LTC e-Rx demo first example of shared records

June 25th, 2013 by Rod Baird

Last week I was fortunate to participate in a truly significant event for LTC physicians, facilities and pharmacies.

The annual LTPAC IT Summit was June 17-18. This is where thought leaders from LTC providers, CMS, ONC, HIEs and the software vendors who support those entities gather. The event includes presentations, panel discussions, interconnectivity exhibits and a trade fair.


I was gratified to be invited to give a presentation on the use of EHRs by LTC physicians in the nursing home setting. That forum would have been more than enough to satisfy my objective to advance the ability of physicians and extenders to use EHR technology in the LTPAC setting and improve patient care.

That opportunity was overshadowed by a demonstration of the NCPDP LTC ePrescribing model. For those readers who have better things to do than follow data message standards, let me explain.

NCPDP is a voluntary national standards setting organization. It develops standards that govern the transmission of ePrescribing messages between providers and pharmacies, and the communications between pharmacies and prescription drug plans. Last fall, CMS regulations mandated that all electronic prescription messages follow the NCPDP 10.6 standard. This applies to nursing homes in the fall of 2014.

The 10.6 standard was written to accommodate the needs of nursing homes and LTC pharmacies. It includes a complete census message and fields that support the entire prescription/supply/dispensing cycle.

Fortuitously, this standard message contains all the basic data needed for the LTC physician to admit a patient to their practice, manage scheduling and satisfy Stage 1 Meaningful Use. I want to personally express my gratitude to the software developers at American HealthTech, Prescribers Connection and GPM who adapted their applications to process these standard messages of the future.

Here are the specifics of what we demonstrated at the LTPAC Summit:

·       Nursing home admits a patient (using American HealthTech’s standard LTC EMR)

o   Patient automatically appears as new admission in gEHRiMedÔ EHR

o   Patient census message appears in LTC Pharmacy (we used a dummy pharmacy for the demo)

o   All three records are synchronized

·       Patient Status changes at LTC Facility – new demographic data

o   Status change appears in gEHRiMedÔ & LTC pharmacy

·       Physician verbally approves admission medication list with LTC facility nurse

o   Nurse enters verbal orders into facility CPOE

o   E-Rx request is delivered to gEHRiMedÔ

o   Physician accepts all orders (no data entry required) and proceeds with normal review and e-Rx activities.

o   Approved (signed) orders sent to LTC pharmacy and facility. Orders are indexed and archived.

·       Facility discharges patient

o   Patient status changed to discharged in gEHRiMedÔ

There are many additional elements that will be incorporated in the final product, but we have proven that it is practical to manage a “shared care” model for a physicians’ EHR.

The model has tremendous practice management implications – the physicians’ EHR, the facility EMR and the pharmacy, only have to maintain one secure interface. Some of our audience was from LTC facilities. After seeing the demonstration they identified the labor savings that will arise during the required monthly medication reconciliation procedure – where physician orders and medication administration records are matched. This collaborative model assures that signed physician orders are available and any that are missing can be readily tracked.

As this NCPDP model spreads, there will be additional opportunities to advance collaborative care for the LTPAC population.

Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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