Introduction to the HITSP

1
HITSP Real World Sites Medication Management
Webinar 8 September 10th, 2009 200 330
pm (Eastern)
Moderator Ken Majkowski, Surescripts Presenters
J. Marc Overhage, Regenstrief Institute Peter
Kaufman, DrFirst
2
Learning Objectives

• During this 90-minute webinar, participants will
  learn
• Learn how the HITSP Medication Management
  Interoperability Specification is being used
  today by the Regenstrief Institute, DrFirst, and
  Surescripts
• Explore the value and limitations of external
  sources of medication history
• Learn how various standards are employed in the
  HITSP Medication Management transactions
• Discover how DrFirst and Regenstrief have
  employed HITSP in the real world in the areas of
  e-prescribing, patient eligibility, formulary and
  benefit inquiry, and medication reconciliation

3
Agenda

• What is HITSP?
• Surescripts case study
• Regenstrief Institute case study
• DrFirst case study
• Overview of the 2009 Webinar Series
• Questions?

4
Mission
To serve as a cooperative partnership between the
public and private sectors for the purpose of
achieving a widely accepted and useful set of
standards specifically to enable and support
widespread interoperability among healthcare
software applications, as they will interact in
a local, regional, and national health
information network for the United States.
5
Overview

• HITSP is a volunteer-driven, consensus-based
  organization that is funded through a contract
  from the Department of Health and Human Services
• Created in 2005
• HITSP develops Interoperability Specifications
  (IS) documents that harmonize and recommend
  the technical standards that are necessary to
  assure the interoperability of electronic health
  records
• Production to date13 IS and 60 related
  constructs

6
HITSP Stakeholders

• Patients
• Consumers
• Employers
• General Practitioners

• Outpatient Providers
• Government Agencies
• Hospitals

• Review Boards
• Practice Guidelines
• Residential Care Providers

• Standards Developers
• Specialists
• Payers
• Suppliers

Current Participation in HITSP 800
organizations 1,000 individuals Over 25,000
volunteer hours
7
HIT Standardization

• HITSP members agreed that a standard is a
  well-defined approach that supports a business
  process and . . .
• has been agreed upon by a group of experts
• has been publicly vetted
• provides rules, guidelines, or characteristics
• helps to ensure that materials, products,
  processes and services are fit for their intended
  purpose
• is available in an accessible format
• is subject to an ongoing review and revision
  process

Standards Harmonization is required when a
proliferation of standards prevents progress
rather than enabling it.
8
Status Interoperability Specifications
Recognized
Released
Accepted
Secretary of HHS has recognized the IS for
immediate implementation
Secretary of HHS has accepted for a period of
testing
Panel approved for submission to HHS
Federal projects must use HITSP recognized
standards Per Executive Order 13410
9
HITSP Interoperability Specifications (IS)
Recognized
Accepted
10
HITSP Interoperability Specifications (IS)
11
Meaningful Use
From existing Interoperability Specifications,
determine subset required for meaningful use
as called for in the American Recovery and
Reinvestment Act (ARRA). Effort began on April
7, 2009.
12
(No Transcript)
13
Todays Focus . . .
Recognized
Accepted
14
Medication Management Real World
Sites Surescripts
Ken Majkowski, Pharm. D. Vice President, Clinical
Affairs and Product Strategy, Surescripts
15
Definition of E-Prescribing

• E-Prescribing supports a shift to a paperless and
  more informed way for payers, prescribers and
  pharmacists to communicate.
• E-Prescribing occurs when a prescriber uses a
  computer or handheld device with software that
  enables him or her to
• Electronically access that patients prescription
  benefit.
• With a patients consent, electronically access
  that patients prescription history.
• Electronically route the prescription to the
  patients choice of pharmacy. When the patient
  runs out of refills, his or her pharmacist can
  also electronically send a prescription renewal
  request to the physicians office for approval.

16
Provides electronic delivery of patient
prescription history from payers and pharmacies
to prescribers

• Prescription History Data
• Date Range of History
• Drug Name (Brand/Generic)
• Oldest Fill Date, Most Recent Fill Date
• Number of Fills, Days Supply, Quantity Dispensed
• Pharmacies/Prescribers

