AF Pharmacy Operations for MTFs final · 10/28/2015 3 AFMH Clinical Pharmacist: Background •Clinical pharmacist integration into PCMH –Robust VA and civilian practice experience

10/28/2015

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Air Force Pharmacy Operations for MTFs

Lt Col Jason LennenMaj Justin Lusk

Maj Richard Caballero

CPE Information and Disclosures

The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Lt Col Jason Lennen, Maj Justin Lusk, and Maj Richard Caballero declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

CPE Information

• Target Audience: Pharmacists & Technicians

• ACPE#: 0202-0000-15-194-L04-P/T

• Activity Type: Knowledge-based

Learning Objectives

1. Describe the current and future state of the pharmacy automation technology system-wide refresh.

2. Describe the status, lessons learned from current operations, and future state of clinical pharmacy support to the patient-centered medical home.

3. Explain the key components of efficient lean pharmacy operations and list key resources to help improve pharmacy operations.

4. Describe how staff assistance visits and inspection preparation checklists can help to improve pharmacy operations.

Self-Assessment Question 1

How many MTFs are participating in the initial phase of embedding pharmacists into AFMH?


Which of the following are key components of lean pharmacy operations?

A. Efficient, High-Reliability Organization

B. Optimized, standardized workflows

C. Automation, manpower, infrastructure, innovation, leadership / management

D. All of the above

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List three tools that can help improve MTF pharmacy operations.

PhAFMOAcists – Past & Present

Source: Jason Lennen’s iPhone

MHS Organizational Overview

MHS Governance

ASD(HA)SGs, JSS

USD(P&R), Vice Chiefs

CJCS

USD(P&R)

ASD(HA)

PolicyExecution

MDAG, DASDs,

JSS

MTFs

D f

Agency

Defense Health Agency

NCR Directorate

MTFs

ArmyOperational

Units

NavyOperational

Units

Combat Support Agency

Responsibilities

USUHS

Sec Army

CSA

Sec Air Force

CSAF

ArmyMEDCOM

Army SG

MTFs MTFs

Secretary of Defense

PAC

PDASD, Deputy

SGs, JSS

Personnel Operations Budget

MPOG MBOGMOG

MDAG

MHSER

SMMAC

Sec Navy

MarineOperational

Units

Air Force SG

Air ForceMAJCOMs

Air ForceOperational

Units

CNO CMC

C2

Coordination & Assistance

NavyBUMED

Navy SG

JOGJoint

Source: Air Force Medical Operations Agency

AFMOA Organizational Overview

PPBE

Medical Operations

Administration/ Support

Dental Operations

Clinical Inpatient Ops

Aerospace Medicine Ops

Biomedical Sciences Corps

Directorate Map to Functionals

Directorate Map to Squadrons

SGA SGD SGBSGHSGNSGP

SGASGA

SGAL/ Logistics

SGAP/ Manpower

SGAT/ Health

Benefits

SGAI/ Systems

SGAR/ RMO

SGDSGD

SGDD/ Clinical

Dentistry

SGDS/ Dental

Support

SGDT/ Dental

Training

SGPSGP

SGPB/ Bioenviron.

Engineer

SGPF/ Flight & Ops Med

SGPM/ Public Health

SGPP/ Human Perform

SGNSGN

SGNE/ Ed & Tng

SGNP/ Provision Nurs Care

SGNR/ Nurs Svc

Resourcng

SGHSGH

SGHC/ Clin Bus Analysis

SGHM/ Prov Care

SGHQ/ Quality

SGHW/ Mental Health

SGBSGB

SGBD/ AFDTL

SGBH/

HCoE

SGBL/ AF Blood

Pgm

SGBP/ Pharmacy

Ops

SGBP/ Optometry

Ops


AFMOA Pharmacy Operations

• AFMOA pharmacy SME / Action Officer

• Liaison with HAF, MAJCOMs & MTFs

• Clarify/inform policy, provide guidance

• Information conduit

• AF pharmacy representative

• Improve AF pharmacy operations

“Coaching and partnering for improved performance”

Clinical Pharmacist Integration into AF Medical Home (AFMH)

• Background

• Status

• Lessons Learned

• Next Steps / Future

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AFMH Clinical Pharmacist: Background

• Clinical pharmacist integration into PCMH– Robust VA and civilian practice experience / data

