Improving Physician Efficiency and Patient Care with Electronic Prescription of Controlled Substances (EPCS) Thursday March 3rd Todd Smith, MD, CMIO Lou Gallagher, System Director of Engineering and Architecture
Conflict of interest Lou Gallagher Todd Smith, MD Has no real or apparent conflicts of interest to report.
A quick survey In everyday life are you? A. IS/Technical C. Neither B. Provider/Care Giver
Agenda I. Learning objectives II. Healtheast s knowledge gained III. Doctors vs Technologists (Let the battle begin) IV. Value of EPCS: Patient and provider satisfaction V. Regulations: All things legal (Security/DEA/Regulatory/Meaningful Use) VI. How to think: A method to the madness VII. How to execute: Easy as 1,2,3 VIII. Summary of actions IX. Physician comments and user experience (Video)
I. Learning Objectives Interpret the DEA interim final rule allowing EPCS to understand the requirements for EPCS, including provider proofing Develop the right technology strategy to meet DEA requirements while preserving workflow efficiency to drive EPCS adoption Apply best practice approaches and lessons learned from other healthcare organizations that are early adaptors of EPCS
II. Healtheast's knowledge gained Value of EPCS Within a larger workflow EPCS improves patient care and provider satisfaction Regulations DEA regulations/security should not be the driver EPCS done properly achieves greater security and compliance while enhancing the physician/patient experience How to think: Planning, teamwork and open minds are more important then technology How to execute: Partnership between IS and the business is critical
III. Doctors vs Technologists - The Battle Begins Round 43 21 (PARTNERSHIP!) (EASE (SECURE) (SPEED) OF USE) Doctor Easy Technology Tom
A quick survey Where does your organization fall within rolling out EPCS? A. Fully deployed and integrated with single sign on and security B. Fully deployed stand alone C. In the middle of an installation D. In planning stage E. Just getting going
IV. Value of EPCS Satisfaction Patients have given 12 proactive positive EPCS comments in the past year Physician Quote: The best part of our EHR rollout was the tap-n-go and EPCS! We have had ZERO IS tickets around EPCS from physicians http://www.himss.org/valuesuite
IV. Value of EPCS Clinical Electronic prescribing is used by more than 90% of providers Nurse Comment: It is nice not being constantly interrupted for narcotic prescription refills. Nurses involvement is down from 40 refills a day to ZERO http://www.himss.org/valuesuite
IV. Value of EPCS Secure data Quote from our CISO The use of biometric identification for EPCS substantially bolsters our layered security program while introducing ease-of-use Fax Machine Quote: It has been a great run but like 8 track tapes, all technologies must die! It is my time. At the same time it reduces a tremendous amount of privacy risk associated to the old-world of paper faxes and orders http://www.himss.org/valuesuite
IV. Value of EPCS Patient and population management With EPCS, our patients are much happier being able to go directly to the pharmacy for their refills, and can now get them off hours. Customer Quote: HealthEast has freed up my time as it relates to my prescription refills, thank you! Patients have ZERO need to go to the clinics for controlled substance prescribing http://www.himss.org/valuesuite
IV. Value of EPCS Savings 95% of our controlled substance prescriptions are completed electronically (National Average 1.4%) The time, accuracy, and end user satisfaction is ~$20K/month Time spent for prescribing of controlled substances is down by ~500 hr/month http://www.himss.org/valuesuite
V. Regulations - All things legal
A quick quiz Are you aware of the Controlled Substance Act of 1970? A. Yes B. No Were you even born in 1970? A. Yes B. No
The Controlled Substances Act of 1970: 3 areas of focus Is/was the prescription written by a DEA-registered physician Is/was it filled by an authorized pharmacist Is/was it delivered to the correct patient
DEA regulations regarding EPCS Identity proofing Two-Factor authentication something you know (a knowledge factor) something you have (a cryptographic token) something you are (biometric information) Federal Information Processing Standard 140-2 Security Level 1 (FIPS)
Identity proofing and enrollment Identity proofing starts with credentialing Streamlining physician onboarding becomes very important Enrolling in EPCS becomes part of physician training when joining our team
Auditing and reporting Modern electronic archives allows faster audits of prescriptions written by our physicians Electronic archiving requires much less physical space than paper archives, allowing more rooms for patient care
VI. How to think - A method to the madness Is EPCS a stand alone conversation? OR is it part of a larger strategy?
EPCS Don t is the letfinal EPCS step stand in aalone workflow Device Timeouts EPCS Databases Databases EHR Tap-N-Go Security
VII. How to execute - As easy as 1, 2, 3 1. Assemble the technology team and assess your technology 2. Recognize and create partnerships 3. Implement the plan
Assemble a technology team Our technology team lead all aspects of the project from ideation stage through installation Virtualization Engineers Desktop Engineers Security Consulting Services
Technology assessment Where are you at with related technologies? Legacy Single-Sign-On solution (SSO) Multiple legacy EMR s Are all devices FIPS compliant Do you have remote 2 factor authentication Security capabilities and technologies
Recognize and create partnerships Gain executive acceptance Partnership between IS and physicians was critical Marketing created an enterprise wide marketing campaign We were changing out our EHR We marked the rollout with a tech fair This was part of the new training What is your organizations marketing opportunity
Technical implementation milestones Virtualization & Desktop Team Build appliances, desktop images and test servers Security Team Create standards for screen savers and timeout policies Consulting Services Profile legacy apps for Single Sign On
Business & marketing implementation milestones We created a user enrollment fair Badge and fingerprint enrollment Workflow analysis User feedback We did a multi-phased rollout for acceptance Phase 1 = Inpatient Phase 2 = Outpatient
Project Timeline
VIII. Summary of actions S Partnerships are key T Overall environment experience E Consider all related systems P Rollout in an enticing format S Think beyond EPCS http://www.himss.org/valuesuite
IX. Physician comments and end user experience videos
Physician and Patient Experience Video
Questions Contact Information Lou Gallagher lgallagher@healtheast.org Todd Smith tsmith@healtheast.org