17
Surescripts National Progress Report Summary
Adoption
2006
2007
2008
Q2 2009
Prescription Benefit
33M
37M
79M9 patient visits
66M
Prescription History
4M
7M
16M1.8 patient visits
24M
Prescription Routing
11M
29M
68M4 eligible Rxs
78M
Total Message Volume
69M
107M
242M
303M
Opportunity
According to the August 2008 National Ambulatory
Medical Care Summary, an estimated 902 million
patient visits were made to office-based
physicians in 2006 an average of about 306.6
visits for every 100 persons. According to NACDS,
1.57 billion new prescriptions and renewals
eligible for electronic routing in 2008 in the
U.S. (Note Those 1.57 billion prescriptions do
not include controlled substances as they are not
eligible for e-prescribing under current DEA
regulations. That figure also excludes
preauthorized refills on existing prescriptions
because they do not require communication
between a physician and a pharmacist.)
18
Surescripts National Progress Report Summary,
continued
Adoption
2006
2007
2008
Q2 2009
Prescribers
16K
36K
74K
126K 21 prescribers
Payer Member Records
160M
200M
230M
222M
Community Pharmacies
34K
41K
47K
50K82 pharmacies
Mail Order Facilities
3
3
6
6
Opportunity
According to the August 2008 National Ambulatory
Medical Care Summary, an estimated 902 million
patient visits were made to office-based
physicians in 2006 an average of about 306.6
visits for every 100 persons. According to NACDS,
1.57 billion new prescriptions and renewals
eligible for electronic routing in 2008 in the
U.S. (Note Those 1.57 billion prescriptions do
not include controlled substances as they are not
eligible for e-prescribing under current DEA
regulations. That figure also excludes
preauthorized refills on existing prescriptions
because they do not require communication
between a physician and a pharmacist.)
19
Medication History for Hospitals

• Provides clinicians access to up-to-date
  medicationhistory for patients they are treating
  in an inpatient setting
• Person search
• Dispensed claims medication history

20
Medication History for Hospitals, continued

• Delivered to the acute care setting via strategic
  distribution partners
• DrFirst
• Emerging Health
• GE Healthcare
• Healthcare Systems
• InterMedHx
• HL7 Interface
• ADT
• RDS
• ORU

• Regenstrief
• Siemens
• Standard Register
• others

21
Value Drivers Disaster Relief

• In response to the lessons learned in the
  aftermath of Hurricane Katrina, a collaborative
  of public and private organizations launched
  ICERx.org (In Case of Emergency Prescription
  Database).
• This online resource allows authorized physicians
  and pharmacists to get evacuees medication
  records
• Prescription history information is pooled from a
  variety of sources, including Surescripts,
  payers and state Medicaid programs.
• This information allows health care professionals
  to safely renew prescriptions for evacuees and
  help coordinate care, while avoiding harmful
  prescription errors and potential drug
  interactions.
• For more information, visit www.icerx.org.

22
Additional External Medication History Sources

• State Medicaid Programs
• Enterprise Medication History Databases
• Pharmacy Benefits Managers (PBMs)
• Health Plans
• Pharmacies
• Personal Health Records (PHRs)
• Others

23
For More Information
The E-Prescribing Resource Center www.surescripts.
com A Comprehensive Resource Center for Payers,
Prescribers and Pharmacists
http//www.surescripts.com/news-sign-up.html
24
Medication Management Real World
Sites Regenstrief Institute
J. Marc Overhage, M.D., Ph.D. Director of Medical
Informatics and Research Scientist, Regenstrief
Institute
25
Background
26
Regenstrief Solutions and Problems Solved

• Incomplete medication histories
• Fragmented patient data
• Difficult to obtain electronic formularies
• Difficult to maintain pharmacy data
• Providers without an Electronic Medical Record
  (EMR)

27
Regenstrief Use Cases

• ePrescribing
• Provide a comprehensive medication history
  (greater starter set)
• Incorporate allergies and other clinical data
• Incorporate formulary decision support
• Capture prescriptions written
• Medication Management
• Provide a comprehensive medication history
• Incorporate allergies and other clinical data
• Incorporate formulary decision support

28
E-Prescribing Flowchart
Surescripts
Dispensing Databases
Providers Appointment System

• Merge Sources
• Merge providers
• Aggregate
• De-duplicate Records
• Age Records
• Compute MPRs

HL7 Appointment
Patient Matching
PBM Databases
MedicationHistory

• Matching prescription and dispensing data
• Provide views of merged data
• Allergy checking
• Clinical decision support

Claims Database
Formulary Databases
Prescribing Databases
Prescription Records
Formulary
29
E-Prescribing Flowchart, continued
HITSP T43 Med Order NCPDP SCRIPT Std.
Surescripts
Prescription
Update Prescribing Database
Prescribing Databases
30
HITSP Constructs Used

• Transaction Packages
• TP13 Sharing of documents
• TP20 Access Control Transaction Package
• T 15 Collect and Communicate Security Audit
  Trail Transaction
• TP 43 Medication Orders Transaction Package
• TP 46 Medication Formulary and Benefits
  Information Transaction Package

• Constructs
• C 26 Nonrepudiation of Origin
• C 38 Patient Level Quality Data Document
• C 44 Secure Web Connection
• C 80 Clinical Document and Message Terminology

