HP Newsletter - Hospice Pharmacia

Passionate for the Appropriate Use of MedicationVolume 5 | Issue 1I n T h i s I s s u eexcelleRx Institute Update2HP’s Clinical New BusinessTeam3New Offerings from HP4The New HP Fax System5PROM Update6Second Delivery Charges6Using PROM to ImproveHospice Practice7HP Sightings8Dear Laura9Quality in Action: HP Improves HospiceMedication Therapy- Calvin H. Knowlton, RPh, MDiv, PhD, CEORecent reports in the press have brought tofore that “medication safety” is an oxymoron.Prescription medications that are appropriatelyprescribed, dispensed, and administered causeprofound mortality and morbidity.Some obvious examples include Cox-2 inhibitorsand hormone replacement therapy. Then thereare those less publicized studies over the past fewyears that have also heightened our awareness ofharm due to medications:• 30% of hospitalized patients suffer at least oneadverse drug reaction;• 1.9 million adverse drug events occur in theMedicare population;• 24% of the 500 new medications approvedfrom 1986 to 1999 have been subsequentlywithdrawn or affixed with a “black box”warning by the FDA, etc.So, what about medication use within hospicepopulation?are able to mine the data from each consultation,analyze it, and report the results!Our findings indicate that our population entershospice with an array of medication-relatedproblems not unlike those of the general Medicarepopulation. The chart on page 11 below showsthe results of a March 2005 study of identificationand prevalence of potential medication-relatedproblems in ~ 250 consecutive hospice admissions.Our clinical pharmacists see an average of 10medications per patient upon admission—over40% of which we identified upon consultation asbeing problematic for one of six reasons:• Medications prescribed with no indication• Potential or actual adverse drug reactiondetected• Dose too high• Dose too low• Medications indicated but not prescribed• Medications inappropriateIT Corner10EMAAC Update11Regulatory Remarks12Hospice Pharmacia processes more than 1,000new hospice patient admissions every weekday.Our specialists most directly and evidently supportthe hospice team upon admission and uponeach change in symptom when we evaluate eachpatient’s medication profile. Being a technologyrichcompany, we track what we do. Thus, weThough we were pleased to quantify the highprevalence of medication-related problemsdetected and resolved by our pharmaceutical caresupport center, we were a bit disheartened by thestate of the healthcare system, as evidenced byour data.continuted on page 11www.hospicepharmacia.com

2Passionate for the Appropriate Use of MedicationEducation Corner- Jill A. McMath, PharmD, Continuing Education AdministratorThe excelleRx Institute is a nonprofitcorporation that is committedto collaborating with you to enhancepharmacotherapy outcomes for ourpatients through education, research andparticipation in public policy. We providepalliative care educational programs toenhance practice and career growth for healthcare professionals.The first 2005 CNE program, “Introductionto Non-opioid and Opioid Pain Therapy” wasoffered as a web teleconference in February.We had 173 hospice offices registered andover 440 health care professionals receivedcredit for this continuing education session!This program is now available online as anindependent study.We encourage you to participate in theother CNE modules online. Please visit therecently updated CNE website! The availableprograms include:Converting Opioid Analgesics: Focuson MethadonePalliative Sedation in Hospice PatientsPalliative Care in AmyotrophicLateral SclerosisPalliative Care in Patients with DementiaPalliative Care in Huntington’s DiseasePalliative Treatment of DsypneaManagement of Seizures inEnd of Life CareThe Palliative Management of InsomniaIntroduction to Non-opioid andOpioid Pain TherapyWe look forward to your participation in theupcoming CE web teleconference in May.The program, Beyond Opioids: AdjuvantPain Therapy, will be held on May 10, 2005at 9:00am EST, May 11, 2005 at 12:00pmEST, and May 12, 2005 at 3pm EST.This educational program has been selectedbecause of the large number of patients thatrequire more than the employment of opioidsto effectively manage various pain syndromes.An “adjuvant” is a medication with otherindications that may provide analgesia incertain pain disorders. This program willHospice Pharmacia is pleased to spreadthe news that one of our partners, HopeHospice (Ft. Myers, FL), has been awardedthe excelleRx Institute 2005 Excellencein Pharmacotherapy Outcomes Award.The purpose of the Award is to recognizeoutstanding achievements by a hospiceorganization that is dedicated to superiorcare and to promote best practices.Hope Hospice was most notably recognizedfor their collaborative practice system, inwhich pharmacists implement, monitor, andadjust medication therapy for patients