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Pharmacy Automation in the VA

 

“In the 1950s, VA became the first organization in the country to mail prescriptions to patients,” explained Siehr. “At that time, the mailing was done from local medical center pharmacies.” Initial consolidation of that service in the mid-1970s led to progressive increases in centralization and automation over the next several decades. The seven current CMOP locations were established in 1999, and were consolidated under one leadership structure in 2005.

So the process is that when a veteran visits a VA facility for outpatient treatment, the provider enters prescription information into the VA’s electronic medical record. That prescription is electronically transmitted to the local medical center or clinic pharmacy, where it is reviewed in combination with the patient’s electronic medical record information, including medical history and other prescribed medications. That differs in the private sector, where each individual entity has only the potentially fragmented information that it was provided.

A distinct quality of CMOP that is a major departure from commercial mail-order pharmacies is that it’s an integrated part of the whole VA pharmacy automation system, and in fact, extends those features into the mail-order process, improving continuity of care and providing additional safety and convenience for veterans. Siehr explained that in the private sector, the pharmacy automation systems can be completely separate for inpatient and outpatient venues as well as nursing homes and mail-order pharmacies, with separate decision support mechanisms. “We’re unique in VA in that those can all be combined and integrated much more closely than they are in the private sector,” he said.

Additionally, the VA mail-order system works differently than its private-sector counterparts.

barcode medication

In this 2002 photo, Jeffery Dubea, LVN, ensures veteran Willie R. Hutcherson receives the correct medication in the correct dose at the correct time by using a hand-held scanner to read Hutcherson’s barcoded identification wristband. The VA was an early adopter of barcode medication administration, one example of pharmacy automation. Photo by Shawn James, HVAMC Media Section

“If you or your loved ones get prescriptions from a mail-order pharmacy in the private sector, your physician communicates directly with the mail-order pharmacy,” explained Siehr. “The mail-order pharmacy has its own automation system to track that individual prescription. So they input that prescription into their automation system and then they use their automated equipment to fulfill that prescription and send it to you. So you are a direct customer of that mail-order pharmacy.”

But if you then go to a brick-and-mortar pharmacy, they have a different profile, Siehr continued. “They may not have the same drug profile that the mail-order pharmacy has. The mail-order pharmacy only knows about those prescriptions you sent to them; [the non-mail-order pharmacy] only knows about those prescriptions that you sent to [them]. No one has a complete picture of your medication therapy. In VA, we realized that problem and fixed it.”

A key difference is that the VA’s CMOP system is designed for the veteran to have a single point of pharmacy care, and that point is the medical center pharmacy.

“If the veteran doesn’t know CMOP exists, that’s a good thing, because we want the veteran to have one point of pharmacy care, not multiple points of pharmacy care like they have in the private sector,” Siehr said.

So the process, Siehr continued, is that when a veteran visits a VA facility for outpatient treatment, the provider enters prescription information into the VA’s electronic medical record. That prescription is electronically transmitted to the local medical center or clinic pharmacy, where it is reviewed in combination with the patient’s electronic medical record information, including medical history and other prescribed medications. That differs in the private sector, where each individual entity has only the potentially fragmented information that it was provided.

“The local VA pharmacy processes that prescription on the front end,” said Siehr. “‘Is everything right for this patient? Is the drug at the right dose? Are there any interactions with other medications?’ – all those sorts of things. Once they’ve done that review, that prescription information is put into an electronic queue, assuming that patient wants it mailed. Then, every night, the queue of those prescriptions from every medical center across the country is sent to the CMOP core system database.

“From there, we have seven CMOP facilities across the country, actual physical plants, that receive that prescription information from the medical centers, fulfill that prescription – in other words, put the pills in the bottle – and then mail the prescriptions or send them via commercial carrier to the veteran,” Siehr said, noting that once CMOP receives those prescriptions, the standard is that they enter the delivery system in 48 hours or less.

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