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HIMSS 2009 Summary by Sylvia Thomley

05/05/2009

Thanks so much to Dr Thomley for this summary of the 2009 HIMSS convention from a pharmaco/pharmacy informatics perspective.

HIMSS 2009 Summary by Sylvia Thomley, PharmD MS, Manager, Medication Safety & ITS University of Wisconsin Hospital & Clinics, Madison WI

PHARMACY INFORMATICS FORUM (Saturday)

What’s New with E- Prescribing: A Federal Update

Speaker: Tony Trenkle, Director of The Office of E-Health Standards and Services, Centers for Medicare and Medicaid Services

§       He provided an update on the CMS regulations & incentives for e-prescribing, including they’re discussions with the DEA.  He said that Controlled substances account for 12-20% of all prescriptions and that the rule regarding e-prescribing of CSs is expected in late 2009.

§       The standards that are in place (now as of April 1st) regarding formulary & benefits, medication history, and ‘rx-fill’ are done, and that rx-fill is the only one not required for the incentive program.

§       The standards for RxNorm, codified sigs, and prior authorizations are not done and he didn’t give a timeline for when these were expected.

§       The incentives program for physicians started January 2009 – and there’s a ‘dis-incentive’ program starting in 2012, at the same time that the computer generated fax exemption is expected to be removed.

§       Regarding ARRA  (American recover & Reinvestment Act) that President Obama signed in Feb 2009, he stated there are two sections for health-care IT and that they’re still trying to clarify what the specifics are e-prescribing in this act and how they either supercede or don’t those of the Medicare Modernization act and related bills from last year and previously.

Personalized Healthcare and Pharmacogenomics Trends

Speaker: Bonnie Bukaveckas, PhD, FACB
Assistant Professor, Department of Pharmacy, Virginia Commonwealth University

§       This was a high level overview of pharmacokinetics and pharmacodynamics and genotyping is being used in the clinical care of patients.  Essentially, we were reminded that our genetic makeup can determine how we respond to certain drug therapies.

§       This provided more thought-provoking questions than answers for an EHR implementation.

§       What do we do if a patient has a genotyping done?  Where is this stored in the electronic record?  How is it available for future decisions that may need to take it into account?  If a patient’s drug response is dependent on their genotype, how do we communicate that?  If we change drug therapy for a patient (example, take them off of a long-acting beta agonist because they are resistant and genetically won’t tolerate the drug) how is this communicated so that all providers who see this patient are aware of how and why they are no longer on this medication?

§       Key – how do we have this genetic information persist in the EHR?  How do we capture, store and use it? What’s the liability? How do we build rules on it?

How to Create an Effective IT Infrastructure

Speaker: Linda Greene, RN, CCRN-R, Owner-Manager, Clinical Informatics Consulting, LLC

§       This was my favorite pharmacy informatics session as it completely spoke to how and why the changes and updates my MM team members are doing are so important to the integrity of our drug databases.

§       This session talked about the requirement that states collect the NDC numbers for select drugs when submitting claims to Medicaid for medications administered in hospital affiliated outpatient clinics.

§       The presenter is a former CIO of an organization where she stated that a new pharmacy system shed the light on them that the NDC & J-code information they had was very outdated.

§       She talked about the struggles with maintaining it and the fact most hospitals don’t pay attention.

§       She provided an outline of how her organization cleaned it up and then worked with their wholesaler to get automated information so that they could maintain it going forward.

Challenges and Solutions to Sharing Patient Medication-related Information

Speaker: James Shalaby, PharmD, Chief Informatics Consultant, Practical Solutions in Medical Informatics Consulting, LLC

§       This session explores solutions to some of the greatest challenges in sharing and communicating patient related medication information ranging from current medicines to drug allergies and intolerances.   He talked what the CCHIT certification expectations include regarding medications.

§       He talked about the standards that exist in the realm of medication management, including NDPDP, NDC, RxNorm, and HL7 standards.  He stated there is some mention of allergies for HITSPc32 and NDFRT for classes for drug allergies but that overall allergy terminology is not standardized.  The other challenges in communicating electronically regarding medication histories is the lack of standards for medication instructions (sigs), prior adverse drug reactions, and tried and failed therapies.

§       He spoke to a project being done at Partners in the Boston area regarding electronically being able to pull medication histories from multiple databases together.  He stated the issues dealing with ½ tab prescribing, instructions of what a patient is actually taking, and the warfarin and other various dosing schemes that exist as areas they have yet to provide a solution for.

"DX on RX": Pharmacy on Management Circles, Including In-Patient Indications

Speaker: Stuart Levine, PharmD, Informatics Specialist, Institute for Safe Medication Practices

§       This session was a one-sided debate about whether or not a diagnosis should be attached to a prescription, which has been one of the most important controversies in pharmacy. The most recent CCHIT standards require that electronic prescribing systems support this capability.

§       The audience had a very large discussion on the many hindrances we see to providing indications and how the vendors can make these barriers less obtrusive.

EMR: Does It Really Improve Medication Safety? What Is the Evidence?