– Reduces costs and improves access, quality, safety & outcomes

• ASD/HA tasked Svcs to review requirements

• AF/SG “Go Do” Initiative, 11 MTFs x5 yrs

• Big picture– Quality, access, safety, cost … outcomes

– Pt-centered, MTM-centric, collaborative effort

AFMH Clinical Pharmacist: Background (cont’d)

15

Pilot Concept: 5 MTFsDec 14

CONOPs &Resource

DevelopmentFeb 15

Expanded MTFs:11 MTFs

Jan 15

Briefed to Medical

Support PanelMar 15

SG “Go Do” Funded 11 MTFs

Feb 15

Brief to AFMS GroupApr 15

FY16 BudgetFY17 POM PCT

submittedApr 15

FY15 Contract funds loaded

May 15

Target IOCOct 15

Target FOCDec 2015


AFMH Clinical Pharmacist: Status

• Clinical pharmacist embedded at 11 MTFs

• Contract employees hired at all sites

• Implementation at various stages

• Family Health, Internal Medicine, or Both

AFMH Clinical Pharmacist: Lessons Learned

• Building the practice / success tips

• Standardized work flow / documentation (TSWF Clinical Pharmacy Form)

• Site feedback

• BHOP lessons

AFMH Clinical Pharmacist: Next Steps / Future

• “Living” support guide

• Tool kit

• Performance targets and measurement

• Local assessment / practice refinement

• Potential expansion across AFMS

• Practice changes…from product to patient

Lean Pharmacy Operations

• Efficient, High-Reliability Organization

• Optimized, standardized workflows

• Automation, manpower, infrastructure, innovation, leadership / management

• Leverage SIG expertise

• KX / Resources

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SACs, SICs & SAVs…oh my!

• Self-Assessment Communicators (SACs)– UEI construct

– MICT

• Self-Inspection Checklists (SICs)– TJC standards

– Top compliance issues

• Staff Assistance Visits (SAVs)– Observations

– Requests

Key Points

• Clinical pharmacist support to AFMH

… wave of the future

• Lean pharmacy operations

… best for us and our patients

• Internal & external reviews

… make your pharmacy better

Pharmacy Technology and Automation

Maj Justin Lusk, USAF, BSC

Pharmacy Equipment 101

• Pharmacy Management System: CHCS

• Pharmacy Workflow System– Innovation PharmASSIST

– Parata P2000

– ScriptPro SP Central

• Automated Dispensing Cabinets– CareFusion Pyxis

– Omnicell

Pharmacy Equipment 101

• Will-call Systems– GSL

– PickPoint WCS

– Innovation PharmASSIST

• Patient Interaction (Queuing Systems)– ScriptPro PSP

– QMATIC

– Q-Flow

AF Projects

• Automation/Workflow Refresh

• ADC Refresh

• Centralized Queuing

• Centralized ADC IA Monitoring

• ScriptCenter

• Will-Call Systems

• Thermal Printers

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AF Projects

• Automation/Workflow Refresh– Phase 1: In progress

• Open discussion from staff that have completed refresh (Q/A | Lessons Learned)

– Large Sites: At contracting

– Phase 2: At contracting

• ADC Refresh– MedStation and CII Safe

– Future state: ES

AF Projects

• Centralized Queuing– Salient Characteristics

– Site Selection

• Centralized ADC IA Monitoring

• Other Projects– ScriptCenter

– Will-Call Systems

– Thermal Printers

– PhocusRx

DHMSM

• DHMSM: Defense Healthcare Management Systems Modernization

• DOD plan to replace CHCS/AHLTA/Essentris

• Contract awarded to Leidos

DHMSM

Image provided by DHA DHMSM Program Office

DHMSM

Image provided by DHA DHMSM Program Office

CHCS AHLTA DHMSM

DHMSM

• FAC: Functional Advisory Council

• TSWAG: Tri-Service Workflow Advisory Group– Inpatient

– Outpatient

– Clinic

• DDWG: Design Decision Working Group

• CSP: Clinical Standardization Process

• DMIX: Defense Medical Information Exchange

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Customer Pharmacy Operations Center (CPOC) Updates

Maj Richard Caballero, USAF, BSC

Overview

• DMMonline Tools– Medical Master Catalog (MMC)

– National Contract Compliance Report (NCCR)

– Product Sourcing Request (PSR)

• DMMLS Strategic Sourcing

• CPOC Monthly

• Trade Agreements Act (TAA)

• Narcotic Order Review Application (NORA)

• Drug Supply Chain Security Act (DSCSA)

