The CAPT James A. Lovell
Federal Health Care Center:
It Takes a Whole LOT of Apps For That!
Presented By:
Jennifer Hirsh, PharmD
Kay Willis, RPh
Aug 2011
Objectives
• Understand pre-merger Pharmacy operations
at the Naval Hospital Great Lakes and North
Chicago VA Hospital.
• Compare and contrast pre- and post-merger
workflows.
• Recognize challenges involved in merging DoD
and VA pharmacy operations.
• Gain information regarding the use of IT in a
merged VA/DoD pharmacy.
Timeline of a VA/DoD Merger
Phase 2
Phase 3
Phase 4
Phase 5
Picture from: http://www.lovell.fhcc.va.gov/
Executive Decision Memorandums
•
•
•
•
CMOP for DoD Beneficiaries
Formulary
Physical Design
Prime Vendor
Medium Rocks
• Computer System—IM/IT group working on it. We will adapt to whatever
computer system is selected
• Electronic C-II Prescribing
• Inventory Control
• Controlled Substance Inventories
• Controlled Substance Rules
• Non-formulary process
• Line-item Extension/Tablet-Splitting
• Smoking Cessation Program
• Medication Error Reporting System and ADE:
•
•
VA reports medication errors to NCPS
Navy reports medication errors to BUMED
Pre-Merger Workflow
• DoD: Utilizes ScriptPro SP200 and QMatic
– Bank teller concept outpatient windows
• VA: Automed and other systems
– Double queue concept outpatient windows
Pharmacy Merger: By the Numbers
• 7 Pharmacy sites
• 130+ staff members
• 2 pharmacy processing
systems (CHCS/VISTA)
• 2 electronic health records
(AHLTA/CPRS)
• 2 networks (East and West
Campus)
• 2 formularies
• 3 patient queuing systems
• 2 telephone refill systems
• 3 door access and alarm
systems
• 4 ScriptPro filling robots with
42 RCM cells
• 33 ScriptPro verification
terminals
• 6 CII Safes
• Pyxis machines
• 1 Pharmacy Informaticist and
1 VISN 12 Pharmacy
Consultant=Priceless
Challenges
Two
Pharmacy
Systems
Staff
Training
Two
Formularies
Reporting
Requirements
Workflow
From imdb.com
Challenges
• Required to maintain 2 separate pharmacy
processing systems (CHCS/VISTA) hosted on two
servers in conjunction with two electronic health
records.
• Must adhere to 2 separate formularies based on
patient eligibilities (VA/DoD/Dual Consumer).
• Short time frame and limited resources inhibited
ability to provide in-depth hands-on cross-training of
staff prior to merger.
• Pre-merger workflow models did not meet the new
mission of a combined DoD/VA healthcare facility.
Challenges
• Must be able to maintain separate workload reports
and inventory utilization reports for each beneficiary
group.
• Ensure maximum patient safety while maintaining
efficiency standards in prescription processing, filling
and dispensing.
• Workload from two pharmacies combined into one
pharmacy with only a modest increase in space.
Staff Training
• FHCC Outpatient Pharmacy uses both CHCS and VISTA
pharmacy processing systems. Inpatient Pharmacy uses VISTA
for inpatients, CHCS or VISTA for discharges.
• Pharmacy Informaticist developed a 2-hour “Introduction to
VA Pharmacy” presentation +Q&A session which was
presented to DoD staff members by Pharmacy Informaticist
and two VA volunteers. Presentation covered basic eligibility
info, workflow, co-pays, etc.
• PBM Informatics group provided additional VISTA Pharmacy
menu step-by-step training PowerPoints as well as two “overthe-shoulder” trainers to provide a week of in-depth handson training.
Staff Training
• The DoD provided a series of two hour CHCS
Pharmacy training sessions for VA staff. VA
pharmacy staff members with knowledge of
CHCS provided additional support and
references.
• A Department SharePoint site was developed
by the Pharmacy Informaticist to provide
continued training and reference materials for
hospital staff.
Staff Training
Patient Queuing System
• A touch screen patient queuing system (Q-Flow) was installed
in order to filter patients by eligibility/priority category.
– Categories include: DoD, VA, Active Duty in Uniform and
ER/Discharges.
– Has since evolved into a combined VA/DoD category.
• System is multi-purpose:
– Serves as patient-run queuing/ticketing system.
– Captured initial basic patient population and wait time data.
– Allows pharmacy supervisors to control number of windows open for
each patient category based on need .
– Provided staff members additional time to cross-train on processing
systems (CHCS/VISTA).