underprotocol with physician oversight and nurseassessment.Hope Hospice demonstrated success inpain control, appropriate use of medication,focus on utilizing adjuvant medications to aidin the effective relief of neuropathic, bone andvisceral pain maladies. After participation inthis program, the audience will be able to:1. Recognize the effects of untreated painand inadequate pain management.2. Describe how pain is classified.3. Recommend appropriate adjuvanttherapies based on the suspected painetiology, type of pain and various patientspecific factors.continued on page 12Hope Hospice Winner of 2005 Excellence inPharmacotherapy Outcomes Awardappropriate use of adjuvants, and side effects.The Excellence Award, which consistsof $1,000, two paid registrations to theNHPCO Conference and a commemorativesculpture, will be presented during a dinnersponsored by Hospice Pharmacia on April22, 2005 at the NHPCO Clinical TeamConference.The excelleRx Institute is a non-profitcorporation. Its mission is to enhance qualityof life in palliative care through research andeducation. The Institute offers continuingeducation in palliative pharmacotherapy forend of life andadvanced disease management. Seewww.excelleRxinstitute.org for moreinformation.www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 3HP’s Clinical New Business Team:PharmDs in the Field- Tara Callaghan, Program Communications CoordinatorHospice PharmaciaPartners Need to KnowThe Value Proposition of HospicePBMs for Pharmacy ManagementThe Clinical CoreWe have been asked, more than once, whyHospice Pharmacia (HP) invests its time andresources maintaining a New Business Teamof clinicians and palliative care experts.The answer is that HP takes the presentationof clinical services role very seriously. It is ourbelief that hospice pharmaceutical care is bestintroduced by specialists who have experiencecollaborating with hospice nurses, doctors,and patients in the field. How could a salesforce of non-clinicians who have little or nounderstanding of hospice possibly understandthe needs of a hospice and anticipate theconsequences of the pertinent healthcaredecisions that face hospices on a daily basis?HP’s field team is the only one of its kind,with a core of five regionally based Doctorsof Pharmacy who represent the organizationacross the United States.The clinical field team is supported by ourProgram Communication Coordinators whoinitiate contact with hospices to communicateabout HP’s services. Interested programs areimmediately forwarded to a PharmD in thefield for a service consultation. The ProgramCommunications Coordinators also receiveincoming calls from hospices that would like tomeet with an HP representative.Each New Business Team member has beenhand-picked to ensure expertise in palliativecare and penchant for solution-based clientpartnering—they are excellent listeners!A Proven ApproachOur team works to develop all elements ofthe partnership including understandingthe existing systems at the hospice, creatingan interface with the hospice’s softwareprovider, and working with the hospice’sstakeholders to understand our uniqueservice offerings. Whether a program islarge or small, rural or urban, hospitalbasedor freestanding, our primary goal is tounderstand a hospice’s particular needs andcreate specific solutions for that program.The HP organization boasts a 98%retention rate, and many clients haveworked with HP since the inception of thecompany. Remember, our philosophy isone of client partnering. Once a hospicehas signed a partnering agreement withHP, they are transitioned to our veteranClient Development Team (also comprisedof hospice specialists with advancedhealthcare degrees) for program and servicesimplementation.What the New Business Team Can Dofor YouHP’s approach to service is one of creatingvalue for hospice professionals. Members ofthe New Business Team attend over 30 stateand national hospice organization meetingseach year, sharing information about HP’sservices and offerings, and providing clinicalpresentations for CNE credit.If you believe that HP’s services couldbenefit you or a hospice you know, giveus a call at 877-882-7822 or email us atinfo@hospicepharmacia.com. We will bedelighted to discuss with you the scope ofour services, and how we can enhance yourhospice pharmacy experience!PBM stands for Prescription BenefitsManagement. PBMs have been around sincethe early 1980’s. They bring the followingfeatures to hospices: price control and singlebilling. These features have been useful tohealth plan payers that are responsible formanaging thousands of patients’ prescriptionbenefits without actually being involved in thecare process.Unlike hospice, PBMs work under a fee-forservicemodel where “the more you fill, themore you bill” mentality prevails. As youknow, if the medication is not appropriate forthe patient, the price of the medication itselfdoesn’t matter—the cost