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2015 Annual ConventionDate:Time:Location:Saturday, October 10, 201510:00 am – 11:00 amGaylord National Harbor Resort and Convention Center, Chesapeake 7/8/9Title:Pharmacists’ Role in Health IT and Health Information Exchanges Pharmacy HIT /HIEACPE # 207-000-15-106-L04-P 1.0 CEUsACPE # 207-000-15-106-L04-TActivity Type:Speaker:Application-basedShelly Spiro, Executive Director, Pharmacy HIT CollaborativePharmacist and Pharmacy Technician Learning Objectives:Upon completion of this activity, participants will be able to:1. Describe a roadmap the pharmacy practice can follow to adopt pharmacist electronic health records(EHRs) to facilitate safe and effective medication use through integrating pharmacist-provided patientcare service documentation with other health care providers and the patients.2. Explain how collection, documentation and exchange of standard electronic clinical information throughHIEs will assist in value-based payment models for pharmacists for transitions of care, MedicationTherapy Management (MTM), and other pharmacist-provided patient care services.3. Discuss how pharmacists’ adoption of EHR system functionality for documentation and exchange ofpharmacist-provided patient care services helps to bring together all providers on the health care team toreach better patient outcomes.Disclosures:Shelly Spiro declares no conflicts of interest or financial interest in any product or service mentioned in thisprogram, including grants, employment, gifts, stock holdings, and honoraria.NCPA’s education staff declares no conflicts of interest or financial interest in any product or servicementioned in this program, including grants, employment, gifts, stock holdings, and honoraria.NCPA is accredited by the Accreditation Council for Pharmacy Education as a provider ofcontinuing pharmacy education. This program is accredited by NCPA for 0.1 CEUs (1.0contact hours) of continuing education credit.

TechnologySeminar –Pharmacists’ Rolein Health IT andHealth InformationExchangesDisclosureShelly Spiro, Executive Director, Pharmacy HITCollaborative reports no relevant financialrelationships.Learning Objectives1. Describe a roadmap the pharmacy practice can follow to adoptpharmacist electronic health records (EHRs) to facilitate safe andeffective medication use through integrating pharmacist-provided patientcare service documentation with other health care providers and thepatients.2. Explain how collection, documentation and exchange of standardelectronic clinical information through HIEs will assist in value-basedpayment models for pharmacists for transitions of care, MedicationTherapy Management (MTM), and other pharmacist-provided patientcare services.1

Pre-Test Questions1. How does the Pharmacy HIT Collaborative’smission, vision and goals affect communitypharmacists providing patient care services?2. What’s value does pharmacy data bring toHealth Information Exchanges?3. What type of pharmacist-provided patientcare services would provide patient value ifclinical data is exchanged with other healthcare providers?Voice of Awareness Meaningful Use (MU) EHR CMS incentive program Pharmacy and pharmacists’ health IT struggles Joint Commission Pharmacy Practitioners (JCPP)– 11 national pharmacy associations– Vision: “Pharmacists will be health care professionalsresponsible for providing patient care that ensuresoptimal medication therapy outcomes.”– Pharmacy HIT Collaborative formed to be a JCPP areaof focusJCPP Areas of Focus: To Achieve Vision for Pharmacy PracticeJCPPPatient Care ProcessPQAQuality Measures and StandardsJCPPProvider Status and PaymentPharmacyHITAACP, ACPE,CCPJCPPHealth Information Technology (HIT)Education and accreditation standardsEvidence that demonstrates and validates value2

