Pharmacists complete health IT communication loop

MANY PATIENTS SEE THEIR pharmacists more than they see their doctors. With trips to the pharmacy to refill prescriptions or fill prescriptions from various specialists, as well as medication therapy management services, pharmacists quickly become the face of healthcare for many. That makes the information they dispense and collect as important as the prescriptions themselves when it comes to patient safety and adherence to drug regimens.

Because they are at the point of sale, pharmacies have traditionally been ahead of the technological curve. Their records have been computerized for years, though they’ve often had to communicate with doctors and patients via phone and fax. E-prescribing and electronic healthcare records (EHRs) promise to change that.

“There’s a lot of potential for information to be communicated that way: diagnosis codes, benefits, formulary information, plan information, sales status all those things can be communicated at various levels,” says Harry Hagel, director of the Academy of Managed Care Pharmacy’s (AMCP’s) Healthcare Information Technology department. “The potential is there. E-prescribing is potentially connected to an electronic healthcare record. That’s a lot of information for pharmacists to use when advising patients and resolving problems with medication use.”

SETTING THE STAGE

The benefits are obvious: fewer harmful drug interactions, a reduction in prescription errors, immediate drug regimen adherence information and access to patient medical history. But the hurdles seem just as impressive: determining what information should be shared and by whom, implementing standards and convincing every segment of the industry to adopt them.

“The biggest hurdle is time,” says consultant Shelly Spiro, president-elect of the American Society of Consultant Pharmacists. Spiro has served on a number of national and local committees involved in healthcare information technology. “It’s very difficult for me because I work day-to-day five years [in the future],” she says. “The things I work on, the average pharmacists won’t see for five years. Standards are done first, then adoption. So we’re laying groundwork for what will be happening with technology in the future.”

John Klimek, senior vice president of Industry IT for the National Council for Prescription Drug Programs (NCPDP), agrees.

“There’s no question that the technology is there,” he says. “It just has to be adopted by everyone to use in the same way. Pharmacy got together and decided how to process claims, for example. That’s the position we’re in now with medical records. EHRs have the same data elements, but they are not necessarily in the same format that’s recognized between different providers.”

Adoption requires time and money. As standards and formats are set, systems need to be modified to use them, pharmacists and clinicians need to be trained, and cultures need to shift.

“Probably the main beef of pharmacists revolves around technology adoption issues and communication issues—having systems that may not communicate seamlessly,” says Hagel. “There’s the cost of implementing that, the impact on workflow and efficiencies, transaction fees, moving that info along the tech highway—there are fees associated with that. Currently those fees are assigned to pharmacy. Right now, prescribers don’t have those fees. Our hope is that as the volume increases, the costs will decrease.”

More difficult to quantify, but just as important as costs, is the effort to change mindsets that may be resistant to using new technology. Spiro says some pharmacists and physicians who don’t understand what is happening are afraid technology will replace them. Even healthcare professionals who understand technology well may not want to use it because it’s new and different.

Spiro says there is a cultural progression that must take place with technology. She recalls a business colleague who was “very into health information technology” but was still using a Franklin Planner.

Perhaps because the pharmacy segment was so early to adopt technology to electronically communicate with payers and processors; it is at risk of not being included in current electronic healthcare communication efforts.

“I can’t tell you how many times I’m involved in national healthcare information technology issues, and I’m the only pharmacist in the room,” Spiro says.

Klimek knows that feeling. He says part of his goal at CMS meetings is to see that pharmacy claim data becomes part of EHRs and that there’s some intent to incorporate it into the record.

“Whether that happens from the pharmacy level or at the processor level, that remains to be seen,” he says. “The key part of that is the ability of pharmacy to be able to view those EHRs as well.”

LOOKING AHEAD

Despite the obstacles, pharmacists are embracing healthcare IT.

“I may come off as optimistic, but we’ve already built standards to document medication therapy, to make sure we are capturing the right information, to do eligibility, and we’re building information into the prescription that pharmacists need to have,” Spiro says. “It’s all being worked on and created now. It’s there, but how do you get a person doing a manual process to adopt those steps? Technology is a tool; we just need healthcare professionals to use it more effectively and efficiently.”

Spiro isn’t alone on her positive outlook of healthcare IT.

“I pretty much agree with the current Administration in terms of healthcare IT being a tool to provide improved quality of care and efficiencies,” Hagel says. “But, it’s going to take some time.”

The goal is to get EHRs adopted nationally by 2015 under the Health Information Technology for Economic and Clinical Health (HITECH) Act, according to Klimek.

“Being able to use the patients’ electronic health record for pharmacy will help pharmacists take care of their patients more comprehensively,” he says.

NEXT GENERATION

It may seem like the younger generation is addicted to technology, but that could be a good thing, according to Spiro. All of the videos uploaded to YouTube, the texting to friends, the tweets and Facebook status updates could evolve into a generation of Americans who are not just extremely comfortable with electronic communication, they expect to communicate with healthcare providers electronically.

“Where I see pharmacists going in the future is using a tool like Facebook to communicate with patients one-on-one,” Spiro says. She says pharmacists already use LinkedIn, Facebook and Twitter to communicate with one another. She sees electronic communication with patients as the next logical step.

But what about privacy concerns? “Will Facebook create secure portals for people? Who knows? It could be easily set up,” she says. “I think the privacy thing is going to go by the wayside. Look at the teenage population today, they really don’t care.”

Consumer demand drives the market, and if tomorrow’s consumers demand to communicate with doctors, pharmacists and plans via social media, then that may be the next focus of healthcare IT.

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