– Linked to television screens, provides patients updates on pharmacy
department news.
Patient Queuing System
Insert lovell screenshot here
Patient Queuing System
Patient Queuing System
35.0
New Pharmacy Q-Flow Wait Times
by Patient Category (in Minutes)
30.0
25.0
20.0
15.0
10.0
Qflow Active Duty WT
5.0
Qflow Emergency/Discharge WT
May-2011
Apr-2011
Mar-2011
Feb-2011
Jan-2011
0.0
Qflow All Other WT
Pharmacy Processing Systems
• Pharmacy Informaticist maintains two separate pharmacy
systems/drug files.
• To assist staff with transition, worked to standardize drug file
entries between two systems.
– Inactivated outdated entries.
– Adjusted nomenclature to match RX Norm/CMOP .
– Entered additional messages/comments to drug file entries to assist
with unit of use differentiation.
– Mapped entries across both systems in order to develop a basic
formulary.
Pharmacy Processing Systems
CHCS
CHCS/VISTA
VISTA
Lovell Outpatient
Main
Mail Out
Lovell Inpatient/ER
Discharges
Inpatient
(Admitted Patients)
Fisher Clinic (237)
USS Tranquility
(1007)
Dental Clinic (1017)
Burkey Mall
EAST CAMPUS
WEST CAMPUS
Pharmacy Processing Systems
Pharmacy Processing Systems
Barcode Automation System
• A barcode-driven
filling/verification/dispensing system
(ScriptPro) was installed in 3 pharmacy areas
(Oct-Dec) and 2 additional areas this July.
• System receives inputs from both VISTA and
CHCS via two HL7 interfaces connecting to one
filling robot IP per site.
• Both interfaces require linkage of label printer.
Barcode Automation System
Barcode Automation System
Lovell
Mail Out
Share patient
dispensing profiles
and use of robot
filling
Burkey Mall
Refills filled by
Fisher robot
Lovell
Outpatient
Share patient
dispensing
profiles
Lovell
Inpatient
Discharges
Refills filled by
Fisher robot
Fisher Clinic
Barcode Automation System
• Multi-purpose system:
– Barcodes required to fill and verify prescriptions (helps staff
differentiate between products/increases patient safety).
– Allows shift of workload between sites:
• To satellite pharmacy robot/staff for completion of DoD refills.
• From Mailout Pharmacy for completion of building patient batches.
-Reduces extra steps in workflow.
-Release notification sent back to VISTA automatically.
-Controlled substance signature log now electronic.
-Reduces number of label reprints and partials.
-Serves as pharmacy downtime system during system/network outages.
-Provides valuable reporting tools.
Barcode Automation System
• Customized reporting tools include:
– Patient census data based on source interface (# of VA vs
DoD beneficiaries and # of prescriptions)
– Workflow processing time data (receipt of prescription by
automation until dispensing)
– Drug utilization reports by site and beneficiary category
(VA/DoD) to assist with procurement, stock areas and
future financial reconciliation.
– Controlled substance signature/receipt logs.
Barcode Automation System
12000
New Pharmacy Number of
Prescriptions Filled by Processing
System (DoD/VA)
10000
8000
6000
4000
2000
CHCS # of Prescriptions DoD
VISTA # of Prescriptions VA
May-2011
Apr-2011
Mar-2011
Feb-2011
Jan-2011
0
Formularies
• Per the merger EDM, the combined FHCC pharmacy is
required to maintain two formularies: the VA National
Formulary and a hybrid DoD/VA formulary.
• Over 500 new line items (medications and supplies) were
added to the DoD formulary.
• Pharmacy Informaticist has worked with LexiComp to develop
two online searchable formulary tools: outpatient network
prescriptions and in-house provider.
Formularies
Conclusion
• Merging two federal health care systems
across two servers presents significant
challenges and requires changes in workflow
to meet the new joint mission.
• Multiple “workarounds” have been developed
to overcome said challenges.
• IT systems and “apps” have shaped the
workflow of Pharmacy operations and
provided significant reporting capabilities.
References and Acknowledgements
•
•
•
•
Cartoons provided by Ron Parker
Lovell FHCC picture from: http://www.lovell.fhcc.va.gov
Formulary splash page developed in conjunction with Lexi-Comp.
Patient Queuing System screenshot and cartoon from Q-Flow.
• Special thanks to the PBM Informatics Team for providing
VISTA training documents and trainers (Shirley, Nancy and
Kay) for the Lovell FHCC Pharmacy Staff.