About Pharmacy HIT CollaborativeFounding Organizations 9 Professional Pharmacy Associations Represents over 250K members in all practice settingsMembers ASPA‐NCPAAssociate Members Surescripts – NCPDP – RelayHealth – ScriptPro –OutcomesMTM – Amgen – Pfizer – Greenway Health– Cardinal Health, FuseVision- MissionVisionMission The US healthcare system is supported bymeaningful use of Health InformationTechnology (HIT) and the integration ofpharmacists for the provision of qualitypatient care. To advocate and educate key stakeholdersregarding the meaningful use of HIT and theinclusion of pharmacists within atechnology‐enabled integrated health caresystem.GoalsAccess Ensure HIT supports pharmacists inhealth care service deliveryConnectivity Achieve pharmacists’ integrationwithin health information exchangeQuality Support national quality initiativesenabled by HIT3

Pharmacy HIT CollaborativeRoadmap for Pharmacy HeathInformation Technology Integration inU.S. Health Care 2014-2017 is an updatedversion of the update to the Pharmacy HealthInformation Technology Collaborative’s revised2011-2015 Roadmap. It provides guidanceto provider organizations, policymakers,vendors, payers, and other stakeholdersstriving to integrate pharmacy HIT into thenational (U.S) HIT infrastructure. Therevisions align the roadmap to theCollaborative’s 2014-2017 strategic plan,vision, and mission. A synopsis of thedocument provides a shorten overview ofthe Roadmap.Interoperability “Interoperability describes the extent to whichsystems and devices can exchange data, andinterpret that shared data.” “For two systems to be interoperable, they must beable to exchange data and subsequently presentthat data such that it can be understood by a user.”Source: HIMSS “What is Interoperability” dards/what-is.(accessed August 12, 2014)Interoperability ModelMeds, Labs,DiagnosisCDA (SNOMED, RxNorm, LOINC)RxNormMedsLOINCLabsSNOMEDDiagnosisHealth InformationExchange (HIE)OutputEHREHR22OutputOutputOutputEHREHR1 1RxNorm, LOINC,SNOMED CTReportingQuality &RegistriesCDA (SNOMED, RxNorm, LOINC)4

Clinical Terminologies Systematized Nomenclature of Medicine - ClinicalTerms (SNOMED CT)– Named in Meaningful Use for clinical mentationSNOMED CT Download through National Library of Medicine(NLM) SNOMED CT web browser Resides in International Health TerminologyStandards Development Organization (IHTSDO)and NLM for U.S. realm Free for use in U.S., requires NLM Unified MedicalLanguage System (UMLS ) license Updated twice yearlyStandard Terminologies Systematized Nomenclature of Medicine ClinicalTerms (SNOMED CT)–––––––––Vital signsHeightWeightBlood pressureSmoking statusAdverse drug eventsAllergiesEncounter diagnosisProblems5

SNOMED CT for Pharmacists’ Medication Management Pharmacy HIT Collaborative project Medication Therapy Management (MTM) value set– Search under SNOMED browser– Topic: Medication Therapy– More than 270 MTM clinical terms Other types of pharmacy value sets beingconsidered by Pharmacy HIT CollaborativeGuidance Documents Clinical Documentation– Medication Therapy Management Services ClinicalDocumentation: using a structured coding system – SNOMED CT– Documenting Comprehensive Medication Management in Team‐Based Models Using SNOMED CT e DocumentsEnvironmental Scan of Pharmacogenomics Coding:Current Practice and �documents/WG2‐Post‐2015‐01.pdf6

Other Standard Terminologies RxNorm– Medications Logical Observation Identifiers Names and Codes(LOINC)– Laboratory test results CVX for immunizations ICD10 CPTNational Library of Medicine Tools for EHR Certification and Meaningful Use,http://www.nlm.nih.gov/healthit/meaningful use.html, accessed February 26, 2015Terminology Projects Billing Codes and MTM Use Cases– MTM CPT– Transitional care management services (TCMS) and Complexchronic care coordination services (CCCCS)– Support team‐based (multidisciplinary) patient pdfs/workshopdocuments/WG1-Post-201501.pdfCommon Clinical Data SetSource: ONC 2015 Edition Proposed Rule Modifications to the ONC Health IT Certification Program and2015 Edition Health IT Certification Criteria Presentation, HIT Policy Committee Meeting les/HITPC 2015 Ed NPRM 2015-04-06.pptx.7

