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Pharmacy Re-Engineering (PRE) Project Overview

April 24, 2007 Birmingham, AL

Mike MimsProgram Manager for Pharmacy Systems

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PRE Background

Many VHA technology problem areas and weaknesses identified Prior to 2001 First Consulting study Included patient safety issues

SwRI awarded multi-year, fixed-price contract FY04 to develop new pharmacy system Renewable annually starting in FY05 Period of performance ends January 2008

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FY07 - Changing Environment

Entire VA Environment changed New Organizational Structure Continuing Resolution No Approved Budget (80% of FY06 Budget) Unable to move forward with New Contract

with SwRI Generated Re-planning effort

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PRE Restructuring in FY07Reasons for change: Budget reductions, PRE & dependent projects Uncertain/incomplete HeV Architecture Lack of Common Services maturity Pharmacy “Out of Sequence” Perceived Duplication of Efforts

Standards and Terminology Services

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2007 Development PlansGoals for New Plan

Stay within expected budget Release something of value to field in 12-18

months Priority to address recent patient safety issue Reduce/delay dependencies on other

development efforts Review scope of SwRI contract & distribute

work as appropriate

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2007 Development PlansGoals for New Plan (cont’d)

Spread release of PRE functionality over long period to allow architecture to mature

Phase new staff into VA Teams to help transition PRE development in-house

Incorporate Standards and Terminology competencies/resources into project team

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Standards And Terminology Services Added to PRE Team

Terminology standardization includes: Analysis of current usage and existing standards Determination of the VHA standard Assignment of unique identifiers (VUIDs) Modeling the term to ensure consistent meaning Implementation/Deployment of the standard

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Standards And Terminology Services Added to PRE Team (cont’d)

Terminology standardization includes: Maintenance of the national standard through

additions and deletions of terms Monitoring sites for compliance with the national

standard

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Revised PRE Plan – Overview

SwRI FY07 Contract $2M for PEPS v0.5 $5M proposed to develop significant v1.0

components FY08: Recruit staff for transition to in-house

development Redistribute SwRI tasks to other

development teams 5 major releases deployed over 7 years

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PRE Versions

PRE v0.5, v1.0 and Remaining Work Major Features Schedule Costs (current)

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PRE v0.5

Order Checks

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PRE v0.5

Builds on December 2006 Proof of Concept Implements all demonstrated order checks

Use commercial drug database services Enhanced order checks New dosing checks APIs to support order-check enhancements

through legacy Pharmacy & CPRS

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PRE v0.5 Major Features

VistA Enhancements Enhanced Checks

Drug-Drug Duplicate ingredient (drug) Duplicate Therapy (class)

New Checks Maximum Single Dose Daily Dose Range

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PRE v0.5 Major Features

VistA Enhancements Renal/Hepatic Impairment Dose Indicators APIs to support order check enhancements Ability to i.d. recently DC’d/expired med

orders

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PRE v0.5 Major Features

HealtheVet Construction Create COTS Drug database - Legacy VistA

interfaces Components developed for Proof of Concept

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PRE v0.5 Assumptions

No local data migration or conversion required Minimal FDB–VistA data mapping required FDB Enhanced Therapeutic Classification

(ETC) used for duplicate therapy checks only Standard FDB processes for database

updates GCN_SeqNO populated in NDF for all drugs

in order checks

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PRE v0.5 Responsibilities

PRE Team Overall project governance Design & develop

VistA changes to legacy pharmacy VistA interfaces with PEPS

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PRE v0.5 Responsibilities

Standards and Terminology Services (STS) Lead VistA NDF data standardization efforts

Provide requirements to PRE team Lead Structural/content analysis

Med Routes, Drug Interactions, VA Product, & Drug Units files

Model Terminology Maintain standard terminology

Possible VistA-PEPS-COTS data mapping Validate local mappings

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PRE v0.5 Responsibilities

Southwest Research Institute (SwRI) Design & develop PEPS interfaces for VistA -

FDB order-check messaging Based on FY06 PEPS v1.0 Proof of Concept

Support PRE v0.5 stages I and II testing

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2007 2008 2009 2010

PRE v0.5: Enhanced Order Checking Functionality

Coding/St. I Test

6St. III

7Deployment

5St. II

1 2 3 4

1 Feb 1-Apr 30 ‘07 Coding Discontinue/Hold Functionality

2 May 1-Jul 31 ’07 Coding New Order Checks/Warnings

3 Aug 1-Sep 30 ’07 Coding Enhanced Order Checks

4 Oct 1-31 ’07 Stage I/User Acceptance Testing

5 Nov 1-Dec 31 ’07 Stage II/Lab Testing

6 Jan 1-Mar 31 ’08 Stage III/Field Testing

7 Apr 1-Aug 31 ‘08 Deployment

PRE v0.5 Schedule

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PRE v0.5 Risks

Production environment Support staff Legacy system enhancements Performance COTS drug database licenses

