MU-RxCheck

• 1. Automatically and electronically generate and indicate (e.g., pop-up message or sound) in real-time, alerts at the point of care for drug-drug and drug-Allergy contraindications based on medication list, medication Allergy list, age, and CPOE.
• 2. Enable a user to electronically check if drugs are in a formulary or preferred drug list in accordance with the standard specified in Table 2A row 2.
• 3. Provide certain users with administrator rights to deactivate, modify, and add rules for drug- drug and drug-Allergy checking.
• 4. Automatically and electronically track, Record, and generate reports on the number of alerts responded to by a user.

Note: VistA currently doesn't maintain formularies. This will need to be done with an interface to a 3rd party Application, such as the NewCrop ePrescibing service. Drug interactions are handled in VistA but because of the additional requirements, the current approach is that ePrescribing is used to check for allergies and interactions as part of that service using the drug database of the ePrescribing service. The first service being interfaced with it the NewCrop service which uses the First Databank Database that is the same one the VA was slated to use. The VA was slated to release the source code for that project but the project was stopped as it was running over budget and is under review, so we can't expect any help from the VA code anytime soon. The work being done and funded by Oroville hospital as an extension of the CCR-CCD project to provide ePrescribing is vital to this effort. It will be released as open source when it is completed.

Eventually the code for ePrescibing can potentially come "in house" so that VistA instances can become their own ePrescribing service with interfaces to the insurance eligibility and formulary databases (proprietary), Sure Scripts and the commercial drug databases, but Phase one of this effort is to use the ePrescibing service software provided by the ePrescribing service and to send demographics, allergies and medication lists to the service and to return lists augmented by additional information brought back from the service, i.e., additional allergies and medications provided by other providers, etc.

The third item may be difficult to provide in the setting of using the ePrescribing service.