Technology Corner 

Do You Know What You Don’t Know? ––>

We absolutely know you don’t have time to have
your head in the clouds, envisioning a future scenario where technology
allows you to morph your practice into another unanticipated level. We
also fear that many of you are spending most of your waking moments in
the weeds of survival in your practice, while changes are afoot that can
dramatically impact your business. In fact, you may not even be aware
of opportunities that are developing in your own community. Answer this
question: Can you describe your practice as being part of an integrated
delivery system?

An integrated
delivery system (IDS) is a network of healthcare organizations that is
owned or tightly affiliated with a large provider, such as a local
health system or a powerful physician network. Many IDSs have an HMO
component, while others are a network of physicians only, or of
physicians and hospitals. Thus, the term is used broadly to define an
organization that provides a continuum of healthcare services for
patients in a defined population or community. Larger communities can
hold two or more competing networks or systems, where you may want to
seek integration with only one, or both, depending on what is best for
your patients and your practice. Many physicians maintain privileges in
multiple hospitals, but just like them, you may encounter challenges
brought about by different electronic health records and communication
standards being employed in each system.

Do you see your
pharmacy operations as a big enough player in your community that larger
organizations are going to seek you out and propose cooperation,
collaboration, or affiliation with them in their future planning? Do any
of these larger organizations see any potential of your practice beyond
the distribution of medications and perhaps durable medical equipment?
IDSs will typically either purchase, build, or affiliate with providers
that are needed to help them offer some level of population health. Ask
yourself, if the largest employers in your community were enlisted by an
IDS in a contract that did not utilize your practice, would this impact
your practice significantly? Some of you can say “no” to this question,
because you are too small, too rural, or too near to retirement to
care. This column is being written for the rest of you.

Meet the People

We advocate that
each of you take the time to have a meeting with key members of your
local health system and the administrative staff of any significant
physician networks in your community, if they are so organized. You may
want to go as a pharmacy practitioner or as a representative of a local
pharmacy network of providers. In either case, the key players in the
health system would include, of course, the CEO, if you want to know how
regulatory changes are impacting how the health system is planning
strategic and tactical moves in the near future. This source will also
allow you to discover how the insurance industry changes that are
ongoing right now may impact your community. Are you aware that
insurance companies are attempting to merge, and that three companies
may soon insure one-half of the covered lives in our nation? Would you
like to know what your health-system CEO sees as the implications of new
regulations and insurance company changes, and how straddling the
transition from fee-for-service to population health is impacting his or
her health system?

You have probably
read in a previous column that we advise an informal meeting with the
chief information officer (CIO) for your health system. Larger physician
networks will probably have a similar position being filled. Hopefully,
we don’t have to tell you how important connectivity with other
providers and with patients is to your practice. Are you aware if a
provider portal is available in your community? Do you have access to
it? Are you aware of a patient portal that could either be branded or
selected from third-party offerings in that sector? Have you ever asked
your patients if they are participating in a portal where they would
give you access to their information directly? Would the ability to see
lab results, diagnoses, and care notes improve your ability to serve
your patients’ needs more effectively and efficiently?

We can still state
from a tongue-in-cheek posture that, “The nice thing about information
standards is that there are so many to pick from.” After you meet with
the information technology officer, you will be able to communicate to
your pharmacy management system vendor the exact standards being
employed, and examine connectivity opportunities that result from this
information. There are so many ways now to move data from one disparate
system to another that can be employed. The only way this will occur is
when you acquire the necessary parameters to achieve it.
We recommend that all of these patient questions should be preceded by you asking the question, “When you think about everything that is going on with your health and the health of those you care about, what is your biggest concern right now?”

Another key group
from health systems is the discharge planner personnel that are working
locally with your patients. Do these individuals know how you can assist
patients during the handoffs from acute care to ambulatory care? Do
your patients know when they schedule procedures in your hospital that
they can request that discharge documents be forwarded electronically so
that you can facilitate the assistance with the medications,
postsurgical supplies, and home care appliances that may assist them
with their transition needs back home? Again, do these people know you
and what you can do?

The last key
individual we want you to talk with is the patient who darkens the door
of your pharmacy. Do you know how and if each of these individuals would
prefer to send and receive communications that can improve their health
status? Are these patients also caregivers for other individuals? Do
you know the specific communication channels they employ, such as email,
texting, portals, and social media? Do you know their tolerance for the
frequency of these communication channels? Have you asked them whether
specific adherence issues might be improved by simple technology

recommend that all of these patient questions should be preceded by you
asking the question, “When you think about everything that is going on
with your health and the health of those you care about, what is your
biggest concern right now?” If you have the courage to ask this
question, and then address the issue posed with the services that you
are already equipped to provide, you may be pleasantly surprised with
how this interaction will open the doors to many opportunities for your
practice. The title of this column could be
called “click bait,” to get you to read where we were going with this
title. If you are still reading this, you know that we are open to
helping you by continuing the conversation and by answering any
questions you may have. Feel free to reach out to us.


Bill G. Felkey, M.S., is professor emeritus, and Brent I. Fox, Pharm.D., Ph.D., is an associate professor,
in the Department of Health Outcomes Research and Policy, Harrison
School of Pharmacy, Auburn University. They can be reached at