of an unmanagedsymptom can be astronomical (e.g., theuse of Kytril for nausea/vomiting when theassessment shows that the patient’s nausea isdue to constipation from opioids).Last year, over 100 hospices beganpartnering with HP that had previouslybeen with a PBM. In April 2005 alone, HPwelcomed five clients who left a PBM service.These hospices cite the need for clinicalconsultation with an emphasis on palliativecare, the ability to contain cost in a per diemarrangement, and the provision of efficiencieslike delivery direct to patients’ homes.Still, the PBM segment continues toactively market to HP partnering hospices.According to one of our partnering clients,the PBM sales approach has been to promisedirect medication cost reduction. A PBMquoting a ‘per diem’ under a fee-for-servicemodel should raise a red flag.It is Hospice Pharmacia’s Medication UseGuidelines that enable successful per diempartnerships. We use millions of patientdaysof hospice medication management data,conttinued on page 7www.hospicepharmacia.com

4Passionate for the Appropriate Use of MedicationNew Offerings from Hospice Pharmacia (HP):Group Purchasing, Data Set Collection and On-line Clinical ReferenceHospice Pharmacia’s business philosophyis one of partnering. Hospices who partnerwith HP value our medication managementservices as well as our many additionalofferings that can provide enhancedpatient outcomes, efficiency throughstandardization, and cost savings.Preparations are well underway for launchingthe following initiatives that will greaterenhance our partnerships!On-Line Medical SuppliesThrough a partnership with a nationalsupplier HP will form a Group PurchasingOrganization (GPO) through which hospicescan purchase medical supplies, surgicalsupplies, and durable medical equipment.Some advantages of this purchasing methodwill be:• On-line access to supplies, includingwound care, that are competitivelypriced.• Hospice-specific supply ‘formularies’ inappropriate quantities of distribution.• Direct delivery of these supplies topatients’ homes saving driving time fornurses.• Ability to maintain stock-closet withinventory controlsHP’s Outcomes Data CollectionServicesHP has identified that both our hospiceclients and other hospices can benefit fromproprietary HP technology for easy outcomescollection and reporting, particularly for theNHPCO Data Set. The collection process iseasy with many options from which hospicesmay choose, including:• Fax Scanning Technology—the hospicefills out the NHPCO data set form onadmission and at the appropriate followuptime period and then faxes it to HP.Scanning technology automaticallyenters the data into HP’s confidential andsecure database.• Interactive Voice Response—onadmission, or at the appropriate followup,the hospice is able to answer theNHPCO data set using the telephonekeypad or via speech recognition. Thedata is automatically entered into thesame confidential and secure databasethat captures the faxed information.• Reporting—entered data is availablereal-time via the Internet. A userIDand password will be provided forsecure, individual access outcomesreports. These can be used internally asa management tool or can be providedto the NHPCO or your data collectionagency (e.g., Perforum).Drug Information DatabaseHP offers Electronic Communications...- Jenna Brooks, Marketing AssociateGold Standard Multi-Media’s ClinicalPharmacology will soon be accessible throughHP’s Xeris on-line tools! Through volumepurchasing, we are able to offer this featureat a nominal fee, based on the size of thehospice. This database requires no specialsoftware and provides needed access toan abundance of drug information. Moreinformation will be communicated to you inthe upcoming months.If you are interested in any of these services,or you would like more information, pleaseemail info@hospicepharmacia.com.Would you like to receive your weekly fax announcements and/or quarterly newsletters viaemail? Hospice Pharmacia is able to send weekly announcements and publications in anemail format to hospices who are internet-friendly. If you’re interested, please visit www.hospicepharmacia.com, click on the “e-Communications” link and complete the electronic form.Or, send an email to jbrooks@excelleRx.com and include the following information:• Your name• The name of your organization• A list of the email addresses where you would like the e-communications to be sent• Indication of whether your would prefer announcements sent via email only, or via emailand fax• Indication of whether you would prefer newsletters sent via email only, or via email and U.S.MailThank you!www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 5Communicating Historical Data for LTCPatients: The New HP Fax SystemHeather Omlor, PharmD, VP Client Development & Relationship PartneringMany Hospice Pharmacia (HP) hospiceprograms have reported that for Long TermCare (LTC) patients