• Transactions
• T 16 Consistent Time
• T 17 Secured Communication Channel
• T 31 Document Reliable Interchange
• T 68 Patient Health Plan Authorization Request
  and Response

31
Solution Benefits

• More complete medication histories for more
  patients
• Data from multiple sources enriched the clinical
  context (laboratory results, allergies,
  diagnoses)
• More formularies available
• Patients cared for by providers without
  Electronic Medical Records (EMRs) still received
  the benefit of clinical decision support

32
Successes

• Reduced number of adverse drug events
• Improved therapeutic monitoring
• Improved formulary adherence ? lower patient
  costs
• Improved provider satisfaction

33
For More Information
www.regenstrief.org
34
Medication Management Real World Sites DrFirst
Peter N. Kaufman, M.D. Chief Medical Officer,
DrFirst, Inc.
35
Impact of E-Prescriptions on Physician Office
Workflow

• Improve efficiency - Increase staff productivity
• Improve patient safety, quality of care, and
  satisfaction
• Minimize time spent phoning/faxing to clarify
  prescriptions and authorize renewal requests
• Minimize time spent phoning and faxing to ensure
  formulary compliance
• Minimize chart pulls - Reduce time to find
  prescribing information
• Simplifying staff workflow, allowing completion
  of refill authorizations in seconds, not hours
• Remotely check patient medications and allergies
  and prescribe

36
Information Available in the E-Prescribing
Workflow via HITSP and SDO Technical Standards

• Patient Demographics (HL-7, CCD)
• Eligibility (X12 270/271)
• Medication History (NCPDP SCRIPT)
• Pharmacies
• Payors
• Formulary and Benefits (tiers, co-pays,
  substitution) (NCPDP SCRIPT)
• Renewal Requests (NCPDP SCRIPT)
• New Prescription (retail and mail order) (NCPDP
  SCRIPT)

37
Workflow example

• Staff confirms on arrival
• Demographics
• Pharmacy - ask patient
• Medication History List - pull down through
  Surescripts and confirm with patient
• Prescriber
• Reviews current medication list
• Insurance eligibility is displayed
• Formulary alerts, substitution, co-pay etc.
  present when medication is chosen
• Clinical alerts present during prescribing, if
  applicable

38
Standards Not Yet in Wide Use for E-Prescriptions

• Allergies (CCD)
• Diagnoses (CCD)
• Prior authorization (NCPDP SCRIPT)
• RxNorm (to supplement/replace NDC codes)
• Structured and codified SIG (NCPDP SCRIPT)

39
Remember . . .

• Having a feature is not the same as having a
  usable feature

40
How Physicians Realize the Benefits of True
Electronic Prescribing

• Improves efficiency
• Minimizes time spent phoning and faxing to
  clarify prescriptions, authorize renewal requests
  and ensuring formulary compliance
• Inbound calls decreased from 36 to 18.5 of RX
  filled outbound calls were reduced by more than
  50
• Increases staff productivity
• Simplifies staff workflow, allowing completion of
  refill authorizations in seconds, not hours
• Enables remote access to patient medications and
  allergies
• Re-allocate staff time to other activities

41
How Physicians Realize the Benefits of True
Electronic Prescribing, continued

• Improves quality of care
• Improves safety and quality of care drug/drug
  drug/allergy, drug/diagnosis and dose checking,
  medication history
• Reduces errors due to misread prescriptions and
  medications with similar sounding names
• Increases patient satisfaction
• Decreases pharmacy wait times while improving
  safety
• Formulary compliance can reduce co-pays

42
For More Information

• Peter N. Kaufman, MD
• CMO, DrFirst
• 3206 Tower Oaks Blvd. 310
• Rockville, MD 20854
• Cell 301-806-8004
• pkaufman_at_drfirst.com

43
The 2009 Webinar Series www.HITSP.org/webinars
?
?
?
?
?
?
?
?
44
Questions Welcomed
45
View the Complete Set of HITSP Deliverableswww.HI
TSP.org
46
How YOU can become involved

• Use or specify recognized HITSP Interoperability
  Specifications in your HIT efforts and in your
  Requests for Proposals (RFPs)
• Ask for CCHIT certification
• Leverage Health Information Exchanges to promote
  HITSP specifications to make connections easier
  in the future
• Ask . . . Is there a HITSP standard we could be
  using?
• Get involved in HITSP . . . Help shape the
  standards
• Implementation feedback to HITSP is welcome

47
Join HITSP in developing a safe and secure health
information network for the United States

Visit www.hitsp.org or contact
Michelle Deane, ANSI mmaasdeane_at_ansi.org Re
HITSP, its Board and Coordinating Committees
Allyn Clemons, HIMSS Theresa Wisdom,
HIMSS aclemons_at_himss.org twisdom_at_himss.org Re
HITSP Technical Committees
48
www.HITSP.org