Category: Federal Forum Posters
Purpose: Veterans Affairs (VA) Northern California Health Care System (NCHCS) utilizes population management dashboards to identify Veterans requiring interventions. Primary Care dashboards facilitate management of chronic conditions such as diabetes and chronic pain. Pharmacy dashboards facilitate laboratory monitoring of specific medications. Schools of Pharmacy need introductory practice experiences that prepare students for advanced practice, however space and availability at medical facilities may limit accessibility. This poster describes the partnership between a VA Primary Care Service and a School of Pharmacy that utilizes remote access to electronic medical records for students to provide population management services for Veterans.
Methods: A collaboration between NCHCS and University of the Pacific (UOP) was established in September of 2015. Pharmacy students, under the direct supervision of VA clinical pharmacists, provide population management services for Veterans within NCHCS. An introductory pharmacy practice experience (IPPE) elective course was piloted in August 2016 and subsequently approved as a required course beginning April 2018 with 60 students. The population health experiences are conducted at the university by students precepted by VA clinical pharmacy specialists. Students are granted remote access privileges to the VA computerized patient record system (CPRS) and use personally owned laptops and VA provided cell phones. Students focus on the VA opioid safety initiative, specifically performing prescription drug monitoring program (PDMP) activities and review of urine drug screen results. Other activities include ordering laboratory tests for medication safety, calling patients with upcoming appointments to educate about the importance of pending immunizations, and facilitating annual hemoglobin A1C testing for patients with diabetes mellitus. Students document progress notes in CPRS, and communicate with other health care providers by adding additional signers to the progress note. Students complete a baseline assessment during the first day of the course regarding their experience and competence performing population health activities and again on at the end of the IPPE. Additionally, changes in the clinical dashboard metrics are monitored.
Results: Three process improvement activities were implemented. VA Human Resources (HR) staff travel to UOP to conduct fingerprinting and picture taking, reducing foot traffic into the VA HR office and reducing travel time for students. Because paperwork for student onboarding was excessive for VA staff, two UOP staff became VA without compensation employees and have assumed these responsibilities. The original immunization report identified Veterans who missed immunizations at their prior appointment. The VA clinical applications coordinator developed a report that identifies Veterans with upcoming appointments and an active clinical reminder for immunizations. This enables the students to call veterans prior to the appointment and provide education about the benefits of immunizations. The outcomes of student activities are available in two domains. Over 4,700 Veterans are prescribed chronic opioid therapy within NCHCS. Students complete approximately 300 PDMP progress notes per week. This has enabled over 99% completion of the annual PDMP requirement and an improvement of the quarterly PDMP measure from 39% to 58% between April and June 2018. NCHCS was not meeting immunization goals for Human Papilloma Vaccine (HPV), Hepatitis B Vaccine and Meningococcal Vaccine. Students’ efforts resulted in meeting the measure for Hepatitis B and approaching the goal for HPV.
Conclusion: The collaboration between a VA Primary Care Service and a School of Pharmacy utilizing remote access to CPRS meets many objectives. VA’s teaching mission is accomplished while addressing the limitations for work space and computers at the medical facility. Students are provided real-world introductory experiences with population management including educating patients, navigating CPRS and documenting progress notes. NCHCS has an additional team to address quality measures and support population health activities.
Sian Carr-Lopez– Associate Chief of Pharmacy, Primary Care Service, VA Northern California Health Care System, Fairfield, CA