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Health Current Summit October 2017
- G. Cameron Deemer
President, DrFirst
What CMIOs had to say…
“You have to make Costco give you records
- n OTCs and
Health Current Summit G. Cameron Deemer October 2017 President, - - PowerPoint PPT Presentation
Health Current Summit G. Cameron Deemer October 2017 President, - - PowerPoint PPT Presentation
Health Current Summit G. Cameron Deemer October 2017 President, DrFirst What CMIOs had to say You have to make Costco give you records on OTCs and supplements. Then you need to do the same with GNC! What we do at DrFirst
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What we do at DrFirst…
1,000+ Hospitals 21,000 Ambulatory Facilities 20 Million Patients Per Year 68,000 Physicians Prescribing Monthly 170,000 Healthcare Users 100 Million e-Prescriptions Annually 67,000 Connected Pharmacies 350+ EMR/EHR/HI Partners
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Overview of the Medication Reconciliation Process
When conducted as intended, medication Reconciliation is a conscientious, patient-centered Inter-professional process that supports optimal Medication management A BPMH provides the backbone for medication reconciliation because it consists of 2 aspects:
- 1. A systematic process for interviewing the
Patient and/or family
- 2. A comprehensive and complete list of
The patient’s home or outside medications from a reliable source
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Home Meds (Med History) Data Sources
Prescription data from eRx trans Claims Data Feed Calls to Providers and Pharmacies Patient/Patient Family Med rec data from ambulatory EHRs Can be outdated, and mostly only available with integrated homogeneous EHRs Pharmacy Fill Data Feed Typically only partially accurate, and sometimes not available Somewhat effective, but not efficient Becoming more prevalent as eRx adoption improves Industry options with quantity and quality differentiation
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A perfect medication history is complete, clean and consumable
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Industry-standard medication history feeds are far from perfect
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The dirty little secrets of industry standard medication history feeds…
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Dirty Little Secret # 1:
Not complete, and can’t be
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So, what’s missing?
Non- participating pharmacies Traditional Medicaid Veteran’s Administration DoD OTC and supplements Non-participating payers Prescription s
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You are missing, if you change plans
With pharmacy claims, PBMs often don’t provide historical data from the previous plan
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Dirty Little Secret # 2:
Not “clean”
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Why not?
SIG not available on claims data SIG is often free text, not codified Drug description not standardized to NDC Drug compendia differs by record
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Dirty Little Secret # 3:
Often not consumable by the hospital
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Why not?
Free text or mismatched elements
cannot import properly
Poorly maintained databases help
create mismatches
Failure to update Limited load of NDCs Hospital-specific nomenclature
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How bad is it?
For one of the largest HIS systems,
- nly 43% of records “match”
A full 57% require manual data
entry
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What should be available?
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Pursuing Perfect Data
Quantity of patients Completeness of records
All plans, OTC, supplements Track across plan changes
Usability of data
Proper formatting De-duplication Support workflows Match to drug databases
Types of information
Claims – Who paid for what? Pharmacy – How is drug to be taken? Rx – What was the physician’s intent? Patient-elicited – How is patient self-
medicating?
QUANTITY COMPLETE USABLE TYPES
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Getting to “perfect”
Accept that what’s available is not enough Improving the feed requires partnership and work
Plan for almost perfect
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Seek more complete record sets
If you can only have one type,
pick pharmacy fill data
Possible Legislation Medication history vendor
with existing relationships
Contract directly with
pharmacy vendors and individual pharmacies
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Seek more complete record sets
Missing payers and government
programs require direct relationships
Hosting system
Health Plan Gov’t payer PBM
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Seek more complete record sets
Prescriptions are uniquely valuable and available
- nly from
vendors and sites
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Seek more complete record sets
Patient-elicited data is vital but very difficult
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Commit to cleaning
De-duplication is the minimum standard Crosswalk NDC/Drug descriptions Ensure hospital database readiness
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Don’t neglect usability
Present in workflow Minimize manual transcription Provide missing workflow
elements
Pharmacy name and phone
number
Provider name and phone number
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