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PRE v0.5 Dependencies

Standards & Terminology Services (STS) SwRI CPRS COTS Drug Database

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PRE v0.5 Costs

VA staff: $1.34 million Non-VA: $4.07 million

Includes PRE contract staff PRE support from CPRS, STS, BCMA, EVS

contractors Contractor travel

Equipment: $70k

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PRE v1.0

Remaining Pharmacy Enterprise Product Systems (PEPS)

Functionality

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PRE v1.0 Major Features

VistA Enhancements All v0.5 functional plus: Identify 

Product type and storage requirements High-risk drugs for follow-up Drugs requiring witness for administration

Display of lab/vitals information

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PRE v1.0 Major Features

VistA Enhancements (cont’d)

Implement dispensing limits (qty/days supply)

Enhanced do-not-mail functionality

Order Checks Lifetime cumulative dose

IV compatibility

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PRE v1.0 Major Features

HealtheVet Construction

Replace legacy PDM and NDF applications Drug update and maintenance tools Ability to manage pharmacy users’ roles Enhanced system management tools Improved reporting capabilities

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PRE v1.0: Remaining Pharmacy Enterprise Product System (PEPS) functions

2007 2008 2009 2010

6Test I

9Deployment

8Test III

7Test II

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1 Mar 1-May 31 ‘07 Coding PEPS Local & Nat’l GUIs, Definition of VUID Messaging

2 Jun 1-Aug31 ’07 Coding Enhanced Item Mgmt Functionality

3 Sep 1-Dec 31 ’07 Coding Enhanced Complex Item Mgmt Functions

4 Jan 1-Mar 31 ‘08 Coding VistA DRUG file synchronization

5 Apr 1-Jun 30 ‘08 Coding VistA PDM file synchronization

6 Jul 1-Sep 30 ’08 Stage I/User Acceptance Testing

7 Oct 1-Dec 31 ’08 Stage II/Lab Testing

8 Jan 1-Mar 31 ’09 Stage III/Field Testing

9 Apr 1’09 –Feb 28 ‘10 Deployment

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Coding

PRE v0.5 Schedule

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PRE v1.0 Costs

VA staff: $928k Non-VA: $8.85 million

Includes PRE contract staff PRE support from CPRS, STS, BCMA, EVS

contractors Contractor travel

*v1.0 SwRI Costs estimated based on remaining contract funds

Equipment: $40k

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Beyond PRE v1.0

Remaining Pharmacy Enterprise Product Systems (PEPS)

Functionality

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Beyond PRE v1.0

Working with Business Owners Organize Prioritize

Sequencing must consider: Patient safety issues Funding requirements Availability of common services Ability of other applications to implement

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Major Features – Remaining PRE

PRE v2.0Inventory Replace current packages

Controlled Substances Drug Accountability Automatic Replenishment/Ward Stock

Requirements gathering based on SwRI work

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Major Features – Remaining PRE

PRE v3.0 Order Entry, Clinical Monitoring Replace parts of current packages

Outpatient Inpatient IV order processing

Changes to support ordering through CPRS Based on requirements gathered by SwRI In-house analysis & construction

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Major Features – Remaining PRE

PRE v4.0 Dispensing functions Replace remaining order processing parts

Outpatient Inpatient IV

Based on requirements gathered by SwRI In-house analysis & construction

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Major Features – Remaining PRE

PRE v5.0 Administration Replace current BCMA functions

Based on requirements gathered by SwRI In-house analysis & construction

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Remaining PRE Functionality

Schedule

PRE v0.5

PRE v2.0 Inventory

PRE v3.0Order Entry, Activate & Clin Mon (HeV) Coding

PRE v4.0Dispense

PRE v5.0Administration & Migration

2007 2008 2009 2010 2011 2012 2013 2014

PRE v1.0

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Questions?