Documenting and Sharing Clinical Information: Key to Pharmacy’s Future

Monday, July 3, 2017

Marsha K. Millonig, MBA, BPharm

Pharmacy has long been at the forefront of the electronic exchange of information. It started with the first claims submission decades ago and followed with the advent of electronic prescribing. But now, pharmacy may be at risk of lagging behind the rest of the industry when it comes to the electronic storage and exchange of clinical information.

Electronic information efforts so far have been incredibly valuable for the industry: Electronic claims submission today is used for nearly all of the approximately 4 billion prescriptions dispensed each year in the United States. These claims are processed in seconds, determine a patient’s eligibility, and apply a myriad of coverage rules. Drug utilization edits support patient safety, alerting professionals to potentially dangerous interactions or dosing levels.

Electronic prescribing has improved patients’ speed to therapy, allowed for productivity increases, and it also enables patient safety via codification and clinical decision support functionality. There are certainly still opportunities to do more with e-prescribing, such as greater use of messages to communicate desired changes and to cancel prescriptions.

Nonetheless, pharmacy needs to improve its ability to send and receive clinical information with other care providers — whether physicians, labs, nursing facilities, or other pharmacies. Clinical information includes:

  • Discrete data:
    • Lab and biometric values
    • Medication administration data, including vaccines
  • Subjective information, like progress notes

Next Steps for Pharmacy

Tremendous work has been done to develop recommended elements of a pharmacist/pharmacy provider electronic health record (EHR) functional profile — essentially an outline for which functionalities a pharmacy system needs to support so that pharmacists can effectively document and bill for their services and share information with other providers. This functional profile was jointly developed by two leading healthcare standards development organizations, HL7 and NCPDP, to facilitate the capture, maintenance, and sharing of point-of-care prescription and medication-related clinical data.

Work continues on the profile to ensure that it aligns with the EHR certification requirements associated with the Meaningful Use program. Use of the functional profile will put pharmacists on a more even technical standing with other providers, something that can only help in efforts to achieve provider status under Medicare.

Advances also have been made to support the exchange of information related to medication therapy management (MTM) services. Pharmacies that provide MTM services most likely would love to receive electronic referrals for those services and to be able to submit their clinical documentation to the referring provider electronically. This is another area for which NCPDP and HL7 have come together to develop the technical standards to support the electronic exchange of service requests, referrals, and documentation of services rendered. There is also guidance on the use of CDA (clinical document architecture) templates for pharmacy transition of care and pharmacy care notes.

All of these technical tools are meaningless if they aren’t implemented and used. Wider implementation is essential to the success of these tools, which have been designed by industry volunteers to ensure that pharmacy stays on the leading edge of using technology to support patient care.

We live in a world of big data, and pharmacy has a treasure trove of information that must be digitized in order to maximize its benefit. Think for a moment of the information you have stored about any given patient:

  • Demographics
  • Medication history, including immunizations you’ve administered
  • Allergies
  • Possibly lab values and biometrics, such as blood glucose, cholesterol, height, weight, and blood pressure
  • Which doctors patients see
  • Language(s) each patient speaks most fluently
  • Possibly additional information about other services you’ve provided, such as medication reviews or lifestyle and behavior counseling

Now imagine having all of that information available in structured, discrete fields that can also be codified. You could generate reports, attach those in a message to a physician, include them as evidence for billing, review them to improve internal processes and operations, even publish findings based on your work. This is where pharmacy needs to be!

We have the opportunity to harness the tools that are available now — and those being developed — to ensure that we continue to lead in leveraging technology to improve patient care, improve our operations, and enhance our standing with our provider partners and payers.

Marsha K. Millonig, MBA, BPharm, is president and CEO of Catalyst Enterprises, LLC, and an Associate Fellow at the University of Minnesota College of Pharmacy’s Center for Leading Healthcare Change.

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