an optional systemof faxing would be an efficient method ofcommunication with HP. HP has pilotedand refined a fax system for LTC that isavailable for your hospice.LTC Fax Criteria1. The patient has already been admittedinto the HP system and the existingprofile requires an update of historicaldata. For example: The patient wastreated with a short course of antibioticsfor a condition not related to the hospicediagnosis but the HP profile does not yetreflect this therapy.2. The patient has been discharged oris deceased and must be processed inHP’s system for census/billing. Forexample: The patient is deceased and themedication profile needs to be updatedto allow the facility pharmacy to bill formedications.LTC Fax Process1. For new admissions, thenurse calls HP for initialpatient activation in HP’ssystem, medication careplanning (also for changesin patient status), andmedication authorization thatwill enable the LTC pharmacyto dispense.2. The fax system is availablefor LTC patients for thecommunication of historical data.• This system is for nursing facilitypatients and is not an option for homecare or IPU patients.• The fax system does not supplant thenormal care planning process. Newmedication requests or medicationchange requests will not be processedthrough this system, as they requirean initial consultation with an HPPharmacist.3. The dedicated toll-free fax number is877-265-6852.We also have created an updated QuickReference Guide for nurses that includesinformation about the LTC fax option.If you would like more information aboutthis new option for your LTC patients,please contact your Regional Director ofClient Development or email hppartners@hospicepharmacia.com with any questions.HP CollaborativePractice UpdateHP Collaborative Practice (HPCP)is Hospice Pharmacia’s patient careservice that enables physicians to preapprovesymptom-specific protocolsfor patients upon referral to hospice.This, in turn, allows pharmacists andnurses to mutually assess the patients’symptom management issues, andinitiate a medication care plan based onthose protocols.HP has been partnering with hospicesand physicians through the HPCollaborative Practice system for a fewyears now, and have evidence that thistype of care• creates time savings for nurses andphysicians (~30 min/week);• reduces time to symptomcontrol (medication care-plan isimplemented immediately); and• removes barriers to hospicereferrals (documented increase inpatients referred).For more information on HPCollaborative Practice, contactKeith Omlor, Director of NewBusiness Initiatives via email atKOmlor@excelleRx.com.www.hospicepharmacia.com

6Passionate for the Appropriate Use of MedicationPROM Update- Joanne Reifsnyder, PhD, APRN, BC-PCM, Senior VP, Research and InnovationPatient reported outcomes are the goldstandard for clinical assessment in everyhealth care setting. At HP, we are preparingto make available to our partner hospicesan assessment tool that we call “PROM”for hospice patients – patient reportedoutcomes measures. The PROM toolcontains 8 patient self-report items. Sixof the items measure symptoms and twomeasure quality of life.We have already tested the tool in a numberof ways, both with hospice patients and infocus groups with hospice staff. We havefound that patients are willing and able toanswer the questions and that the items areeasy for the patient to answer. Each item isscored using the familiar zero to ten numericrating scale.Currently we are testing PROM in anIRB-approved research study at one ofour partnering hospice sites. In this trial,we are examining how well PROM scorescorrelate with self-report scores on a similarinstrument (a test of validity), how wellPROM scores hold up in repeated measures(a test of reliability), and how feasible it isto collect data from hospice patients usinginteractive voice response telephone calls.So far, so good! In the near future, partnerhospices who participate in PROM for theirpatients will receive real-time reports oftheir patients’ scores and detailed summaryreports. The symptom score trends foreach patient will be viewable on Xeris. Thegraphs can be downloaded by the hospice inXeris as well.We anticipate that the patient-specificreports would be used during IDT meetingsand as a permanent part of the patient’sclinical record. Summary reports can alsobe used in conjunction with the hospice’sown PI initiatives, helping to meet JCAHOand regulatory requirements for qualityassurance. So stay tuned – PROM is on itsway!www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 7Using Patient Reported OutcomesMeasures (PROM) to ImproveHospice Practice- JoAnne Reifsnyder, PhD, APRN, BC-PCM, Senior VP, Research and InnovationClinicians, patients and families havebecome accustomed to assessing pain andother symptoms using simple descriptive,numerical ratings or other scales.Measurement of outcomes associated withsymptom management