NCPDP eyeing standards for e-MARs for nursing home patients

March 31, 2008

A work group is looking at what interoperatability standards are needed to establish electronic medication administration records in long-term care.

A newly created task group under the National Council for Prescription Drug Programs (NCPDP) will begin work shortly on issues around electronic medication administration report (e-MAR) communication standards for long-term care.

A Feb. 6 focus group meeting of health information vendors and long-term-care providers, brought together by NCPDP, had recommended the formation of the task group.

She noted there's a need "to flush out gaps in the current communication that is taking place, whether that is through NCPDP SCRIPT or HL7, version 2."

The Feb. 6 focus group wrote a working baseline definition of an e-MAR as a system that "electronically presents translation of the actionable medication orders and facilitates real-time documentation of the actions taken to satisfy the orders."

The group also listed components that are frequently charted in a medication administration record as including: orders of the nurse; demographic information, information on whether the medication was given and if not, why not; labs related to medication and not related; treatment of wounds including topical meds; ancillary orders; and several other elements.

The group listed characteristics of an e-MAR communication as data feed for a consultant pharmacist; massaged data feed to and from an order entry system; data feed to and from the patient's electronic health record; and communication between a pharmacy and the e-MAR.

In discussing the NCPDP's SCRIPT standards potential for the e-MAR, Frank McKinney of Achieve Healthcare Technologies said, "At this point, I think the industry consensus is that it supports the long-term-care workflow reasonably well."

"It's less flexible with respect to clinical data ... It did not grow up as a way to communicate clinical data. Some of that has come into play where it has really been pertinent to the prescribing process or the dispensing process, but it does not have the full range of support for clinical data like an HL7 would."

There were also questions in the focus group on whether, if this process takes two years, other standards will overtake the effort.

"I believe... we can punch this out rather quickly to meet an immediate need and then from there, we probably will have a list of other items that we will have to address, then decide what we want to do," said Spiro.

"So why are standards relevant? Well, they reduce total information technology expenditures. Because if everybody is writing to the same standard, hopefully we can reduce some of those expenditures of time and programming that vendors are actually doing. It also allows for broader connectivity," as opposed to having to connect with each facility and each pharmacy independently, Spiro explained.

The head of the new task group is Jim Hancock of the information company QS/1, according to Sue Thompson, who is NCPDP staff for the group.

THE AUTHOR is a writer based in the Washington, D.C., area.