Remote Order Checking

In addition, with the Remote Data Interoperability (RDI) project, it is now possible to perform a limited number of order checks against remote outpatient pharmacy and allergy information from other Veterans Health Administration (VHA) facilities that is stored in the Health Data Repository (HDR). Another project, the Clinical Health Data Repository (CHDR) will enable remote order checks against allergies and outpatient medication data from Department of Defense (DoD) facility data that is stored in the HDR. The CHDR data only relates to active dual consumers (patients that are seen at both VHA and DoD facilities).

For the selected patient, RDI requests from the HDR all outpatient pharmacy data with an expiration or discontinued date starting 30 days in the past and going forward, including into the future.

What Remote Order Checks Are Available?

With RDI and CHDR, the following order checks occur:

· Allergy Contrast Media Interaction

· Allergy-Drug Interaction

· Critical Drug Interaction

· Duplicate Drug Class Order

· Duplicate Drug Order

· Significant Drug Interaction

Which Items Are NOT Used in Remote Order Checks?

Some items are not used in remote order checking because they are not stored in the HDR. Others have a high annoyance factor and therefore were not included at the request of field sites. The following items are not included in remote order checks:

· Inpatient Medications

· Non-VA Meds

· Supply items

· Local drugs that are not matched to the National Drug File

Note: The HDR-Hx and HDR-IMS contain prescriptions with drugs that are not matched to the National Drug File (NDF). This prescription data should be used in remote order checking for duplicate drug classes. Because the National Drug File is updated regularly, these missing order checks could be resolved whenever the NDF is updated. Some drugs may never be matched, especially drugs used in research.

Will the Display Change?

With RDI, if an order check finds a problem, CPRS displays the information to the user. The dialog is the same one that CPRS users are accustomed to with the addition of some additional information:

· Medication orders include the last refill date and the quantity.

· Remote medication order checks also display the facility name where the medication was prescribed. The facility information is provided as a convenience should the user need to get further information from the facility. Local medication order checks do not have any text where the facility name would be.

· For allergies, the term "remote", "local", and "local and remote" will display based on where the allergy is recorded.

Examples of the order check screen with remote facility names in the order checks are shown below.

The Order Checking dialog with the source of the order check information highlighted in red.

In this screen capture, several order checks are displayed. For allergies or adverse reactions, indicates if the allergy or reaction is recorded locally, remotely, or both. Red boxes were added to show where location information for the order.

the order checking dialog

This screen capture shows a duplicate therapy warning, a general dosing check, and a message that the daily dose range check could not be performed because of missing data.

The Order Checking dialog with the Drug Interaction Monagraph button and locations highlighted in red.

This screen capture shows sample order checks. Red boxes have been added to show where CPRS displays the remote medication order's location, in this case a Department of Defense medical facility. The red boxes are for emphasis and do not display in CPRS. In this example, "4th Medical Group" denotes a DoD medical facility. Order checks also indicate if a monograph is available that contains additional information.

Allergy and local order checks do not display the facility name.

To ensure that providers have the information they need, CPRS also provides the message "Remote Order Checking not available-- checks done on local data only" if CPRS cannot communicate with remote sources.

CPRS shows this message once during an ordering session when it cannot communicate with the HDR and then does not show it again until the user begins another ordering session. However, after displaying the message, CPRS continues to attempt communication with the HDR. If CPRS reaches the HDR, remote order checks will display when orders are placed.

How Is RDI Remote Order Checking Enabled?

To use remote order checking, your site must enable a parameter to access HDR data. This parameter is set for the entire facility.

When Does CPRS Get Remote Data?

Order checks from CPRS can happen several times during a CPRS ordering session:

· Beginning to write/copy/change orders - When a user selects an order menu to begin writing orders, CPRS requests some order checks, such as polypharmacy, renal function, or creatinine clearance, for example.

· On order acceptance - When the user selects Accept, CPRS requests the order checks.

· Signature of orders - When a user signs the order, CPRS requests order checks.

How Long Is the Data Used?

A parameter that sites can set controls how long HDR data is stored locally and is considered "fresh" and can be used for order checks before the data will be retrieved again from the HDR. The default time for this parameter is 120 minutes or two hours, but each site can change the time in that parameter.