CATALYST CORNER: July/August 2013

The American Society for Automation in Pharmacy (ASAP) recently completed its midyear conference in Louisville. I was delighted to be asked to provide an update on advances in pharmacy data flow between the pharmacy and electronic health record systems. My only regret was due to other business commitments, I could only stay for the first half day of the program. During that time, I picked up some great information from the other five speakers and had a super interchange with a new ASAP member on the break. It’s what I like most about the ASAP conferences: fast-paced, new information, and great networking. I am already making plans to attend the next ASAP annual conference, Jan. 16 to 18, 2014, in Amelia Island, Fl., and promised I will clear my schedule to be there for the entire event.

While interacting with and providing services to the pharmacy IT community has been a longtime activity for me and my business, it is my observation based on a number of key issues, that the pharmacy IT community is truly going to be front and center as the pharmacy profession seeks to fulfill its vision for 2015 and beyond. That vision, that “pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes,” was crafted by the Joint Commission of Pharmacy Practitioners (JCPP) in its paper “Future Vision of Pharmacy Practice” in 2004. The current issues that may impact achieving that vision are many, including:

  • Achieving provider status for pharmacists so they may more fully integrate their services into current and emerging healthcare structures such as accountable care organizations (ACOs) and patient-centered medical homes and have these services reimbursed. This will include defining a standard process of care. 
  • Achieving integration of pharmacy clinical and dispensing data with electronic health record (EHR) systems and progress on the pharmacy health information technology (HIT) collaborative’s roadmap. 
  • Addressing medication adherence issues, especially in patients with chronic disease, which is estimated to cost the nation $200 billion annually.

Pharmacy IT vendors are right in the middle of each of these issues. And my sense is that we are moving toward “the perfect storm,” where action must happen rapidly due to two other forces: the impending entry of up to 30 million Americans into the healthcare system in January 2014 and the increasing number of highly educated and trained pharmacy graduates who have the skills — but may not have the positions created to use them — to achieve pharmacy’s vision for the profession.

I wrote about the pharmacy provider status campaign in the March/April issue of ComputerTalk, and Jim Owen of the American Pharmacists Association (APhA) gave a presentation on this issue at the ASAP midyear conference. As Jim noted, the future of healthcare is value driven, revolving around:

  • Providing care to patients efficiently and effectively using an evidence-based, patient-centered team approach. 
  • Focusing on quality outcomes. 
  • Providing treatment where patients need care (in the most cost-effective and feasible treatment location possible). 
  • Preventing excessive, avoidable costs to the healthcare system and to patients.

The cornerstones of this value-driven healthcare are fourfold, and include:

  • Measuring quality and price (value) of care. 

  • Publishing quality and price (value) of care. 

  • Using health information technology effectively. 

  • Creating positive incentives for high-quality, efficient healthcare.

In order to align the pharmacy profession to meet the emerging needs of the U.S. healthcare system, three things are necessary, Jim said:

  • Providing pharmacist’s services with a consistent process of care. 

  • Developing and integrating pharmacy technology solutions that are interoperable with the U.S. HIT infrastructure and that facilitate patient care provision by pharmacists. 

  • Recognizing pharmacists for the value provided to the healthcare system, and achievement of “provider status.”

The JCPP organizations are currently addressing the consistent process-of-care issue. There is a need for consistency in patient-care process and service delivery so that MTM practice can be measured and valued. A common agreed-upon terminology is part of the effort, as is identifying and describing the spectrum of services that pharmacists offer. When this happens, pharmacy IT vendors will be able to more efficiently implement necessary standards to achieve interoperability with the EHR systems. Finally, as healthcare reform continues and health professionals and hospitals are being held accountable for total-person care, the ability for pharmacists to fully participate in these structures is hampered by not being recognized as providers in the Social Security Act and a number of CMS regulations that are related to the Affordable Care Act (ACA). APhA is working with other interested organizations on a multipronged, multifocused effort to achieve provider status.

Pharmacy IT vendors will be critical to these efforts by updating systems to communicate with EHR systems and implementing tools to help pharmacists address patient adherence and provide medication therapy management (MTM) services and the standardized care process. Information technology-related goals are to:

  • Build HIT solutions that support the profession’s developed and defined process of care. 

  • Use standards (HL7 and others) that are used by other health professionals for electronic health records and implement the HL7 EHR Pharmacist/Pharmacy Provider Functional Profile and other electronic structured documents. 

  • Use industry standard coding (SNOMED CT) for documenting care to promote information sharing/ interoperability and quality/outcomes reporting and assessment. 

Pharmacy-related electronic structured documents that have been completed include the Medication Action Plan and Medication List. A “pharmacy care” note document is under development that follows the format of other health providers with the SOAP note format (subjective, objective, assessment, and plan). Two proposed documents include the Quality & Value Assessment Document and the Pharmacy Care Transitions Document. The latter, in particular, is of interest, as there are now CPT (common procedural terminology) codes to bill for services related to care transitions. Lack of provider status is a barrier to pharmacists billing using these codes — another reason achieving provider status is so important.

There is much to be done. Pharmacists’ patient care services, including serving as an access point to referral, will be needed even more when provisions of the ACA kick in during January 2014. Of the expected 30 million Americans entering the healthcare system, approximately half of those will go into Medicaid. States can opt to expand Medicaid, and at least 24 states and the District of Columbia plan to do so. Yet this influx will occur at a time when there is a shortage of primary-care physicians. Patients may find it difficult to see a provider. Yet pharmacists are readily accessible and will continue to be, with the forthcoming increase in pharmacy program graduates.

I want to encourage pharmacy IT vendors to add integration and interoperability with EHR systems as a priority. Pharmacists will be dependent upon these in order to fulfill the new roles envisioned and to align with the changing health system. Many vendors are helping pharmacists address medication adherence challenges, which have been receiving more press of late, and this is a good start. I plan to address that in the next issue of ComputerTalk. CT

Marsha K. Millonig, R.Ph., M.B.A.,
is president of Catalyst Enterprises, LLC, located in Eagan, Minn. The firm provides consulting, research, and writing services to help industry players provide services more efficiently and implement new services for future growth. The author can be reached at