# Remote Order Checking

In addition, with the Remote Data Interoperability (RDI) project, it is now possible to perform a limited number of order checks against remote outpatient pharmacy and allergy information from other Veterans Health Administration (VHA) facilities that is stored in the Health Data Repository (HDR). Another project, the Clinical Health Data Repository (CHDR) will enable remote order checks against allergies and outpatient medication data from Department of Defense (DoD) facility data that is stored in the HDR. The CHDR data only relates to active dual consumers (patients that are seen at both VHA and DoD facilities).

For the selected patient, RDI requests from the HDR all outpatient pharmacy data with an expiration or discontinued date starting 30 days in the past and going forward, including into the future.

What Remote Order Checks Are Available?

With RDI and CHDR, the following order checks occur:

· Allergy Contrast Media Interaction

· Allergy-Drug Interaction

· Critical Drug Interaction

· Duplicate Drug Class Order

· Duplicate Drug Order

· Significant Drug Interaction

Which Items Are NOT Used in Remote Order Checks?

Some items are not used in remote order checking because they are not stored in the HDR. Others have a high annoyance factor and therefore were not included at the request of field sites. The following items are not included in remote order checks:

· Inpatient Medications

· Non-VA Meds

· Supply items

· Local drugs that are not matched to the National Drug File

Note: The HDR-Hx and HDR-IMS contain prescriptions with drugs that are not matched to the National Drug File (NDF). This prescription data should be used in remote order checking for duplicate drug classes. Because the National Drug File is updated regularly, these missing order checks could be resolved whenever the NDF is updated. Some drugs may never be matched, especially drugs used in research.

Will the Display Change?

With RDI, if there is a problem with an order check, CPRS displays the information to the user potentially in two separate dialogs. The first dialog displays the allergy order checks:

- It displays the facility name where the allergy was recorded, the reactant, signs, severity, and symptoms.
- For remote allergies, the user is required to give a reason for overriding order checks. The user is also able to write a local comment on a remote facility allergy.
- Allergies are sorted by clinical danger level:
  - In cases where allergy severity and symptoms are identical in one or more order checks, a single consolidated order check will display. The sort order hierarchy is:
    - First by Severity (Highest to Lowest).
    - Second by Causative Agent.
    - Last by Local and Remote locations.

The second dialog displays the following information:

- Medication orders include the last refill date and the quantity.
- Remote medication order checks display the facility name where the medication was prescribed. Local medication order checks do not display the facility name.

The screen capture above shows order checks with remote facility names listed.

If CPRS receives no data from the HDR, it will display the message “Remote Order Checking not available – checks done on local data only,” as shown in the screen capture above.

Allergies display the facility name where the allergy was recorded. If there is more than one station, the local station is displayed first.

To ensure that providers have the information they need, CPRS also provides the message “Remote Order Checking not available – checks done on local data only," as shown above, if CPRS cannot communicate with remote sources.

How Is RDI Remote Order Checking Enabled?

To use remote order checking, your site must enable a parameter to access HDR data. This parameter is set for the entire facility.

When Does CPRS Get Remote Data?

Order checks from CPRS can happen several times during a CPRS ordering session:

- Beginning to write/copy/change orders - When a user selects an order menu to begin writing orders, CPRS requests some order checks, such as polypharmacy, renal function, or creatinine clearance, for example.
- On order acceptance - When the user selects Accept, CPRS requests the order checks.
- Signature of orders - When a user signs the order, CPRS requests order checks.

How Long Is the Data Used?

A parameter that sites can set controls how long HDR data is stored locally and is considered "fresh" and can be used for order checks before the data will be retrieved again from the HDR. The default time for this parameter is 120 minutes or two hours, but each site can change the time in that parameter.

Related topics

Order Checking Overview

Site-Defined Clinical Reminder Order Checks

Order Checking Local

Ordering a Diet

Ordering Inpatient Medications (Simple Dose)

Ordering Inpatient Medications (Complex Dose)

Ordering Outpatient Medications (Simple Dose)

Ordering Outpatient Medications (Complex Dose)

Ordering IV Fluids

Ordering Lab Tests

Ordering Radiology and Imaging Procedures

Ordering a Consult

Ordering Vitals

Text Only Orders

Event-Delayed Orders