Slide 1

"Using Clinically-Enhanced Claims Data to Guide Treatment of Acute Heart Failure"

An AHRQ Grant to MHA

Data Acquisition & Transmission - Pharmacy Data

Minnesota Hospital Association Logo

MPA Logo

Slide 2

Overview of Data Acquisition Strategy

• Establish data specifications and formats
  • Phase 1: 15 hospitals submit developmental data
  • Project team prepares data specifications and formats
  • Project team maps data for Phase 1 hospitals
  • Phase 2: remainder of hospitals map own data with assistance
• Implement operational protocols to submit data from electronic repositories using established data specifications and formats
• Test data submissions to validate protocols
• Transmit data for comparative effectiveness study

Slide 3

Pharmacy Data Acquisition - Phase 1

• Phase 1 hospitals will
  • be limited to hospitals with CPOE systems
  • include no more than two hospitals from a single chain using the same pharmacy order system
  • submit all hospital drug orders for patients with a principal diagnosis of heart failure discharged during a one year period
  • provide identifiers required to link drug orders to claims data already submitted to MHA
• Project team will evaluate the type and completeness of data provided by Phase 1 hospitals and will map these data into the standard format developed for this project

Slide 4

Evaluation of Phase 1 Pharmacy Data

• Evaluation of Phase 1 pharmacy data will
  • focus on drugs related to the planned research study
  • assess the variability of data across sites and systems to establish minimum requirements for data acquisition
• Findings will be used to prepare
  • a final list of drugs to be monitored, a dictionary of drug order data elements, and a customized drug classification system for this project based on existing non-proprietary systems
  • a standardized flat file data layout, field definitions that conform to existing standards whenever possible, and instructions for submission of data by all participating hospitals

Slide 5

Special Issues for Phase 1 Evaluation

• The Phase 1 analysis of drug order data will pay particular attention to how potentially problematic issues are managed at different hospitals
• Examples include
  • use of order messages that are strictly informational (e.g., dosing reminders, clarifications, verifications)
  • management of order cancellations and discontinuations
  • identification of PRN and one time orders
  • Identification of patients' own medications that are not dispensed by the hospital pharmacy

Slide 6

Types of Drugs to Treat Heart Failure

• Angiotensin converting enzyme inhibitors (ACEI)
• Angiotensin II receptor blockers (ARB)
• Antiarrhythmics
• Anticoagulants
• Beta blockers
• Diuretics
• Inotropic agents
• Statins
• Vasodilators

Slide 7

Drug Order Data Fields

• Drug name
• Internal drug code
• External drug code, e.g., NDC, RxNorm, SNOMED-CT (if available)
• Drug strength/unit
• Drug dosage
• Route of administration
• Order start/stop dates and/or duration or order
• Interval (i.e., frequency)

Slide 8

Drug Classification Systems

• Alternative classification systems are available to support the collection and analysis of standardized electronic pharmacy data.
• Several promising non-proprietary systems will be evaluated to determine their strengths and weaknesses for use in this study
• Systems to be evaluated will include
  • RxNorm
  • SNOMED-CT
  • NLM MeSH Drug Categories

Slide 9

Pharmacy Data Acquisition - Phase 2

• Phase 2 hospitals will
  • map their electronic data into the standardized flat file format based on data specifications established in Phase 1
  • submit completed data maps for review by project team
• Project team will
  • Prepare standardized materials to support data mapping by Phase 2 hospitals
  • assist individual hospitals in preparing their data maps
  • review completed maps for completeness and accuracy
  • provide feedback and assistance as needed

Slide 10

Future Collection and Use of Drug Data

• A principal goal of this project is to test the feasibility and value of collecting drug order data to determine the comparative effectiveness of alternative therapies
• A secondary goal is to learn from participating hospitals whether electronically captured drug dispensed and/or administered data could replace drug order data
• After collection and transmission of study data are completed, hospitals will be surveyed to document their experiences and to learn how data acquisition and transmission processes could be improved