DLA Mission:Supporting the Warfighter

"We are America’s Combat Logistics Support Agency. We provide effective and efficient worldwide

support to Warfighters and our other customers. "

Every Day Every Crisis• Ready on day one

• Varied missions & requirements

• Resupply & sustainment

• Control commercial/industrial materiel

• Situational awareness

• Health care economics

• The business of health care

• The cost of medical materiel

• Reliable “next day” support

• Business intelligence

Vision: To provide an integrated and responsive system of choice for delivering consistent, quality medical materiel support

for health care providers to perform their patient care mission

Register for DMMonline Access

https://www.medical.dla.mil/registration

Joint National Contracts

• VA, DoD, BOP, HHS Partnership

• Requirements Based Contract– Commitment to brand

– Failure to Supply

• High Priority: doxycycline 100mg ($60M/yr, $1.45/tab)– Awarded 29 Dec 14, Blu @$0.0834/tab

• Calculate customers’ projected monthly usage and send to PPV contractors 30 days prior to effective date

– Ensure greater availability for customers and

– Better production forecasting for industry partners

National Contracts Compliance Report (NCCR)

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NCCR Report by DODAAC or Service

National Contract Drug List

• Resource Information– All medications

currently on a National Contract

• When to Use– Optimization of MTF

purchasing

– Compliance

https://www.medical.dla.mil/nationalcontracts/NationalContractsDrugLists.aspx

National Contract Compliance

Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Nov-14

USA 81.9% 85.7% 83.6% 78.4% 74.5% 75.5% 75.4% 81.6% 81.6% 83.7% 82.5% 86.2% 81.6%

USAF 90.7% 93.6% 92.4% 87.1% 80.5% 83.9% 82.9% 91.7% 90.7% 92.3% 91.8% 93.3% 91.4%

USN 81.4% 74.3% 74.2% 75.3% 69.9% 72.6% 71.8% 78.5% 78.5% 78.0% 82.2% 88.1% 77.8%

USCG 85.0% 79.1% 78.4% 72.8% 68.2% 69.4% 73.8% 77.2% 76.1% 75.3% 81.1% 80.4% 77.6%

Average 84.7% 83.2% 82.1% 78.4% 75.9% 78.3% 77.8% 84.9% 86.3% 85.6% 85.5% 89.4% 85.2%

81.9%

85.7%83.6%

78.4%

81.9%

75.5% 75.4%

81.6% 81.6%

83.7%82.5%

86.2%

81.6%

90.7%

93.6%92.4%

87.1%

80.5%

83.9%

82.9%

91.7%90.7%

92.3% 91.8%93.3%

91.4%

81.4%

74.3% 74.2%75.3%

69.9%

72.6%

71.8%

78.5% 78.5%78.0%

82.2%

88.1%

77.8%

85.0%

79.1%

78.4%

72.8%

68.2%69.4%

73.8%77.2%

76.1%75.3%

81.1%

80.4%

77.6%

84.7%83.2%

82.1%

78.4% 84.7%

78.3% 77.8%

84.9%86.3% 85.6% 85.5%

89.4%

85.2%

65%

70%

75%

80%

85%

90%

95%

100%NC Shortages (Recouped $2.3M credits

Master Medical Catalog

• Information Available– Product name, Strength, Manufacturer, Supplier

– NDC, NSN, MFR Part Number, PVON

– Source of supply

– Equivalent products

– Pricing

• When to Use– Source of supply, Alternative products, Program

item searches https://www.medical.dla.mil/MMC/Search.aspx

MMC Search Result MMC Product Detail

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MMC Sourcing Search MMC Sourcing Search Results

Pharm PV

Secondary Pharm PV

Product Sourcing Request

• When to Use– Item not on Federal Pricing Vehicle

– Item not stocked at your Distribution Center

https://www.medical.dla.mil/MMC/Search.aspx

Product Sourcing Request (PSR)

Best Pharm Report

https://www.medical.dla.mil/Portal/Homepages/CdmiaBestPharm.aspx

DMLSS Strategic Sourcing

1. On the Customer Area Inventory Management

window, select Navigate, Strategic

Sourcing.

2. Select Review Pharmaceutical.

The Strategic Sourcing Criteria window

displays.

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DMLSS Strategic Sourcing Tool

The Strategic Sourcing: Pharmaceutical detail

window for Returned Data Set displays.

Accepting Recommended Sourcing

3. Review the Recommended Sourcing information and click the Accept icon on the vertical toolbar.

Note: User can review the MTF Catalog details if needed by clicking on the MTF Detail icon on the

vertical toolbar.