interventions haslagged behind clinical practice. Wheremeasurement does exist in hospice care,validated and reliable instruments are rareand caregiver or clinician assessment isoften substituted for patient self-report.Further, the findings from such assessmentsare rarely systematically aggregated andanalyzed to modify care at the patient levelor to identify trends and effect policy orprocedural change at the program level.At the upcoming NHPCO Clinical TeamConference, Dr. JoAnne Reifsnyder(Hospice Pharmacia), Terry Meyer (Hospiceof Louisville) and Dr. David Kupperman(Hospice Pharmacia) will:1. Describe a pilot test of an 8-itemsymptom/QOL instrument for collectingpatient-reported outcomes via liveoutbound communications.2. Propose strategies for aggregating andapplying findings in a hospice program.3. Discuss discrepancies between patientreportedand clinician or caregiverreportedsymptom and QOL outcomes.4. Describe barriers to and opportunities forsystematic collection of patient-reportedoutcomes from hospice patients.5. Propose strategies for integration ofPROM methodology into the hospice’sPerformance Improvement program.Hospice PBMs for PharmacyManagementcontinued from page 3evidence-based care protocols,Pharmaceutical Care Support Centerpharmacists, and proven systems of accessand distribution to establish our per diempartnerships.A PBM can only predict a per diem basedon their fee-for-service model, yet theAverage Wholesale Price (AWP) in thefee-for-service model is a moving target.If a PBM calls you, the question toask is this: How will they help you toenhance the quality of your patients’ care,contribute to the professional knowledgeof your nurses to help make their jobsmore fulfilling and easier, improveaccess, and reduce total costs? In theU.S., despite the “PBM intervention,”medication costs continue to increase inthe double digits, and quality continuesto be inadequate for the U.S. healthcareconsumer.Only HP can provide true hospicepharmaceutical care. Call us for moreinformation.excelleRx Newsletter StaffEditor In Chief:Orsula Voltis Thomas, PharmD, MBAorsula@excelleRx.comManaging Editor:Dana Filippolidfilippoli@excelleRx.comLayout and Design:Melissa Morriswww.hospicepharmacia.com

8Passionate for the Appropriate Use of MedicationHP SIGHTINGSEvent Name Date of Event LocationNational Hospice & Palliative CareOrganization (Spring Conference)April 21-23, 2005Hyatt Regency Hotel, Atlanta, GAPennsylvania Hospice Network May 1-3, 2005Sheraton Park Ridge Hotel, King of Prussia,PA27th Annual New England Home CareConference & Trade ShowArizona Hospice and Palliative CareOrganization & Arizona Pain Iniative33rd Annual Conference - Assoc. for Home& Hospice care of North CarolinaHoosier Home Care, Hospice & HMEConferenceMay 5-6, 2005May 6, 2005May 9-10, 2005May 10- 12, 2005Sheraton South Portland Hotel,South Portland, MEBoswell Memorial Hall, Sun City, AZSheraton Imperial Hotel & Convention,Durham, NCLiberty Hall at the Marriott Hotel &Conference Center, Indianapolis, INHome & Health Care Association of MA May 12-13, 2005 Westford Regency Inn, Westford, MAWashington State Hospice & PalliativeCare Organization (Expanding DimensionsSpring Conference)Kentucky Association of Hospice andPalliative CareMay 12-13, 2005May 16-17, 2005Double Tree Hotel, Seattle-Tacoma Airport,WAMarriott Downtown, Louisville, KYTrucia Goodwillie Conference May 19, 2005 Temple Israel in Dover, NHHospice & Palliative Care Association ofNew York StateCAHSAH (Administrator CertificateProgram)Hospice and Palliative Care Council ofVermontLouisiana - Mississippi Hospice andPalliative Care OrganizationNational Hospice & Palliative CareOrganization (1st National Conference onAccess to Hospice and Palliative Care:Opening Doors, Building Bridges)May 19-20, 2005June 7-9, 2005June 8-10, 2005July 29-30, 2005August 1-3, 2005The Prime Hotel & Conference Center,Saratoga Springs, NYChicago, ILLake Morey Inn, Fairlee, VermontNew Orleans, LAHyatt Regency, St. Louis, MOwww.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 9Dear Laura,Recently, I was asked by one of your technicians for my PINnumber when calling in a refill. How do I obtain one of these PINnumbers?Cindythe Specify Coverage (related/not related) designation has nobearing on HP billing functions.Great question!LauraDear Cindy,Please see your Xeris Hospice Administrator (XHA) for a PINnumber. He or she will need to make sure that you have a Xerisaccount, and that it is enabled for PIN. If your hospice does nothave a designated XHA, please contact your Regional Directorof Client Development, or email me at HPPartners@excelleRx.com.Laura Lutz is the Client Development Manager at Hospice Pharmacia.She is responsible for coordinating implementations and for supportingnew hospice partners as they transition from their current pharmacyproviders to HP. Laura also helps with the planning and organizationof HP’s