Managed care pharmacies reap benefits of EHRs
Increased adoption of electronic health records is helping pharmacists who work for payers and pharmacy benefit management companies improve outcomes, offering access to high-quality clinical data.
[See also: Rx playing bigger role in EHR strategy]
An article in a recent edition of the Journal of Managed Care Pharmacy noted that the increase in the number of physicians using EHRs over the past few years "is promising for managed care."
The article, "The Impact of Information Technology on Managed Care Pharmacy: Today and Tomorrow," cited a Kaiser study conducted from 2004 to 2009 revealing a statistically significant decrease in emergency department visits – 28.8 per 1,000 – and hospitalizations among diabetes patients whose doctors used its EHR.
Managed care pharmacy leaders contend that the next step in developing EHRs is to connect disparate EHRs into health information exchanges.
Douglas Hillblom, lead author of the JMCP article, said that there is a group at the Pharmacy Health Information Technology Collaborative working on a pharmacy-based EHR.
"If I'm a community pharmacist who is working with an accountable care organization and also a member of the HIE, than I can provide my data in terms of what I'm doing back to the primary care physician through that HIE," said Hillblom.
"The thing that we're looking to in the future is having those types of provider arrangements where I can be a community practitioner with an EHR on my system that I can proactively and collaboratively share with a primary physician and other members of the healthcare team and doing that through a direct relationship or through a HIE," he said.
Hillblom added that the HIE is only one avenue and that there could be different electronic mechanisms for information sharing such as closed or secured communication networks. The emphasis, he stressed, should be on enhancing the sharing of information for better patient care.
Among the guiding principles of the Pharmacy Health Information Technology Collaborative is to "identify" – through the consensus work of expert panelists – "the minimum data set and functional electronic health record requirements for the delivery, documentation, and billing of pharmacist-provided medication management services."
Rapid Adoption of EHRs provides pharmacist in managed care and other settings better quality data with which to make decisions. Hillblom, pointed out that in the managed care world, the traditional models had the medical information separate from the drug information.
"They are two different databases," he said. "In making a drug decision you may not have the medical information available to you and therefore your decision-making was based on partial information. What was paid for out of the PBM."
But if a patient decided to pay cash for something, the pharmacist didn't necessarily have that information that had been prescribed.
To address that issue, Express Scripts for example, the nation's largest PBM, offers RationalMed, a clinical program that integrates pharmacy data with medical and lab data.
"This allows our pharmacists to provide better patient care, and identify and take action on gaps in care and potential safety concerns," said Heather Sundar, vice president, product development for Express Scripts.
Express Scripts’ Therapeutic Resource Centers have specialist pharmacists who focus in a specific therapeutic area. Sundar noted that this advanced knowledge and experience, coupled with access to vast data resources leads to improved patient outcomes and reduced potential adverse events.
Coordination of care and physicians' workflow
Industry experts point out that the rapid adoption of EHRs present an important opportunity to couple their data with technology innovations in new and different ways.
"Not only are EHRs improving coordination of care, they are also improving physicians’ workflow by being a central repository for all patient information at the point of care," Sundar told Healthcare IT News.
Express Scripts is launching several new programs that improve its bidirectional communication with physicians through EHRs, allowing them to clarify prescriptions, streamline prior authorizations and more with the physician in their workflow.
"This will help reduce administrative processes, and will make patient care more timely, efficient and most of all, effective," said Sundar.
When pharmacists and physicians are provided with actionable data, they are able to make more informed decisions and provide better patient care, she said.