RXM Expunge
PRIORITY EVENT 257/327
Strategic Planning
Review and Setup




Review of the RXM Expunge options
What reports will be run and why
Clean up process: RXM and PHA
Discussion about expected timelines and
resources




Drug manufacturers will utilize old NDC
numbers for new drug entries.
The new drug is entered into the drug list by
the FSV as a new item
The FSV may not have deemed the original
drug entry as obsolete, thus creating an
overlap of information
This will cause a combination of information,
potentially causing problems during
Interaction and Conflict checking
Optimize Drug Interaction Checking
 Optimize the ePrescribing Interface


Insert question: Where are you in the
process of implementing ePrescribing?
◦ Live
◦ Not Live/In-Process
◦ Not Live/Planning stage
◦ Not on current radar



Will detect recycled drugs during an FSV
update
Will run Integrity reports for RXM and PHA to
review Generic descriptions in your database
against the FSV raw data file (PE 257)
Will run Integrity reports for RXM to review
Trade descriptions in your database against
the FSV raw data file and associated GPC
(PE 327)



Hospital will run their scheduled FSV load
MEDITECH will open a task and run their
utility reports to identify numeric generic
mnemonics in RXM and PHA
Hospital will run PHA Generic Integrity, RXM
Generic Integrity, and RXM Trade Name
Integrity reports
◦ MAGIC or C/S – 5.66 reports are available
◦ MAGIC or C/S – earlier than 5.66, programming will
provide reports

All 3 reports will review drugs (including retail
entries in PHA) between what is in your
database versus the raw data on FSV file
◦ Follow the steps provided by MEDITECH. Each
report will have certain criteria to streamline what is
on each report.
◦ There will be thousands of hits – Do NOT be
overwhelmed
◦ Many entries on each report will be “false positives”.
Take enough time to go through each list
thoroughly in Test so that a proper evaluation can
be made



Evaluation of the reports will outline how
many errors reside in your dictionaries.
Logically, the trend has been…. The longer
you have been Live with RXM, the more
recycled NDC numbers that exist.
Insert Question: Are you currently using RXM
functions in your Live environment?
◦ Yes, currently utilize Medication Reconciliation
◦ No
◦ System is in Live, but not being used



If you are not Live or Live but stagnant, then a
complete expunge can be made in RXM
PHA Generic cleanup will still need to be
completed
If you are Live….

Manual Cleanup
◦ After reviewing the reports the hospital chooses to make
RXM edits on their own

Automated/Full Expunge
◦ Completely expunge the whole RXM Drug dictionary
◦ NOTE: Drugs on a patient’s record will be inactivated and
de-indexed

Automated/Almost Full Expunge
◦ Expunge all RXM Drugs not associated to a patient’s record
◦ Can also include other groups from expunging: User
Defaults, RXM Order Sets, Favorite Sets, and Procedures
◦ All drugs not expunged will stay in their current active state

Full Expunge
◦ Since all drugs will be inactivated and de-indexed you
will need to reload the RXM Drug dictionary with the
next FSV load
◦ Alternative workflow process will need to take place
once complete as drugs on patient profiles will be
inactive.
 Medication Reconciliation should be reviewed upon entry
into facility
 Scripts should only be affected during renewal

Almost Full Expunge
◦ You will need to reload the remaining RXM Drugs with
the next FSV load
◦ Manual cleanup will take place for all drugs not
expunged
◦ Workflow should not be affected after completion
 Drugs on patient’s home medication list or previously
written as scripts won’t be expunged






Create a custom report to download the entire RXM Drug
dictionary with fields to assist in the process (recommended
to include GPC code)
Integrity reports that you reviewed before making the
decision to expunge should be used to clean up drug
descriptions.
Trade Names and Generic Names may need to be
optimized/updated for consistency. Create a style guide and
stick to it.
If you run the Almost Full Automated expunge you will need
to manually edit the Drugs not expunged. Report is provided
by Meditech, run manually. Steps to clean up drugs should
follow Best Practice so that they stay linked to FSV.
Strings will need to be added back to expunged drugs
Evaluate Favorites Lists, User Defaults, Procedures and RXM
Order Sets



Manual Expunge: No downtime should be
warranted
Almost Fully Automated Expunge: Downtime
should only last a few hours while the
expunge takes place. FSV reload should not
justify downtime.
Fully Automated Expunge : Downtime should
last a couple of days as you will need to
account for the expunge and the FSV load,
file and RXM parameter connection


The process should be evaluated in Test and
Live
The complete cleanup is not necessary to be
completed in Test (although recommended)
but needs to be diligently evaluated

Recommended to have a Pharmacy
Informatics Analyst to run this project.
◦ Must be able to comprehend and evaluate drug data
on Integrity reports
◦ Must be able to make edits in PHA Drug and RXM
Drug dictionaries
◦ Must be able to review and edit PHA and RXM
supporting dictionaries
◦ Must be able to enter RXM Drug strings


Typically this process takes 12-13 weeks for
1 FTE. Will be 1.25-1.5 FTE if additional
pharmacy resources are needed or may
extend timeline
MEDITECH will open a master PHA task to
follow through the process step by step
◦ Change Control will be necessary before each step
◦ Programming resources will need to be
allocated/scheduled by the RXM Specialist. Allow a
few days notice before you want to run the
expunge, especially if there is downtime associated.

When planning resources for the expunge,
you may want to also consider….
◦ Optimization in PHA for CPOE
◦ Drug strings for CPOE
◦ Setting up Dose Range Checking


Medispan only: Issue with the Generic
Mnemonic repopulating with a numeric value
causing the description field to be nil. Need
to change the FSV Generic parameter to pull
from BOTH instead of KDC ONLY
Micromedex only: Issue where the Control
Schedules loads as a nil value. MEDITECH
needs to run a loop to correct the issue.

FSV Process needs to be kept up-to-date
each month/quarter.
◦ The FSV will not review drugs retroactively for
recycled NDC on previous updates
◦ Should run and review all reports after PHA Load,
PHA File and RXM Parameter Link

RXM Drug Activation: If you do a full expunge
you will be prompted when attempting to
reactivate a de-indexed drug
◦ Message will appear “NDC has been recycled,
reactivation is not recommended. Continue?”
◦ Do not activate. Find diff drug w/same GPC code


Prepare for your ePrescribing Interface
Implementation
Take some time to optimize your RXM Drug
Strings and Pharmacy databases for CPOE
William Salemi
Regional Director



Bill has 20 years experience in Healthcare IT as a Project
Manager, IT Director and Subject Matter Expert as well as
several years experience as a Certified Pharmacy Technician.
Currently as Director at Infinity HIT, Bill specializes on the
implementation and optimization of the Pharmacy databases,
ePrescribing and MEDITECH’s Advanced Clinical Applications.
wsalemi@infinityhit.com
Mobile: 508-838-7293