educational programs, including monthly Xeris training andorientation web-teleconferences. Laura can be reached by emailingHPPartners@excelleRx.com.LauraPraise for the HP Care CenterDear Laura,My hospice distributes my patients’ medication profiles tofamilies, so they have an idea of which medications the hospicewill cover and which medications are the family’s responsibility.Although we understand it, we have found that MUG/MUGRcan be confusing to them. Is there any other way that we canrelay medication coverage to our patients’ families?JillDear Jill,Yes! If you are familiar with Xeris, there is a link near themedication profile that allows you to “Specify Coverage”. Thisis an optional function that is only available to hospices and isintended to help you indicate to caregivers which medications aregoing to be covered by hospice. You may find that your patients’caregivers have an easier time understanding this. Pleaseremember that this determination is separate and distinct fromthe MUG, nonMUG designation, which, as always, is determinedin consultation with an HP clinical pharmacist. Accordingly,Hello ... I’m not sure to whom I should direct this, butI wanted to make a comment. I would like to sincerelycompliment your entire staff on their excellent customerservice. Everyone I have dealt with has been unfailinglyprofessional, & helpful. The pharmacists always takehowever much time is required to confer with me, answerall my questions, help solve problems, & offer usefulsuggestions for symptom management. I am relativelynew to hospice work so I still have lots to learn, and yourpharmacists have been great educational resources forme, too. And they do it all with a pleasant, friendly manner!It is a pleasure working with HP.Thanks!Gayle Terry, RN, BSN, OCNAtlantic City Medical Center Hospice.This quote was received via email and printed with permission.© Copyright 2005 Xeris, Predictive Pharmacotherapy Outcomes System (PPOS), Prospective Medication Management, Medication Use Guidelines (MUGs), ComfortPak, HospicePharmacia Collaborative Practice (HPCP), and all Xeris products and their respective logos are Trademarks of excelleRx, Inc. All rights reserved. No part of the information containedherein may be reproduced, duplicated, or copied without permission. Please inquire if you are not sure. PPOS and Xeris are Patent Pending.www.hospicepharmacia.com

10Passionate for the Appropriate Use of MedicationXeris Interface UpdateElectronic interfaces between Xeris and yourhospice software applications provide a timely,accurate method of sharing critical patientinformation. The unidirectional interfacesends patient demographics (admission,discharge) from the hospice to HospicePharmacia (HP). The bidirectional interfacesends information both ways - patient’smedication list from HP to the hospice, as wellas the patient demographics from the hospiceto HP. Both interfaces save time and reducepotential errors. All information is transmittedsecurely between the hospice systems andHP’s, in compliance with HIPAA regulations.Existing Interfaces - Upgrades Onthe WaySuncoast Solutions has a unidirectionalinterface with HP. This interface isin the process of being upgraded toan HL7 (Healthcare Language 1997)bidirectional. According to SuncoastSolutions, this interface will be availablewith a version 5 release in 2005.Please contact your Suncoast Solutionsrepresentative for more information.Misys Visions has an unidirectionalinterface with HP. Currently, it isbeing upgraded to an HL7 bidirectionalinterface with HP. Please contact DawnHollowell with Misys for more information(dawn.hollowell@misyshealthcare.com).Mills and Murphy (HPMS) has anunidirectional interface with HP. AnHL7 bidirectional interface is underdevelopment.Vx has a unidirectional interface with HP.New Interfaces – More Information toFollowBeyond Now Homeworks (a Cernercompany) has just released aninterface with HP. This is an HL7unidirectional interface with HP. Thebidirectional interface is currently underdevelopment.McKesson HBOC has recentlycompleted the development of an HL7bidirectional interface with HP. This isready for beta testing currently.Interfacing with Xeris saves time, improvesaccuracy, reduces transcription errorsand increases efficiency for our HospicePartners! For more information, emailinfo@hospicepharmacia.com.Xeris Reporting EnhancementsAs you know, Hospice Pharmacia is continually working to enhance and improve our technology, in hopes of providing an evenhigher measure of client satisfaction and efficiency.This month you will notice some changes in Xeris reporting. ICD-9 codes and Diagnosis Groups (Coverage Code categories)have been added to the “Medication Outside Per Diem” reports and the billing “Dispensed Medication” reports.These reports are available through “Report Options” as:• Administrative (particular date span, e.g., one week or one day; available for