VTH Board Minutes 7/25/2019

Updates: Info Only

Personnel

• Tricia Willenborg – HR, moving to FL.  Will be working remotely so use HR service email (hrservices@vetmed.illinois.edu)
• Client Services is almost at full staffing.  Kim Winegardner has asked to be relieved of supervising role.  Lori Heinz is lead and questions directed to her.
• Shawn Stevens has moved to FARMS, open tech position will be filled for SAS.
• J. Vitt – resigning, last day 8/19.  0% adjunct position approved to allow for planned 8 weeks of coverage.

Facilities

• CT update – estimated completion mid-Oct.

Programs

• VTH BO org. changes – S. Camp office moved to C. Dietrich’s old office, Beverly in S. Camp’s old office, Summer in VMBSB, Travel arrangements through ticket system, Jennifer Kinney moving upstairs from storeroom.
• Working with W. Balthazor in VMBSC regarding PO’s, Service contracts, invoice payment
• Non-Client Requests for Necropsy of DOAs – We will encourage clients to have RDVM facilitate submission to the VDL.  If submitted through VTH, patient will be registered and charged as per all VTH patients, including new patient fee and office visit fees.  Client must pay necropsy and disposal fees as well.  VDL will provide report to clinician of record and clinician will be responsible for contacting client with results.
• Laundry surcharge $25/hospitalization chg. – The hospitalization charge used by SAC services will be adjusted to reflect a $25 increase to cover additional expenses in cage bedding/laundry.
• Research Policy – progress update.  JW is updating policy to reflect the VTH board recommendations.
• Intern Vacation Payouts – Interns need to use their vacation days prior to finishing their internship.  Will discuss more in I/R committee.
• Sedation protocols for Imaging – There is concern that current sedation protocols are not allowing for good quality images.  JW will set up round table discussion to talk about protocols.
• Rotation schedule modified Z block 2020 – ASA has advised that the winter holiday schedule requires that the clinical rotation during that time be 3 weeks long as opposed to 2.

Pharmacy Updates:    Information provided by Dr. Lauren Forsythe (Coordinator of Pharmacy Services)

Pricing for pharmacy is a bit of a mystery.  Pharmacy is looking to make it clearer and are wanting to make sure that we don’t overcharge or undercharge.  See Handout for details regarding current and proposed charging structure.  The pharmacy does not have a surcharge now to account for cost of pharmacy operation.  Compounding fee is looking to cover clean room costs.

Pharmacy Fees/Minimums:  it is being proposed that we be more deliberate in our pricing structure and move away from ‘minimum’ charges.  Instead, Pharmacy is proposing to charge for the drug and add a dispensing fee that covers the costs associated with the pharmacy and the processing of the prescription.  When medications are removed from the Omnicell, there would not be a dispensing fee.  This encourages care-providers to use the Omnicell which frees pharmacy staff time.  As chemotherapy compounding process moves to the clean room, a hazardous drug dispensing fee would be charged which would replace the fee currently charged by oncology.  ACTION ITEM: There was discussion regarding charging an inpatient drug charge on a daily rate but what constitutes an inpatient and at what point the charge is ‘activated’ was in question.  Please provide feedback.

Drug Markups- Pharmacy is working to clean up pricing to have less variability.  Must comply with the Robertson-Patman Act which says that VTH Pharmacy can’t sell a product for less than what other vets pay for the product, even though the VTH gets the product at a discount.  Pharmacy is working through the inventory as products are ordered to assess pricing.  Price is adjusted based on Pharmacy costs and then is compared to product available through Chewy or ValleyVet to make sure our prices are at least equivalent, assuming these companies have a minimum markup.  ACTION ITEM: Pricing of products already stocked are being evaluated as well but process is slow-going. Services are asked to notify Pharmacy when prices for pharmacy products are extremely different from external pharmacy sources.  ACTION ITEM: JW will check to determine if VTH is paying for biohazards to be picked up.

FYI ONLY: Drugs that have not left the hospital can be returned.  Pharmacy has put together a protocol for drug return as long as patient hasn’t been discharged from the VTH.  Pharmacy can legally take back tablets as long as they haven’t left the hospital.  Medications returns must be done prior to the patient being discharged and doing so will prevent us from having to refund clients.  Pharmacy can take back compounded capsules.  Pharmacy can take back unopened eye meds or liquid antibiotics in original packaging.  Pharmacy can’t take back dispensed liquid medications that have been dispensed from bulk containers or that were compounded.  Client will get credited for medication, not dispensing fee.

FYI ONLY:  IL law says that we can dispense up to a 72 hour supply of a controlled substance to be sent home with an owner in an emergency when the pharmacy is not open.  Pharmacy is planning to place a locked box in the pharmacy which will contain small aliquots of liquid and tablet doses.  A list of medications will be made available.  Proposed process: Clinician will enter prescription into medical record and PIN twice.  A key for a locked box in the Pharmacy will be kept in Omnicell.  Key will be acquired by authorized user (clinician).  Clinician will take the key to Pharmacy to access the lock box.  Clinician will fill prescription and sign log sheet to ensure multistep control process.  Clinician will return key to Omnicell. 

