The California Department of Veterans Affairs has deployed e-Prescribe, a new software system that streamlines how the entity and its medical staff prescribe medications for the more than 1,700 veterans and their spouses who live at eight Veteran Homes of California across the state, from Yountville to West Los Angeles to Chula Vista. The system sends “all regular medication orders” electronically to CalVet pharmacies, the department’s Public Information Officer Jeff Jardine wrote April 16 on CalVet Connect. This doesn’t just make life easier for the residents. The go-live Dec. 8 enabled the department to comply with state Assembly Bill 2789, signed into law by Gov. Jerry Brown in 2018; generally, it mandated health-care practitioners by Jan. 1 be able to issue prescriptions “as an electronic data transmission prescription.”
“This is just the first step. I think what’s even more exciting is what’s to come,” CalVet Chief Information Officer Isaiah Mall told Techwire. Among the takeaways:
- CalVet had streamlined its pharmaceutical processes nearly a decade ago by implementing a pharmacy management system, and a module added roughly five years ago enhanced its capabilities. But, said Mall, “it was not going end to end.” This meant care providers would enter prescriptions into the system – but the prescriptions were not automatically electronically routed to its pharmacies. At some point, a document would be printed and/or hand-carried to the pharmacy, where the pharmacy tech or pharmacist would fill the prescription – and MED-PASS nurses would hand it out to the resident. E-Prescribe made the process entirely electronic, working with vendor Netsmart to move it off paper and smooth it out. (The pharmacy management system, which works well and is interoperable, will stay.)
“The power of that for us is, as it applies to the veterans, if a veteran goes and gets care outside of CalVet, let’s say they go see a doctor ... and that pharmacy order gets routed to a CVS or Walgreens-type pharmacy,” Mall said. “They can electronically send that prescription over to the CalVet system. No pain. Which means it’s more secure, it streamlines the process and again goes back to our mission, we’re here to serve the veterans. It makes the process more seamless, more robust, more timely and more secure.” - There’s much more to come. E-Prescribe is the first element of CalVet’s Electronic Health Record Program (CEHR), for which Netsmart was the winning bidder. (E-Prescribe is a component of CEHR.) Plans are to do a phased, home-by-home rollout of CEHR at CalVet’s eight Veterans Homes this fall, which will provide a single electronic record and enable the measurement of outcomes. The contract with Netsmart, of about $16 million, sets two years for implementation and two years for maintenance and operations. There’s also the option to add two additional years of maintenance and operations. The system will be software as a service (SaaS) in the cloud, will be interoperable with other CalVet “specialty systems” like nutrition management and pharmacy management, and will help eliminate errors in data transmission. Its deployment, Mall said, will include the scanning of paper that “cannot be turned into data readily,” to make it searchable and useable; and in-person training “by the actual trainer” to ensure users are well-educated in the new solution – and can even refresh their knowledge if needed.
- Mall praised the team of more than 200 that worked on e-Prescribe highly, saying: “It starts with, you have to establish a good foundation.” CalVet engaged “expectant users” of the system – including doctors, nurses and pharmacists – to learn about absolute necessities and desirables for the new system. Leaders also did high-level market research before solicitation and talked to users in a wide variety of disciplines that would touch the new system, from clinical to financial to administrative. The CIO also spoke highly of CalVet Secretary Dr. Vito Imbasciani for making electronic health records modernization his No. 1 priority, and he lauded the work of Chief Project Director Carlos Chavez, who took the role in February, and of Rochelle Dann-Castro, its project manager since inception.
- The CIO offered takeaways from the CEHR project. Testing a new system is essential prior to a go-live, he said – including integration testing, unit testing and user acceptance testing – to ensure functionality and interoperability. And, in the era of SaaS in the cloud, which can eliminate the need to build software, the challenge may lie in the contract or service-level agreement. In that language is where officials must determine where the servers and hardware are really located – whether in the United States or internationally; and it’s here that contractor work hours and general availability should be spelled out. The contract must also lay out the security standards to be complied with and technical requirements as well. “We also have provisions in the contract for if a vendor ever goes out of business or discontinues support of a product. We have to be thinking like this,” Mall said. “You have to. Because it happens.”
