In the last issue I made mention of the functional profile of a pharmacy electronic health record (P-EHR). I thought I would elaborate on this.
But first let me address “meaningful use.” This is a term that is being tossed around and is a little misleading in the context in which it’s being used. Meaningful use applies to physician use of an EHR.
The government isn’t going to fund interoperable EHRs that are not being used to advance heath information exchange. So EHRs have to be used by physicians in a meaningful way. I will use electronic prescribing as an example. To qualify for government incentives physicians must e-prescribe a specific percentage of the prescriptions they write beginning in 2012, with the threshold moving higher through 2015. In 2012 this percentage will be 40%. The incentives are paid out as the practice meets the required thresholds. Worth noting is that pharmacy currently does not qualify for government incentives.
Nevertheless, HL7 and NCPDP collaborated to define the functional profile of a P-EHR. This calls for a single logical health record — meaning an entirely new software module that is used and maintained for each patient, I thought I would give you a peek at some of the required functionality. It must:
- Have mechanisms for incorporating external clinical data such as lab results.
- Allow patients to provide data for entry into the health record or have a given mechanism for them to enter data.
- Capture the complaint or reason for the encounter and handle family preferences such as language.
- Provide the ability to indicate advance directives such as living will, durable POA, and preferred intervention such as “Do not resuscitate.”
- Capture true allergy intolerance and adverse reactions, dietary or environmental triggers, and date on which the allergy was entered.
- Provide the ability to capture non-Rx items such as OTCs and complementary meds such as vitamins, herbs, and supplements.
- Provide the ability to capture the history of all problems and the onset date of the problem.
- Capture, display, and report all immunizations associated with the patient.
- Provide the ability to create assessments.
- Capture patient-specific plans of care and treatment.
- Provide the ability to transfer plans of care and treatment to other care providers.
- Provide the ability to interface with systems of blood banks to manage orders for blood products or other biologics.
- Display the timing, route of administration, and dose of all meds on an order list.
- Provide, during an encounter, the recommended immunizations and when they are due.
- Trigger prompts to consider issues from data entered that would ensure a complete and accurate assessment.
- Provide the ability to access care plans, protocols, and guidelines when requested within the context of a clinical encounter.
- Provide the ability to identify an appropriate drug dosage range specific to each known patient condition and the parameters at the time of med ordering.
If this becomes a reality, the way pharmacy is practiced would change dramatically. But first there needs to be adequate reimbursement to drive this. I take it you will agree with me on this point. CT
Bill Lockwood, chairman/publisher, can be reached at email@example.com.