Speaker: Brent Fox, PharmD, PhD, Assistant Professor, Pharmacy Care Systems, Auburn University Harrison School of Pharmacy

§       Brent presented on the quality and quantity of support in the literature for various healthIT initiatives.  He gave each area a ranking on the quantity and quality, as defined by him and listed below (ranking 1-4, 4 being the highest)

o       Clinical Decision support – (4-quantity, 4-quality),

o       CPOE plus CDS (4, 4),

o       Barcode dispensing workflows (1, 3),

o       Automated dispensing cabinets (2, 2),

o       Barcode med administration (3, 2),

o       Smart pumps (2, 2),

o       Automated ADE surveillance (3, 4), and

o       Advancing stages of implementations (per HiMSS) (1, 1)

HIMSS EDUCATIONAL SESSIONS (Sunday & Monday)

Improving Outcomes with Clinical Decision Support: Practical Peals from the New HiMSS Clinical Decision Support Guidebook

Speaker: Osherof

§       This was a session on the topics covered in the recently released CDS book published by HiMSS.

§       The speaker stressed looking at the workflows and seeing who actually does what work, that what is said and what is done in practice are very different, that CDS needs to be thought of as more than just CPOE, that more than just physicians need to be included in CDS plans, and that he really recommends we ‘metric’ things – measure everything that really impacts customers.

AHRQ Clinical Decision Support Consortium

Speaker: Middleton

§       This session covered the work done in the AHRQ workgroup regarding CDS and the strategies they have found to be successful.  They talked about their workgroup’s process and how they disseminate information as well as shared some valuable tools on the information they received.

§       Decision support is often implicit, not explicit (how the forms, templates, flowsheets, and ordersets are built).  Clinicians access knowledge in the easiest way for them, which may not be the best for reporting and other needs of the organization and that CDS is not a ‘field of dreams’.

§       They stated they have found that 80% of the workflows are usually determined before an implementation, 10% are figured out or customized right away, and 10% are never really adaptable and need to be completely re-changed for an EHR implementation

Keynote: Daniel Quaid

§       Spoke to the horror his family went through with a medication overdose in a California hospital and the steps that he sees have been taken and still need to be taken in health care to improve medication safety for patients.

Chemotherapy Order Entry, It’s All About Treatment Regimens

Speaker: Skarulis

§       This was an overview of the project work by Memorial Sloan Kettering Cancer Center in New York regarding their implementation of chemotherapy order sets using Eclipsys.

§       Their project began in 2003, to date they have over 800 chemo order sets, of them over 350 are research.  They have not yet implemented in all their adult oncology areas and they have not yet begun to work on pediatrics.

§       They don’t have an integrated pharmacy system, and all orders except chemotherapy are interfaced to the pharmacy system.  Chemo is still transcribed by the pharmacists into the pharmacy system!!!!

§       They order labs electronically, but outside of the order sets for chemo.  Included in the order sets for chemo are places for documenting the treatment parameters, protocol information, patient measurement information, and notes (both for the regimen and current treatment).

Maximize the Human Capital of Your Health IT Team!

Speaker: Gardner

§       This was from the Canadian health information society ‘Coach’ and talked about how to provide competencies and training, markeing, deal with competition and availability, and culture and adoption levels of healthcare IT professionals.

§       They provided a recommended process for conducting workforce planning, developing multidimensional staff, looking to untapped resource pools, partnering and outsourcing, enhancing recruitment, and retaining and managing the talent of our teams.

Wisconsin Health Information Exchange ED Lining: Status and Influence

Speaker: Kim Pemble, President of WHIE

§       This was the best HiMSS educational session I went to!!

§       He talked about the initiative which has focused on the 9 county regional area around Milwaukee WI and has started collecting claims and ADT data to provide the ED physicians in Milwaukee with valuable data about patients.

§       There are 14 hospitals contributing their data to the WHIE.  When a patient arrives in the ED, they send an ADT feed and get access to the information that the exchange has about the patient, such as any other previous visits to EDs in Milwaukee hospitals, allergy info, medications, and other information as available.

§       The tool has started to become relied upon for physicians and the next steps include providing clinical data as well as expanding this beyond Milwaukee and beyond the ED setting.  HIPAA allows the information to be exchanged in an emergency setting without patient consent, however for other ambulatory and inpatient areas, he needs to have the patient consent process included.

§       He had some great patient stories on how this information has prevented hospital admissions and unnecessary tests and treatments, particularly for two patients who presented to the ED with chest pain both two with recent previous negative cardiac workups and known other problems.

§       The data in the exchange has been used already for public health monitoring, last summer they watched the data to ensure that the flooding in Milwaukee wasn’t causing increased visits to the ED due to potential water system issues.

§       He had a lot more information and I’d encourage anyone interested to pay attention to what the WHIE is doing, as it won’t be long before this initiative looks to include the Madison area hospitals!

PHARMACY INFORMATICS TASK FORCE ‘FACE TO FACE’ MEETING

§       At this task force meeting we discussed the needs of the pharmacy informatics community with respect to the economic stimulus package and what initiatives we’d like to engage in.  I think that e-prescribing was our largest discussion, as well as standard-setting and remote order review.

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