FYI ONLY:  Pharmacy on-call system is set up and number is posted outside pharmacy, and on Omnicells.

Other Pharmacy Info/Initiatives:

• Pharmacy is exploring possibility for keeping partial tablets of controlled substances.  Omnicell can do patient-specific bins so this may be an option. 
• Pharmacy is verifying if hard copies of Omnicell prescriptions are  required.  We may just need a signed ICU treatment sheet.
• Pharmacy is exploring the pros/cons of student access to Omnicell.  Evaluated other school processes. Need diversion tracking software.  DEA background check question? 
• Question about ensuring accuracy (J. Reinhart) – policy in place about checking doses prior to admin.
• Every doctor has a DEA suffix – come to pharmacy if you don’t know yours.  Using your own DEA if you have one is easier. 
• Clarification about Medications from home protocol – if an animal is on a medication that can be stocked by the VTH, then get from pharmacy while patient hospitalized.  If the home meds are from the VTH RX, then can use those as long as pharmacy checks them and they have been dispensed recently (<1 week).  If some other home medication is needed, then an exception may be made.
• New drug formulary request form – will be available on-line soon.
• New drug adverse event/error form – also will be available on-line soon.
• Seizure med watch kits – new protocol using an ICU lock box.
• Pharmacy will be switching to Euthasol from Fatal Plus.  Volume is still the same but solution is pink, not blue.  Pricing will be set so that cost is not more for horses.  Will be the 100 ml. bottle so EQMS may need to use 2 bottles.  Bottles are okay for multiple dosing.  Switch will occur when we run out of Fatal Plus.  Change was approved last year by VTH Board but Euthasol was on backorder.

S.  Austin: Omnicell Access – expired access after 30 days so no equine clinicians have access.  Good duration would be indefinite for faculty and technicians, and 1 year for HO.  Will put it on the checklist for off-boarding.  ACTION ITEM:  JW will work with Pharmacy to establish new expiration terms.

R. Fries: Outside prescriptions – really time consuming to put them in.  Tech calls the outside pharmacy and logs the communication.  Question - why does doctor have to go pin again on the Vetstar screen? Can the RX also include the client communication?  Currently Pharmacists are pinning outside RX’s for clinicians.

StrongSoft / HIS Updates: Julie Steinman

Background:  StringSoft (SS) often takes 1-2 year to implement.  The VTH purchased in the program in January 2018.  There are 16 internal work teams.  Only 3 teams have been working consistently; the other teams did not have sufficient data or processes to engage with.  8 additional teams are up and running in the last 4 weeks.  There is a lot of work to do going forward.  The VTH (JW) gave the SS implementation leadership the expectation that the VTH would go live with SS by end of year, but there is hesitation that that is realistic. 

Risks/Jeopardy -  

State of IL offers a 2 factor authentication process for controlled drug RXs and SS does not have that capability.  SS has a 2 step process but not authentication.  We would need to print and sign prescriptions for controlled substances.  SS can create an enhancement for a PIN, there will be an expense.

Accounting reports run automatically in VetStar will now have to be manually run by the business office.  This will increase the amount of work in the accounting office.  Tufts BO is open 7 days a week to be able to manage their workload.

Search ability in SS is limited to patient information, procedures charged.  You cannot search on words.  All historical data will be brought in as pdf’s.  You lose hierarchical searching.   Imaging reports, discharge reports not searchable.

Signature devices are not compatible with SS because they are not touch screen device.  VTH would need to purchase touch screen devices ($200-300 per device).

A challenge that is being faced is that SS has minimal documentation.  The VTH is spending time/$ outside of the project to implement.  Work progress is held-up because tools are not developed or delivered timely.

The product has some benefits.  Updates to the program will be pushed out to all users.  Currently, when ATC (VetStar) does updates, they are just for that institution, not shared.  However, historically updates were shared for both VetStar and VADDS.

There is jeopardy in January with the 4D inventory management tool.  This program is being eliminated if SS is implemented but will need to be updated (at a cost) due to its incompatibility with Windows 10.  Can 4D go on a Windows emulator?  J. Reinhart. 

Appointment scheduling is ‘prettier’ in SS than in VetStar but there are many more clicks.  VTH will need to purchase an enhancement to provide anesthesia scheduling tool.

There is a task list process.  However, there is not a report generated to indicate incomplete records.

Multiple windows can be open in SS, as opposed to current VetStar.

SS contract is ~$140,275.  If enhancement spending exceeds 20% of this amount, a new RFP is required to purchase those enhancements.

ATC (owners of VetStar and VADDS) are continuing to provide support. 

Opinion of VTH Board Members:  There is grave concern regarding suitability of this program to meet our needs without causing significant loss of time and revenue specific to post visit processes.  There is also significant concern that this system will not support research search needs (no Snowmed engagement, not able to perform text searches).  Board would like to hold SS accountable to expectations and legal requirements.  VTH Board would like to know options for disengaging from SS project.  Alternative program (Instinct – web-based) was suggested as an option. 

ACTION ITEM: JW has call into procurement to discuss options and determine the rules regarding project failure.  Is there a ‘cut our losses’ date?