Through our current evolution of adopting health information technology, pharmacy has often led the way. We were the first to have real-time claim submission and adjudication. We’ve led the way in receiving prescription orders electronically. We have adopted technology to facilitate patient communication (refill reminders and requests). As we look at the exchange of health information, pharmacy has an opportunity to continue to lead. While many consider electronic prescribing to be health information exchange, there is much more that can be shared by pharmacists and other providers, such as lab values, immunization administration records, allergy and adverse-event reporting, and documentation of care provided, (i.e., medication management counseling). This information becomes even more critical as the role of the pharmacist continues to evolve, whether through regulation or through our enhanced participation in care teams.
Pharmacies have electronic connections to prescribers that can be leveraged to better share information. But there are challenges.
Pharmacists need to identify their priorities — essentially, what information do they want to exchange and with whom? These priorities may have different drivers, i.e., regulatory requirements, improving patient care, or managing costs and revenue. There is data that can be exchanged — such as immunization records, allergy and adverse-event records, and prescription fill status — that may mitigate each driver. Clearly, the challenges of implementation remain — the costs and resources associated with each new type of information exchange. And all of this has to be balanced with other initiatives and compliance efforts; it is expected that the industry will be required to move to a new version of the NCPDP SCRIPT Standard beginning in January 2017.
While many consider electronic prescribing to be health information exchange, there is much more that can be shared by pharmacists and other providers.Once the pharmacists have identified their priorities, they will need to determine how they align with the priorities of their trading partners, i.e., prescribers. It is entirely possible that the priorities may not align, or that the timing of exchange with pharmacies will be delayed while prescribers address exchange with other entities first. How is the pharmacy supposed to know what the prescriber’s priority is?
The technical components associated with health information exchange (HIE) require inspection. While tremendous gains have been made in developing standards to exchange structured health information, adoption and implementation vary. Systems, including pharmacy systems, need to be able to extract and consume structured data. HIE models include public (state run), private, centralized, and federated. Information can be pushed or pulled. Health Level Seven (HL7), an international standards development organization, has created a functional profile for a pharmacy electronic health record (EHR); the criteria are intended to ensure that pharmacy systems are prepared to send, receive, and store patient clinical information. This profile moves pharmacy systems beyond dispensing to health record systems, yet adoption has been limited. Use of the functional profile can also facilitate documentation needed to support medication therapy management (MTM) service claims.
And last but not least, there are financial implications that must be addressed. Investments must be made to enhance systems to support information exchange. Contracts may need to be signed with intermediaries and trading partners, and operating costs may increase. Resources will need to be prepared to handle the additional information being exchanged. As an example, training all staff to be aware that allergy/adverse-event information may now be received on a new prescription, or revising workflow if notifications will be systematically sent to prescribers regarding fill status.
We know from a recent survey conducted by Black Book (http://www.beckershospitalreview.com/healthcare-information-technology/88-of-providers-saycollaborative- hie-initiatives-improving-payer-providerrelations-9-survey-findings.html) that:
Of respondents, 83% of physician practices and 40% of hospitals said they are still in the planning and catch-up stages of sending and sharing secure, relevant data.
Of those respondents who self-identified as a prospective HIE user, 57% blamed their reluctance on HIT/EHR vendor connectivity defects and a lack of vendor preparedness.
In the first quarter of 2016, 88% of hospitals and 95% of payers said collaborative HIEs, where each stakeholder pays for system development and maintenance, are creating more collaborative, trusting relationships.
Pharmacy system vendors and others will continue their efforts to comply with regulatory requirements, such as moving to the next version of SCRIPT. That will allow for more efficient exchange of:
Allergy/adverse event information — between prescribers and pharmacies.
REMS information — between prescribers and REMS administrators, before the prescription arrives at the pharmacy.
Fill status notification — between pharmacies and prescribers, with the prescribers able to specify when they want to receive the notice.
Local and national efforts will continue to catalyze the exchange of health information among care providers. Tracking these efforts through professional associations, state agencies, and national organizations can assist in setting priorities and developing implementation plans. CT
Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises in Eagan, Minn. The firm provides consulting, research, and writing services to the healthcare industry. The author can be reached at mmillonig@ catalystenterprises.net.