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“Incorporating an “Ask A Pharmacist” program into MyHealtheVet and Secure
Messaging”Presented by: Eric Spahn, Pharm D, Veteran Healthcare
System of the Ozarks (VHSO)/VISN 16
Contributors: Lynn Sanders, Pharm D, Director, Pharmacist Re-Engineering, VACO PBMLuAnn Barron, RPH Pharmacy Program Manager, VACO PBMMaureen Layden, MD, MPH Director of the Medication Reconciliation Initiative, VACO PBM
2011 VA Pharmacy Informatics Conference (West Coast Edition)
1
Healthcare literacy, medication adherence, adverse drug events, and access have contributed to a nationwide medication use crisis
Patients have limited “real time” access to comprehensive pharmacy services that mitigate this crisis by concentrating on safe, effective, and patient centered medication treatment management, review, and counseling
Patients have questions about their medications at home, after hours, and seek answers on the internet or in the non VA health care settings
Adverse drug events (ADE)s are the most common of all healthcare-associated adverse events and can occur when multiple changes to medication regimens take place in the context of poor patient education, inadequate medication resources, and lack of concise communication between the patient and provider
Face the Facts
2
Description of Innovation
“Ask A Pharmacist” incorporated within the MyHealtheVet (MHV) Pharmacy Section will provide Veterans, families and their caregivers info on:– Their VA Pharmacy: The CMOP, VA Formulary, and Frequently Asked
Questions– Their Medications: From trusted sources– How to connect with their pharmacist directly through a triage group
within Secure Messaging (SM) called “Ask A Pharmacist”
Veteran Centered - this program will connect the patient to the pharmacy and the pharmacist to the healthcare team
Both Veterans and the VA benefit as Veterans are motivated to become “In-Person Authenticated” and healthcare teams to increase awareness of available resources within MHV
3
Key Components
4
1. Ask A Pharmacist Secure Messaging Triage GroupUtilize slocal triage group development within SM, in which messages sent to “Ask A Pharmacist VHSO" can be triaged from patient or primary care provider to pharmacy tech, then to staff pharmacist. In effect, this should provide less interruption to on-site patient care as well as a reasonable time frame for appropriate response and follow-up. (Can currently being incorporated at local sights)
2. Ask A Pharmacist Clinical Content Addition to Pharmacy Section of MHVMHV will host an Ask A Pharmacist site which will include a Frequently Ask Questions (FAQ) archive developed by a National Pharmacy Workgroup as well as links to internal and external medication resources, maintained by the workgroup and MHV. This component is currently being developed by various MHV and PBM representatives using the CAB content addition process.
Do you have a question for a Pharmacist..?“VA pharmacists are dedicated to your health and well-being. You can search our archive for answers to general questions about health and medications any time, day or night. VA pharmacists have prepared hundreds of answers to commonly asked questions. In addition, Veterans who have completed the In-Person Authentication Process (IPA) can submit specific questions for a prompt, personal response through SECURE MESSAGING!”
Location In MyHealtheVet
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
View In MyHealtheVet
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Links to resources within
content
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Links to SM within content
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Links to Medications: Play
It Safe within content
Frequently Asked Questions
Frequently Asked Questions
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Link(s) to Secure Messaging
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Secure Messaging: Ask A Pharmacist
The way to do this within current functionality would be as follows:1. Have the MHV coordinator activate the Pharmacy Staff at a VAMC whose
job it would be to respond to the Ask a Pharmacist messages. 2. Create a Triage Group called Ask a Pharmacist Portland or Ask a Pharmacist
VHSO, etc and put the pharmacy staff on this Group.3. Have a CAC run a Reminders Due Report on the patients at that site who
have gone through In-Person Authentication and choose the Option to save this report as an OE/RR List. Name the OE/RR list Ask A Pharmacist and be sure to make this list Public.
4. Associate the Ask a Pharmacist Triage Group with the Ask a Pharmacist OE/RR list.
5. Patients will now be able to select the Ask A Pharmacist triage group as a recipient of a New Message.
6. The CAC will have to periodically refresh this list as new patients go through In-Person Authentication.
David Douglas, MD – Facility Chief Health Informatics Officer – Portland VAMC, VISN 20
Secure Messaging: Ask A Pharmacist Setup
Secure Messaging: Ask A Pharmacist Setup
Secure Messaging: Ask A Pharmacist Setup
Secure Messaging: Ask A Pharmacist Setup
Secure Messaging: Ask A Pharmacist Setup
Secure Messaging: Ask A Pharmacist Setup
PATIENT A
PATIENT B
PATIENT B
Secure Messaging: Ask A Pharmacist Example
PATIENT B
PROVIDER
PATIENT A
Secure Messaging: Ask A Pharmacist Example
PATIENT A
PATIENT A,
Secure Messaging: Ask A Pharmacist Example
PATIENT A
Secure Messaging: Ask A Pharmacist Results
David Douglas, MD – Facility Chief Health Informatics Officer – Portland VAMC, VISN 20
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Trusted Resources
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It SafeVA Pharmacy
Medications and Health
Ask A Pharmacist
Medications: Play It Safe!