Standard Electronic Structured Documents Normalized terminologies with standardized structureddocuments Clinical Document Architecture (CDA) when exchangingclinical information between health care providers HL7 Clinical Document Architecture (CDA) Templates– Patient care summary (continuity of care document, CCD)– Discharge summary– Progress note– Care plan Extendable Markup Language (XML)Standard's Work SDO’s– Virtual involvement– Health Level Seven (HL7) www.HL7.org– NCPDP Collaborative Workspace http://dms.ncpdp.org/ Continuity of care document (CCD) using C-CDA– National Council for Prescription Drug Programs (NCPDP) Recommendationsfor Use of the HL7 Consolidated CDA Templates for Pharmacy Version 1. Ø,http://www.ncpdp.org/NCPDP/media/pdf/NCPDP Recommedations for Use CCDA.pdf– Implementation Guide for CDA Release 1 MEDICATION THERAPYMANAGEMENT PROGRAM MEDICARE PART D– HL7 Implementation Guide for CDA Release 2: Consolidated CDA Templatesfor Clinical t brief.cfm?product id 379 for transitions of careMTM Specialized & eRX Revision to the MTM sections of SpecializedTransactionsImplementation Guide to reflect requests for MTMand/or Pharmacist Professional Services by entitiesother than the payer– Request for service– Added examples using SNOMED CT E-Prescribing MU3 2015 EHR certification changes– Names pharmacists 15 times supporting prescribers andpharmacists to bidirectionally communicate during e‐prescribing– RXFILL, RXCHANGE, RXCANCEL– Structured and Codified Sig (include indication?)8

JCPP Pharmacists’ Patient Care Process .Source: Pharmacists’ Patient Care Process, May 29, 2014https://www.accp.com/docs/positions/misc/JCPP PharmacistsPatient Care Process.pdf.The figure depicts a proposedstandardizedpharmacistpatientcentered collaborative care processfor pharmacists providing medicationtherapy management (MTM) services.The pharmacists’ patient care processdescribed in this illustration wasdeveloped by examining a number ofkeysourcedocumentsonpharmaceutical care and MTM.Patient care process components ineach of these resources werecatalogued and compared to createthefollowingprocessthatencompasses a contemporary andcomprehensive approach to patientcentered care that is delivered incollaboration with other members ofthe health care team.Patient Process of CareGuidance Documents Pharmacists’ Workflow– Workflow of Pharmacist Clinical Documentation Process in Pharmacy PracticeSettings– System Vendor Checklist for Pharmacist Clinical Documentation org/pdfs/workshopdocuments/WG3-Post2015-01.pdf9

Pharmacist EHR Certification Adopting Health Level 7 International (HL7) EHRfunctionality– HL7 EHR‐S Functional Model Release 1– NCPDP/HL7 Pharmacist/Pharmacy Provider EHR FunctionalProfileEHR )Guidance Documents Pharmacists’ EHR Certification– Pharmacist Electronic Health Record (EHR) Implementation Guide forCommunity Practice– Electronic Health Record Certification: Making the Pharmacists’ Case toSystem andards/informative/13294 HITSbookHL7 uments/WG4-Post-201501.pdf10

2015 EHR Base CertificationSource: 2015 Edition Health IT Certification Criteria -base.Reason to Collect- Document- Exchange Physician office and hospital EHR adoption aredriving the standard collection and exchange ofelectronic medication-related clinical data Pharmacies can be meaningful users and ACOs tomeet safety and care coordination quality measures Improve inter-professional collaborative practicemodels with one pharmacy and multiple providersAim Prescriber workflow is different than communitypharmacist workflow Data needs to be standardized, prioritized,meaningful and useable Data standardization and EHR certification supportsability to capture data for quality measures Useful clinical data sharing can be used to improvept care, increase medication safe use and reducecosts11