Difference between revisions of "MU Stage1 Final Rule - Drug-Drug Drug-Allergy Checks"

Revision as of 22:38, 12 December 2010

SECTION # Section 170.302(a)—Drug-Drug, Drug-Allergy, Drug-Formulary Checks

MU OBJECTIVE Implement drug-drug and drug-allergy interaction checks

MU STAGE 1 MEASURE The EP/eligible hospital/CAH has enabled this functionality for the entire EHR reporting period

CERTIFICATION CRITERION Final Rule Text: §170.302(a). (1) Notifications. Automatically and electronically generate and indicate in real-time, notifications at the point of care for drug- drug and drug-allergy contraindications based on medication list, medication allergy list, and computerized provider order entry (CPOE). (2) Adjustments. Provide certain users with the ability to adjust notifications provided for drug-drug and drug-allergy interaction checks.

STANDARDS N/A

TEST CRITERIA # §170.302 (a) http://healthcare.nist.gov/docs/170.302.a_DrugDrugDrugAllergy_v1.1.pdf

SOLUTION DESIGN / TECHNOLOGY (Add details here)

SOLUTION COMPONENTS (Add details here - Ex. KIDS patch, Delphi code, User guide, Web resources, Manual test script, etc)

DEPENDENCIES (Add details here)

COMMENTS / NOTES (Add details here)

PREVIOUS NOTES (none)

DEVELOPMENT STATUSAlthough VistA does this now, the need for other interaction checking will be coming and the ability of the purely open source VistA to do this will be leaving because the VA is implementing the use of FirstData and will not be maintaining the interactions in the National Drug File. ePrescribing that is being built by Oroville will need to pick up that function for both patients who have new prescriptions and those who don't.

A document describing adding and allergy, marking it entered in error and also editing an entry in the roll and scroll instead of marking it entered in error and reentering it with corrections can be found at this link:

<http://download.opensourcevista.net/downloads/Drug-Drug_Drug-Allergy302a.doc>

I found it very interesting that the description of of an observed vs. historical reaction is different and more in line with what physicians generally expect in the roll and scroll versus what is in CPRS when it comes to entering allergies. CPRS describes Historical as something of no significance any longer (paraphrasing) and the roll and scroll describes it as "historical data gathered by the patient.

To quote, CPRS has

"HISTORICAL: reported by patient as occurring in the past. No longer requires intervention" (See the yellow highlighting in the document).

CPRS also has "OBSERVED: directly observed and occurring while the patient was on the suspected causative agent. Use for new information about an allergy/adverse reaction and for recent reactions caused by VA-prescribed medications."

This, too, is also not quite right for our purposes, or frankly, I would think also not for the VA's use either.

Meaningful Use criteria requires that certain allergies be able to be changed and implies that they not be displayed for certain users. Nancy Anthracite has written to the Office of the National Coordinator as this is almost certainly a mistake and just an inadvertent spillover from the desire to mark particular Drug/Drug interactions not to display for certain users to avoid "Alert Fatigue".

Nancy has proposed that we not put any work into adding this functionality to VistA in hopes that ONC testers will accept being able to edit an allergy as sufficient to pass because this is something we DO NOT WANT VISTA TO DO!

If we elect to write code for this, Nancy thinks we make that one of the last things we do as it is likely to be removed when the 1.2 criteria are released and it would be a shame to waste a lot of effort on something nobody should ever use.

There is information in the roll and scroll which might help with the mapping of the allergies to meds to RxNorm. See the green highlighting.

ACTION ITEMS / NEXT STEPS (Add details here)

OPEN ISSUES / QUESTIONS (Add details here)