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
VA Pharmacy
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Medications and Health
Frequently Asked Questions
Send A Secure Message
Trusted Resources
Medications: Play It Safe
VA Pharmacy
Medications and Health
Ask A Pharmacist
Medications and Health
Our colleagues agreed!
Strategic Goals Improve patient care
– Safety: Communicating the right information from VA resources and trusted external resources
– Quality: Activates patients to participate in shared and informed decisions about their medications
– Access: Provides asynchronous communication determined by the Veteran, family, or caregiver
Increase satisfaction across many stakeholders– Veteran, family, or caregiver– Their healthcare team
Improve Workflow– Decreases phone calls, visits, and time waiting at the pharmacy
window.– Assists in prescription processing questions as well as other
medication related topics
35
Strategic Goals (cont)
Address multiple unmet needs― Use MyHealtheVet (MHV) as a provider of an "Ask the
Pharmacist" Program ― Give Veterans a chance to “Ask Pharmacists” questions about
medications and health concerns through a pharmacy archive and/or secure messaging
― Provide both general and patient-specific drug information to our Veteran in one venue: MHV
Help meet organizational requirements― VA Medication Reconciliation Directive― Joint Commission― Meaningful Use
36
Success Metrics
Process Metrics– Site usage statistics– Deployment across the VA
Outcome Metrics– Decrease calls and visits to clinic and pharmacy– Decrease medication misadventure-related encounters
Satisfaction– Patient, caregiver, and family– Staff
37
Impacts
Stakeholders– The Veteran, family, and caregiver– Patient Aligned Care Teams(PACT)s, pharmacy, clinic, and
support staff– MyHealtheVet, VA Pharmacy Benefits Management,
National Medication Reconciliation Initiative
Current Support– Pharmacy Benefits Management
VA Medication Reconciliation InitiativeClinical Pharmacy
– MyHealtheVet– Daily Plan
38
Approach
Assemble a stakeholder and subject matter workgroup– Develop business requirements for each task and
functionality – Draw mock ups, use cases, and describe potential
scenarios– Plan for unintended consequences and comply fully with
VA patient information security standards
Submit request for proposal to contracting per VA policy
39
Team and Environment
Levels of support– Veteran Healthcare System of the Ozarks (VHSO)
Patient Satisfaction Surveys (SHEP) – Meets or exceeds National and VISN statistics
VISN 16 Veterans Rank 3rd in nation for online utilization of MHV Ask a Pharmacist VHSO has 297 associated, 266 opted in
– Enabled “Ask A Pharmacist” Secure Messaging Triage Group spread Portland VAMC VISN 20
– MyHealtheVet Clinical Advisory Board (CAB) content addition approval since 2008
Subject Matter and Stakeholder Workgroup– Pharmacists, providers, nurses, clinical application coordinators,
patient safety, quality & performance, and informational technologists– Program office and field representatives
40
Implementation Resources needed
– FTEE Program Analyst– FTEE Program Manager– Contracting for Prototype Development and Testing
Pre-Work: Local Pharmacist Secure Messaging Triage Group Roll Out – This pre-work is ongoing now within our facility (VHSO) and
Portland VAMC
Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet – Assemble candidate pilot groups– Identify project plan, key milestones, and communication
strategies with leadership 41
Timeline
Definition of Above Steps: Pre Work: Local Pharmacist Secure Messaging Triage Group Roll Out
• Step 1: Pre-work “Ask A Pharmacist” Secure Messaging Triage Group Roll Out• Step 2: Completions of requirements and supporting documents
Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet • Step 3: Contracting process• Step 4: Prototype Development• Step 5: Integration MHV applications• Step 6: Complete Testing
InnovationPre-Work
42
Budget Narrative
Pre-Work: Local Pharmacist Secure Messaging Triage Group Roll Out ― Clinical Application Coordinator/MHV Coordinator
development and implementation― Local projected costs based on 1hr/mo is ~$2000/yr
Innovation: “Ask a Pharmacist” Content Addition on MyHealtheVet – The cost of developing and deploying the software to support
the business requirements $150,000– The cost of the supporting pilot implementation $100,000– After the pilots have been deployed, operations and
maintenance costs for spreading throughout the VA $50,000 per fiscal year
43
Challenges and Risks
Challenges & Risks Lack of full incorporation
with MHV business architecture
Poor usage by patients, family, and caregivers
Lack of seamless integration with existing VA facility workflow
Mitigation Ongoing and effective
collaboration with MyHealtheVet
Broad-based outreach campaign
Ongoing and iterative feedback with key stakeholders in the field
44
Measures of Success Ask: Veterans deserve access to comprehensive pharmacy services to help
promote full participation in the successful management of their medication treatment plans
A Pharmacist: The most accessible healthcare profession will participate and promote multidisciplinary team based care via their Pharmacist
On MHV: The most patient friendly platform in the VA: MHV promotes internal sites and services as well as In-Person-Authentication (IPA) while reducing patients waiting on the phone or at the pharmacy window
Our colleagues agreed, ranked this 13th out of 4700 ideas, added positive comments like: “Great Idea!” “Possibilities are endless!” “Connects the patient to the pharmacist” “Helps with pharmacy and MHV integration”
We’ll know we are successful when we hear one Veteran say to another, “Its easy, I just went on “Ask a Pharmacist” and found
the answer I was looking for”. 45
Questions