In this interview with ComputerTalk's Maggie Lockwood, the American Society of Consultant Pharmacist’s Carla Sexton, R.Ph., CGP, assistant director, policy and advocacy, along with consultant and ASCP board member Shelly Spiro, R.Ph., FASCP, talk about the ways evolving technologies, from web-based interfaces to the LTC e-prescribing pilot, are impacting the consultant pharmacist.

CT: How does the diversity of technology that exists for the consultant pharmacist impact day-to-day operations?

Sexton and Spiro: Consultant pharmacists often work with a multitude of nursing facilities that may use different long-term care pharmacies. It can be burdensome for the consultant pharmacist to be knowledgeable about and prepared to use the various types of technology implemented in each nursing facility and dispensing pharmacy. For example, more-progressive nursing facilities may have electronic medication administration records (eMARs), while others may not have computers or technology systems at the nursing stations or on the units or floors. Information necessary to a consultant pharmacist’s medication regimen review may be found in a paper chart at some facilities, while the consultant pharmacist might need passwords and a basic understanding of the computer systems to access the same kind of information in another facility that uses electronic health records (EHRs), eMARs, or other technology solutions. Just knowing where to find resident information and how to access it can be difficult as the consultant pharmacist moves from one facility to the next.

Another way in which diverse technologies impact the consultant pharmacist is access to residents’ medication lists/histories. Most consultant pharmacy software systems typically interface with dispensing pharmacies’ systems in order to populate the consultant pharmacist’s software with the current medications each resident is taking. If different companies make the dispensing and consulting systems, the interface is not necessarily standardized and must be manually written by software programmers. For the consultant pharmacist, how this interface occurs and how the medication information is populated must be considered when purchasing consulting software. Updating the medication list may require action by the consultant pharmacist, which means that the list/history is not always up-to-date and may require time and effort to maintain.

Communication with the physician is a major role for the consultant pharmacist. As the physician’s technology changes, the consultant pharmacist’s software will have to adapt to those changes until standards are developed, accepted, and implemented.

CT: How do you see technology evolving to address the challenge of software compatibility in the marketplace?

Sexton and Spiro: The problem with writing situation- or system-specific interfaces to enable communication between systems is that they lack standardization. Standards help systems “speak the same language” more easily while providing the end-user with enhanced accuracy and ease of use. These benefits to the user will result in better overall care for residents and will be the major impetus for the adoption of standards. There are two major reasons why providers need fully interoperable software systems:

• It will result in access to more information than is currently available

• The accessible information would be more up-to-date, which means less discrepancies in the data and less chance for inaccurate or inappropriate decisions based on the information

Eventually, standardized, inter-operable electronic health records will be the “norm” in long-term care, with which consultant pharmacist and long-term care pharmacy software systems will directly interface. While this is closer to reality than ever before, we aren’t there yet.

CT: What standards are ASCP work groups focusing on from the standpoint of technology?

Sexton and Spiro: ASCP staff and members have been working in a variety of coalitions and groups to further the development of health information technology standards in long-term care. First, a long-term care Workgroup was formed within the National Council for Prescription Drug Programs (NCPDP) approximately two years ago. Within the LTC Workgroup, there are several Taskgroups that are working on topics such as electronic prescribing and the interface between consultant pharmacists, their software systems, and electronic health records in the LTC setting. Thanks to work being done in some of these Taskgroups, revisions to the NCPDP SCRIPT standard, the CMS-named standard for e-prescribing in the community setting, are being proposed. These changes are necessary to accommodate the nuances of e-prescribing in LTC.

In addition, ASCP has been participating in a LTC industry-wide initiative to define the functions and characteristics needed in a standardized EHR specific to long-term care. The EHR functional model was developed by HL7, and it is this model from which the LTC industry is developing a LTC-specific functional profile. The LTC functional profile will eventually be balloted through HL7 and provided to the Commission for Certification in Health Information Technology to aid in defining criteria for certification of LTC EHR systems.

ASCP is also a member of the Health Information Technology Standards Panel (HITSP). HITSP’s mission is to help the public and private sectors define a widely accepted and useful set of standards to support widespread interoperability among healthcare software applications, as to how they interact in a local, regional, and national health information network.

CT: Do consultant pharmacists see the web as a way to work more seamlessly with the various players in the LTC arena?

Sexton and Spiro: In general, nursing facilities have limited access to the Internet. This, in turn, makes it difficult for facility staff and/or visiting consultant pharmacists to access online drug information resources, third-party plan formularies and other plan information, and additional Internet-based resources. Therefore, simple access to the Internet, independent of software systems employing web-based functions, would be beneficial.

In the end, web-based systems and tools are enabling more timely and accurate communication of information between providers. They can be particularly helpful in a LTC setting where more sophisticated technology is not yet present.

As wireless technology becomes more available, the use of the web will help consultant pharmacists communicate more seamlessly with facilities, staff, and physicians.

CT: Tell us a little about the impact of the recent e-prescribing pilot from the perspective of the consultant pharmacist.

Sexton and Spiro: Although more primitive forms of e-prescribing have been used in the LTC environment for many years, the CMS/AHRQ study was the first pilot to test e-prescribing standards in LTC. The purpose of the LTC pilot was to validate the e-prescribing NCPDP SCRIPT and electronic prior authorization standards in the LTC setting and to study the effects on cost, quality, and safety.

The greater efficiency and increased accuracy realized by the nursing facility, dispensing pharmacy, and prescribers through the use of e-prescribing will indirectly impact consultant pharmacists. Based on the CMS regulations and survey guidelines, consultant pharmacists are tasked with playing an intermediary role as consultant to the facility regarding all aspects of pharmacy services. Therefore, part of a consultant pharmacist’s job is to help the facility develop policies and procedures relating to medication orders (e.g., transcribing and recapitulation of orders), medication error reporting and prevention, communication among providers relative to medication order clarifications, etc. E-prescribing has the potential to change medication-related policies and procedures within facilities. In addition, the integration of clinical decision support tools into e-prescribing systems could aid in proactive screening for unnecessary or inappropriate medication use prior to the consultant pharmacist’s medication regimen review.

For all these reasons, implementation of e-prescribing in LTC has the potential to:

• Make daily work more efficient for nursing facility staff, dispensing pharmacy staff, prescribers, and consultant pharmacists.

• Increase patient safety and quality of care for residents.

• Help facilities maintain compliance with federal and state regulations and survey guidelines.

Participation in the e-prescribing pilot helps the LTC industry keep pace with the rest of the healthcare industry. The pilot was the first major step to ensuring that LTC is on the national HIT agenda. Through ASCP and its members’ involvement in the pilot, the consultant pharmacist will have a place at the table.

CT