Managed care pharmacies reap benefits of EHRs

'The real opportunity for EHRs is the ability to improve communication between pharmacists and physicians'
By Anthony Vecchione
12:08 PM

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.

"However, from a PBM pharmacist perspective, we believe the real opportunity for EHRs is the ability to improve communication between pharmacists and physicians to better serve our patients," Sundar added. EHRs provide the means to improve bidirectional communications with physicians, in real-time, at the point of care and within the physician’s workflow.

The proliferation of EHRs provides Express Scripts with another opportunity to improve its innovative model by helping to improve its communication with physicians within their preferred channel and their workflow, said Sundar.

"EHRs also allow physicians to understand the patient’s benefit, and can select – at the point of care – what therapy might be most cost-effective for the patient," she said, adding that smarter, more efficient communication leads to better patient care and outcomes, more timely care and less administrative burden.

Bernadette Eichelberger, director for pharmacy affairs for the Academy of Managed Care Pharmacy, said that her organization is very interested in making sure that they can improve patient outcomes and improve the cost structure for the improved outcomes.

"This requires robust clinical data so that we can really understand how we can close gaps in appropriate use of medications, where outcome and costs are not maximized and ADEs are not minimized, Eichelberger told Healthcare IT News.

Another area where EHRs are having a positive impact is on Pharmacy and Therapeutics Committee.

Eichelberger says P&T committees often have to make decisions on drugs that gain FDA approval based on limited clinical data.

"If you think about those hepatitis C drugs, for example, where California alone would spend $20 billion per year to treat 50 percent of those patients, the effectiveness data for some genotypes was based on less than 200 patients," said Eichelberger.

She noted that having EMR data available to look at those patients a year later, using real-world data would help managed care pharmacy to assess whether it's really getting the value that they expected from those drugs.

"This of course presupposes that you have strong EMR data," she said. "It also presupposes that the data are normalized across payers so that when the incidence of the disease and associated lab results require assessment across large populations, we know we have reliable inputs."

AMCP, noted Eichelberger, is promoting measures to improve HIT adoption.  For example, they recently convened a group that looked at how they can improve transitions of care (TOC) by improving access to medication reconciliation data and using the data to facilitate seamless medication therapy management services.

"One of the findings of that group was that one the health information exchanges practice is are a serious obstacle to pharmacist-provided MTM and TOC services," said Eichelberger. "Because HIEs restrict access to 'approved' providers, they frequently exclude pharmacist-provided services."

"When we're delivering MTM services, getting an HIE to allow my patient assessment data to be bidirectional, I run into a huge stumbling block," she said. "It often takes more than a year to negotiate with the HIE to make sure that pharmacist provider information is part of the whole HIE structure."

AMCP supports the need to include pharmacists services in HIEs and they are also working on various projects designed to facilitate HIE transfer of pharmacist provided patient drug assessments.

"This means ensuring that pharmacists TOC notes become a part of a patient's EMR,"  said Eichelberger. "The corollary step is to make sure that after a patient has an MTM assessment, the physician and the retail pharmacy, via the HIE, get an update of the patients status."

AMCP is spearheading an effort to make sure that more pilot programs are established showing why HIEs are important and pharmacists' access to HIEs is crucial.

Another example of how AMCP members are actively promoting EHR and HIT strategies is in the area of electronic prior authorization.

"We held a task force last year," said Eichelberger. "We've had at least three webinars to promote the new electronic prior authorization component of e-prescribing and to make sure our members are rapidly adopting it."