any nurse who has been given rights by the XHA)• Organizational Aggregate (across multiple offices, only if hospice has multiple offices),• Billing (complete for a single previous month—current reports aren’t accurate until month is closed)Please contact your RDCD or email HPPartners@hospicepharmacia.com with questions.www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 11HP Improves Hospice MedicationTherapycontinued from page 1So, again, we proclaim our call to action.It is time for us to attack this public healthproblem, and ensure that while we have thesepatients on service their medication regimensare appropriate.believe that the quality of medication usein hospice will out-shine all other facets ofhealth care. The appropriate selection ofmedication results in better symptom control,fewer nursing visits, fewer on-call demands,fewer hospitalizations and ER visits, andfewer medication-related liability issues.A patient going through the end of lifeshould not also be subjected to the travailof inappropriate medication troubles, andhospice programs should not be burdenedwith excess downstream medication costsassociated with fixing these preventableproblems.In our ongoing efforts to ensure appropriateand effective use of medication, we continueto offer solutions, such as:• Automation: we’ve added anotherlayer of medication regimen reviewto our complex system or prospectivemedication therapy management, calledIntelliDUR.• Reporting: we’re developing specializedhospice-specific reports that detailthe prevalence of medication-relatedproblems, making the data even moreuseful.With these HP systems in place, we firmly%4035302520151050Med w/o indicationPotential or actual ADR detectedDose too highDose too lowRx Indicated but not prescribedInappropriate drugEMAAC UpdateEMAAC (Evidence-Based Medication Algorithms Assurance Committee) has a varietyof studies underway. Some of the studies use the rich excelleRx database to learnmore about our patient population and outcomes of our work, while other studies arebuilding new ways to measure outcomes, such as PROM. Some of our current EMAACstudy topics:• Pediatric Patients in Hospice• Pain Variability• CHF• Alzheimer’s Disease• Chemotherapy Use in Hospice• Hospitalization of Hospice PatientsFor more information or to become involved in excelleRx research initiatives, contactEMAAC@excelleRx.comwww.hospicepharmacia.com

12Passionate for the Appropriate Use of MedicationRegulatory RemarksSince the hospice movement started in theU.S. in the early 1980s, there have been only afew changes to the Controlled Substances Act(CSA) including:1. Allowing sanctioning of faxing C-II Rxs2. Removal of total quantity dispense limitsand3. Allowance for partial fill on 60-day supply.Proposed new regulations are now beingrequested with the opportunity for publiccomment before they become law.HP supports the recommendations foramendments to the law that serve the uniquepain and symptom management needs ofterminally ill patients. The challenge we face isbalancing these strict governmental controls,intended to ensure safety and security, withthe urgent and changing care needs of theterminally ill population.Hospice Pharmacia provided comments tothe DEA recommending that CSA’s controland accountability parameters should beupdated to reflect improvements in palliativecare practice; controlled pharmacy dispensingsystems; and electronic communications,tracking, and recordkeeping.Also, to minimize the time to palliation forpatients, and to reduce administrative burdenfor hospices, HP is supportive of regulatoryproposals that would allow for prescriptiveauthority for pharmacists, centrally controlleddispensing for hospice patients throughmultiple pharmacies, and easing the process ofrefills on controlled substances.Education Cornercontinued from page 2You may register online for thisprogram at www.excellerxinstitute.org or via fax. Registration deadline is5/3/2005.If you would like to learn more aboutthe excelleRx Institute educationalprograms, please contact Dr. JillMcMath, Director of Education forthe excelleRx Institute, by calling877.882.7822, ext 1677or by emailingjmcmath@excellerxinstitute.org.The government will publish the proposedCSA changes in the National Register andwill provide a public comment period. Weencourage you to watch for this posting and toparticipate in the review and approval process!Puzzled by unpredictable pharmacy costs?Challenged with access?Desire standardization?costqualitydataLet HP solve your puzzle.accessHospice Pharmacia – The Complete Solution forHospice Medication ManagementTo learn more about how partnering with Hospice Pharmaciacan help your hospice achieve measurable improvement inquality, access, and total costs, call 1-877-882-7822, x-1602 ore-mail us at info@hospicepharmacia.com.Other Pharmaciesqualitycostdata accessHospice Pharmacia’s ComprehensivePharmaceutical Care Services