CPOC Monthly UpdatesBrand to Generic (B2G)

Total Sales $ drop = cost avoidance

Trade Agreements Act

• Purpose:

- IAW US Law 19 USC 2501, 48 CFR 1, FAR 25.4

- Maintenance of PPV program

• Best practice: TAADA database development

- Review & removal >9,000 non-compliant NDCs

- Facilitated >500 NAD statements ensuring supply

• Important point:

- Thorough internal review process ensuring availability of only TAA compliant items through the PPV program

• Future look:

- TAA listing incorporated into the MMC database

- Restriction of TAA non-compliant NDCs

Narcotics Order Review and Approval (NORA)

• Defense Medical plans to implement electronic ordering of controlled substance through DMLSS and TEWLS

• This capability will allow registrants and POAs to digitally sign electronic orders

• Digitally signed orders will be sent through DLA Transactions Services to Prime Vendors for fulfillment

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Enroll in CSOSDrug Supply Chain Security Act (DSCSA)

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DISPENSER - a retail pharmacy, hospital pharmacy, a group of chain pharmacies under common ownership and control that do not act as a wholesale distributor, or any other person authorized by law to dispense or administer prescription drugs, and the affiliated warehouses or distribution centers of such entities under common ownership and control that do not act as a wholesale distributor…SUSPECT PRODUCT - reason to believe that the product is potentially: Counterfeit, diverted, stolen; Subject of fraudulent transaction; Intentionally adulterated or appears otherwise unfit for distribution such that would result in serious adverse health consequences or death to humansILLEGITIMATE PRODUCT - credible evidence that the product actually is any of the above

Key Definitions

Definitions: Scope

Product• What’s covered: Prescription drug in finished dosage

form for administration to a patient without further manufacturing (such as capsules, tablets, lyophilized products before reconstitution

Transaction• Transfer of product where a change of ownership occurs

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Transaction Information, History, and Statement (1)

Transaction Information (TI):

• Proprietary or established name or names of the product;

• Strength and dosage form of the product;

• National Drug Code number of the product;

• Container size;

• Number of containers;

• Lot number of the product;

• Date of the transaction;

• Date of the shipment, if more than 24 hours after the date of the transaction; and

• Business name and address of the person from whom and to whom ownership is being transferred.

Transaction History (TH): A statement in paper or electronic form, including the transaction information for each prior transaction going back to the manufacturer of the product. 59

Transaction Statement (TS): A statement, in paper or electronic form, that the entity transferring ownership in a transaction—

• Is authorized as required under DSCSA;

• Received the product from a person that is authorized as required under DSCSA;

• Received transaction information and a transaction statement from the prior owner of the product, as required under the law;

• Did not knowingly ship a suspect or illegitimate product;

• Had systems and processes in place to comply with verification requirements under the law;

• Did not knowingly provide false transaction information; and

• Did not knowingly alter the transaction history.

Transaction Information, History, and Statement (2) Future of CPOC

• Educational Webinars

• Limited Distribution/Specialty Pharmacy Items $400M+

• Compounded drugs $80M+ DHA spend (Retail network)

• Access to real time data, metrics and analytics

• DMLSS Strategic Sourcing Tool

• Drug Quality Security Act (Track and Trace)

• Narcotics Order and Review Application (NORA)

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Customer Pharmacy Operations Center Small Team, Global Impact

MAJ Randall Sweeney, USA – Chief Pharmacist

Maj Richard Caballero, USAF – Pharmacist

LCDR John Dischert, USN – Pharmacist

LCDR Ebenezer Aniagyei, USN - Pharmacist

Mr. Jose Ramos, USN(ret) - Pharmacist

Mr. Dan Geiger, USN(ret) - Pharmacist

Mrs. Doris Anne Downes – Senior Analyst

Workflow EMAIL: [email protected]

Answers To Self-Assessment Questions




ANSWER: 11





D. All of the above






D. All of the above





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ANSWER: SACs, SICs, and SAVs


Closing Remarks

Lt Col Jason LennenPharmacy Operations Division Chief

Air Force Medical Operations Agency (AFMOA)[email protected](210) 395-9972 DSN: 969

Documents

AF Pharmacy Operations for MTFs final · 10/28/2015 3 AFMH Clinical Pharmacist: Background •Clinical pharmacist integration into PCMH –Robust VA and civilian practice experience