Product Effectiveness Benefits Realization
Assessment of the Pharmacy Re-Engineering (PRE)
Medication Order Check Healthcare Application
(MOCHA) software
Tom Fagan
Pharmacy Benefits Management Clinical
Informatics Instructor
Learning Objectives
• Understand the Mission of Pharmacy Benefits Management
• Understand the Background on Pharmacy Re-Engineering
Project (PRE) including (MOCHA) Medication Order Check
Healthcare Application
• Understand the reason and goals for Benefits Realization
assessment of PRE including MOCHA by OHI PE Team
• Understand the data sources, methodology and rationale
used in assessment
• Understand initial assessment findings and recommendations
VETERANS HEALTH ADMINISTRATION
Mission of Pharmacy Benefits
Management
• To improve the health status of veterans by encouraging the
appropriate use of medications in a comprehensive medical
care setting.
• Functions
–
–
–
–
–
Drug Benefit Design
Evidence-Based Formulary Management
Utilization Management
Staff Education
Patient Safety
VETERANS HEALTH ADMINISTRATION
Clinical Informatics
• Application of Information Technology to
deliver Healthcare Services
VETERANS HEALTH ADMINISTRATION
(PRE) Pharmacy Re-engineering
Background
• Began in 2002
• Multiple Increments Project Management
• Main Goal to Improve VistA Pharmacy Package
– Respond to Patient Safety Issues
– Medication cost reduction
– Improved workflow and process
VETERANS HEALTH ADMINISTRATION
PRE Increments
• First Iteration
Increment 1 – PRE Foundational Enhancement
Increment 2 – Pharmacy Enterprise Customization System (PECS)
Increment 3 – Medication Order Check Healthcare Application (MOCHA v1.0 )
(Non-Dosing)
Increment 4 – Medication Order Check Healthcare Application (MOCHA v2.0 )
(Dosing)
Increment 5 – Pharmacy Enterprise Customization System Enhancements
Increment 6 – Enhanced Order Checks
VETERANS HEALTH ADMINISTRATION
PRE Pharmacy Re-engineering Components
• MOCHA
– Medication Order Check Healthcare
Application
• PECS
– Pharmacy Enterprise Customization System
• PPS
– Pharmacy Product System
VETERANS HEALTH ADMINISTRATION
Accessing PECS
•
Have your ADPAC assign you the following security key:
PSS_CUSTOM_TABLES_REQUESTOR
•
Access PECS through this link:
https://vapreapp1.aac.va.gov:8443/ct/public/
Welcome.action
VETERANS HEALTH ADMINISTRATION
MOCHA V1.0
• Medication Order Check Healthcare Application
– MOCHA v1.0
• Rolled out during the summer of 2011
• Delivers a valuable enhancement to medication order checks in
the Pharmacy and CPRS packages
• Utilization of a clinical drug database vendor, First Databank (fdb)
• Enhanced Therapeutic Classification (ETC) allows for multiple
classes per drug, thereby reducing the number of clinically inexact
or inappropriate warnings
VETERANS HEALTH ADMINISTRATION
MOCHA V2.0
– MOCHA v2.0 (Dosing) Development
• Introduces dosage order check functionality which will reduce medication
errors, adverse events, and potential deaths
• Provides an extremely valuable tool to VA clinicians in CPRS, Inpatient
Pharmacy, and Outpatient Pharmacy
• Version 2.0 consists of a maximum single dose check derived from the
patient’s age, weight, and body surface area (BSA)
• Currently installed in six test site environments with a planned national
release of July 2012
VETERANS HEALTH ADMINISTRATION
Stated Benefits of PRE
• Increased Patient Safety
• Increased Efficiency of Prescription and Order
Processing
• Decreased Costs
• Increased Satisfaction
• Increased Regulatory Compliance
VETERANS HEALTH ADMINISTRATION
Goal for Assessment
• Office of Health Information (OHI) Product Effectiveness (PE)
Benefits Realization (BR) Assessment
• One key question
– Is VHA realizing the intended benefits from the PRE functionality, and
if not, what can be done to make needed improvements?
VETERANS HEALTH ADMINISTRATION
Measureable Goals
1.
2.
3.
4.
5.
Patient Safety
Increased Efficiency of Order Processing
Decreased Costs
Increased Satisfaction
Increased Regulatory Compliance
VETERANS HEALTH ADMINISTRATION
Data Sources
1.
2.
3.
4.
5.
6.
7.
8.
PBM Database ProClarity Cube
HR Employee Cube
Non-Formulary Request Processing Reports
National Drug File support Group
PBM Inventory Data
PBM Order Check Analysis Worksheet
vaADERS
Office of Information IT Patient Safety Office
Database:
VETERANS HEALTH ADMINISTRATION
Surveys
1.
2.
3.
4.
VHA National Survey of Pharmacists
PE Customer Satisfaction Focus Groups
VA All Employees Survey
Survey of Healthcare Experiences of Patients
VETERANS HEALTH ADMINISTRATION
Methodology Overview of BR
• Product Effectiveness Mission – Independent
Assessment and Analysis
– Benefit Realization - evaluate benefits against a specific outcome
• Initial Measurement (now)
• Post Implementation Performance (future)
VETERANS HEALTH ADMINISTRATION
Methodology Scope
• PRE Multiple Increments
– Initial
– Post Implementation
VETERANS HEALTH ADMINISTRATION
Rationale
• Measurements
• Findings
• Recommendations
VETERANS HEALTH ADMINISTRATION
Initial Assessment Findings
• Establish a Baseline before PRE upgrades
VETERANS HEALTH ADMINISTRATION
Initial Assessment Recommendations
• Patient Safety
• Alert Fatigue
• Staff Satisfaction
VETERANS HEALTH ADMINISTRATION
Major Recommendation
• Measurements on Annual Basis
• Identify Trends due to upgrades
VETERANS HEALTH ADMINISTRATION
Recommendation Monitoring Details
1.
2.
3.
4.
Safety Metrics
MOCHA
Staff Satisfaction
Work Flow
VETERANS HEALTH ADMINISTRATION
Key Findings
1. Increased Patient Safety and Decreased Costs
2. Increased Satisfaction Mixed
-MOCHA
VETERANS HEALTH ADMINISTRATION
ASHP 2009 Drug Drug Interaction (DDI) Survey
• Pharmacists
• Identify Areas for Improvement
• Knowledge Gap –no formal education on how to evaluate and
respond to order checks
VETERANS HEALTH ADMINISTRATION
Summary
• Benchmark Established
• Increment Assessment
Is VHA realizing the intended benefits from PRE
if not what can be done to make needed
improvements?
VETERANS HEALTH ADMINISTRATION