stre^^Mentone^VIC^3194^Australia^2||(097)870-9999^PRN^PH||8179|5|2011||||||||0|||||N PV1|1|PBS Outpatient Invoice|E2220^F020^F020^2220^^Bed170^2220|6|||^^^^^^^^^^^^BUILD_ERROR||||||||||PH00129^HEWITT^Helen^^^Dr.^^^^^^^External Identifier~R173^HEWITT^Helen^^^Dr.^^^2220^^^^ORGANIZATION DOCTOR~0584286A^HEWITT^Helen^^^Dr.^^^2220^^^^Provider Num|E|6583907^^^2220|NON PBS||Y|||||||||||||||||2220||C|||20130920080000|20130920152255 ORC|NW|185227631^HNAM_ORDERID|15072268^DISPENSEID|15072270^HNAM_RUNID|NW||^^D1^20140307000000^20150307235959^CD:7159890 ^^Take 6 mL FOUR times a day||20140307191710||^CHEUNG^LOUIS|PH00090^PH00090 PH00090 Katherine BRISTOW^0874363~~|CD:18579840^^^CD:9572758^^Pha193^2220||20140307191710|NW|CD:28549375 RXO|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^Stocca|1||^bottle(s)|CD:318203^|||E2220^F020|||1||0||||15072268 RXR|^Oral RXE|^^D1^20140307000000^20150307235959^CD:7159890^^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle T6 ELIXIR QID #1|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^AMT-TPP^22589011000036109^paracetamol 240 mg/5 mL elixir 200 mL^AMT-MPP|1||mls^mL|CD:318203|^T6 ELIXIR QID~^Take 6 mL FOUR times a day~^Take 6 mL FOUR times a day||Y|1|mls^mL|0|PH00090^BRISTOW^Katherine^^^Dr.^^^^^^^External Identifier~0874363^BRISTOW^Katherine^^^Dr.^^^AUSHIC^^^^PRES~SS10^BRISTOW^Katherine^^^Dr.^^^2220^^^^ORGANIZATION DOCTOR~2049737X^BRISTOW^Katherine^^^Dr.^^^2220^^^^Provider Num|PH04471^Cheung^Louis^^^^^^^^^^External Identifier|33723628- ||00|20140307000000|||~^PBS~~OPDRX^Outpatient Pharmacy RXR|^Oral|||MED RXC|B|12601011000036104^Panamax elixir 240 mg/5 mL oral liquid: solution, 200 mL, bottle^AMT-TPP^22589011000036109^paracetamol 240 mg/5 mL elixir 200 mL^AMT-MPP|1|mls^mL|1 OBX|1||1770E^N|||||||| SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 33. Aligning the databases • 1,200 doctors mapped and cross-checked. – Name, unique ID and prescriber # – Currently 1,400 doctors mapped – IT provisioning send doctor codes to pharmacy • iPM (PAS) feeds patient information into both Cerner applications and iPharmacy – no mapping required between Cerner & iPharmacy SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 34. Aligning the databases • Using the Trade Product Pack (TPP) code, – 3,200 formulary items mapped and cross-checked • Generic, brand, strength, form and pack size – 3,200 product unit of measure (UOM) cross- checked and discrepancies addressed – 5,600 item formulary statuses mapped – Review every 3 - 6 months SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 35. Aligning the databases • 3,200 drug imprest locations mapped – Only non-imprest items are sent through the inpatient eRx • 40 inpatient wards mapped – Outpatient wards not currently using Powerchart • PBS codes – Various salts (e.g. clopidogrel) – Dispersible vs. non-dispersible (e.g. omeprazole) – Various pack sizes (e.g. Slow-K vs. Span K) SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 36. Building/translating the SIG SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Dosage Form Verb Quantity per dose Unit of measure Route Frequency Tablet Take x Tablet - Capsule Take x Capsule - Inhaler Inhale x Puff - Liquid Take x mL by metric measure - Eye Drops Instill x Drop [route] Patch Apply x Patch To the skin • Example of SIG translations
  • 37. Lessons Learnt SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE
  • 38. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Issues • Problems on both sides of the fence • PharmNet Retail – unable to check PBS codes – not suitable for PBS claiming – Reg 24 and PRN not immediately obvious – SIG does not always generate • ‘Zz’, SIG = [dose][route][freq][duration][PRN][spec inx] • iPharmacy issues
  • 39. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE iPharmacy issues Date Issue 16/08/13 When Editing a dispensing written by a doctor processed via e-Rx, it only allows us to choose a 16/08/13 Doctor prescribed Clopidogrel-DRLA with PBS code 5436D. In e-Rx pharmacist changed product to Pla 7/03/13 Want to be able to tick the 'Own Supply' tickbox from the e-Rx orders screen 5/07/12 Want to be able to alter the number of repeats from the e-Rx orders screen 19/03/12 The Total Qty being displayed in the Rx Details window is incorrect for orders passed from the 1/10/12 Cannot get the 'Team' field in the e-Rx screen to populate with the Prescriber's Team in i 28/05/12 The e-Rx module is unable to dispense an item not listed in the PBS/RPBS list but has been approved 10/05/12 In the e-Rx interface for Cerner, the Script Classification matches the first word in i.Pharmacy. 8/05/12 When the TPP from the ORM message does not automatically assign a product in the eRx window and 14/02/12 The "On Imprest" 'Action' default in the e-Rx window needs to consider the 'Check Imprest' value 14/02/12 Patient Price and PBS Claim Price are appearing as 0 19/01/12 Placer Filler number (Dispense_ID from Cerner) according to specs supposed to populate dspn_order_id 18/06/13 When dispensing a script from eRx functionality for a patient with GOLD card and SN card, it is rej
  • 40. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Issues • Initial testing shows increased time taken to dispense – Due to iPharmacy issues • Doctors don’t always get the quantity right – Direct information to iPharmacy • SIG is not always correct – E.g. Spiriva inhalation capsules • iPharmacy (Stocca) will reject messages
  • 41. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Lessons Learnt • Novel approach – Process could be more streamline – Preferable if eRx order could be dispensed straight from the eRx window – Potential full roll-out across network if successful • Testing, testing, testing… • Vlookups will be your best friend • Development/maintenance is a full-time job
  • 42. SERVICE • INTEGRITY • COMPASSION • RESPECT • EXCELLENCE Thank you