The Tricare Management Activity, as health care provider and manager for DOD’s military and its retirees, is planning to roll out a new electronic pharmacy system, Centricity, to consolidate drug data and provide a common interface with the department’s patient data records.

DOD plans to deploy Centricity to select facilities for the Army, Navy and Air Force in 2009. From a numbers perspective, the challenges facing the new system are immense: Tricare currently has 9.2 million beneficiaries, with some 6 million using its pharmacy benefit.

The system also will need to unite a number of diverse systems currently in place to keep track of drugs, patients and medical histories. The integration of Centricity and the Armed Forces Health Longitudinal Technology Application has been in the works for some time as the department has plodded ahead with efforts to create single electronic patient records that will follow a military officer from enrollment through retirement.

GE Healthcare is customizing its Centricity Pharmacy Information System under a 10-year, $80 million contract awarded by DOD in October 2004. In the health care arena, more than 150 hospital organizations, including Johns Hopkins, Memorial Sloan-Kettering Cancer Center, the University of Texas MD Anderson Cancer Center, and University of California at Los Angeles run the system. Research suggests that DOD should be able to reduce medication error rate by as much as 50 percent.

‘Big Edd’ Takes Orders
One major component of Centricity will be the Enterprise Drug Database (EDD), which will keep one drug file per National Drug Code number, the unique identifier that the Food and Drug Administration has assigned to every approved drug. This will replace the databases currently in use; while there may be some initial challenges with inputting new medications, ultimately there will be increased data availability and integrity.

“Right now, there are drug files at each of the local hosts,” says Lt. Cmdr. Mathew Garber, director of DOD pharmacy informatics. “With Centricity, we want to get away from that. In the future, they’ll be maintained at the Enterprise Drug Database—Big Edd—and the locals will pull down the files they need.”

In addition, Centricity will feature perpetual inventory, with bar-code scans at order delivery allowing for the real-time control of stock and automatic suggested orders based on predefined stock levels.

Tricare is also using the initiative to deal with another pressing issue: prescriptions. Prescriptions remain an inefficient and error-prone part of the care loop, says Rear Adm. Thomas J. McGinnis, chief of the Pharmaceutical Operations Directorate of the Tricare Management Activity. In extreme cases, misread handwriting on a prescription can lead to costly or even deadly mistakes in treatment. To deal with this, Tricare is developing an electronic prescription initiative, which will support electronic prescribing at both civilian and military treatment facilities.

For those close to the project, there is confidence that Centricity is up to such an enormous task. “The system will be able to handle all beneficiaries,” McGinnis says. “Doctors will be able to electronically tap into our database, to see what other medications the patient has and make sure that a duplicate therapy isn’t prescribed.” The prescription can then be sent electronically to a pharmacy or treatment facility. If there is a potential for an adverse drug interaction, the pharmacist receives an electronic message to that effect.

Prescriptions remain an inefficient and error-prone part of the care loop. —Rear Adm. Thomas J. McGinnis

“If my daughter goes to a [military treatment facility], and they’re full, she has to go into town to another doctor,” says Garber, describing the vision behind the initiative. “Wherever you go, they should have formulary and profile information, and get a clinical check. No more of a doctor writing a prescription and not knowing what other doctors wrote, or even what they themselves wrote two weeks ago.” A major effort is being made to ensure that the system conforms to industry standards, considering the major civilian components involved.

Check Factor
Nationwide, some 58,600 DOD and retail pharmacies are affiliated with the Tricare network, allowing beneficiaries to fill their orders virtually anywhere (including through a mail order service). “At the level of the retail network, there’s a six-second claims adjudication process; they’ll know about co-pays and whether the patient should be receiving that medication,” says McGinnis, who adds that an electronic prescription system is far more time-effective from an administrative standpoint than the old procedure, which involved keeping track of paper receipts.

“It’s not reinventing the wheel,” McGinnis adds. “We have our Pharmacy Data Transaction Service system that’s been running for a number of years, and we make sure things are accurate.”

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