Colorado Pharmacists Using CORHIO HIE to Improve Patient CareDate: January 25th, 2017Category: CORHIO e-NewsletterTopics: Medication Reconciliation, Patient Care, Pharmacy
A group of pharmacists from across the state recently concluded a one-year pilot to evaluate the usefulness of health information exchange for medication management.
Pharmacists play a crucial role in patient care, yet are often “out of the loop” on health information exchange. In Colorado, most pharmacists do not have access to the CORHIO health information exchange (HIE) network, and pharmacies are not submitting data for other community providers to access. This results in a potential gap in the care continuum. To address this gap, CORHIO and Telligen, a Quality Innovation Network-Quality Improvement Organization for CMS*, recently partnered for a year-long project to institute, test and measure pharmacist query of patient information in the CORHIO PatientCare 360® portal.
“Medications are the only things that truly follows the patient through the care continuum,” says Katy Brown, PharmD, Clinical Pharmacy Specialist at Telligen, “and CORHIO was the ideal partner for this project, since both of our organizations are committed to sharing information to improve health. This project shows how much value pharmacists can find in being able to get clinical lab values, comorbidities, and information from previous hospitalizations.”
How the Program Worked
The pilot included 20 pharmacists from different work settings, including hospital, community, ambulatory and consultant, who agreed to join the program for one year. The pharmacists were asked to learn how to use CORHIO’s web portal PatientCare 360, to regularly access patient data on the portal, and to document their experiences. The group met regularly and took monthly assessments to share challenges and successes. Costs to access CORHIO’s PatientCare 360 web portal were waived for the duration of the pilot.
Even though the HIE doesn’t yet have separate and searchable medication lists, the pilot group was able to find valuable information within hospital and lab records and ambulatory care summary documents. The clinical uses identified by the pilot participants include: care transitions, medication reconciliation, reviewing records from prior visits, verifying information, lab records, medication therapy management, and comorbidities.
The chart below illustrates the overall frequency of these clinical uses by the pilot participants.
Disclaimer: This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-CO-C3-01/13/17-11941
Pilot participants reported finding lab results for their patient that resulted in a medication adjustment. “I found an abnormal kidney function (CrCl) and requested an adjustment to a renal medication,” one pilot participant said.
Overall, 69 percent of the pilot pharmacists agree that their ability to provide care improved by having HIE access. “Because of my involvement in this pilot, I am more involved with patients I had not previously been involved with at my clinic. This is helpful in showing how beneficial a pharmacist can be on a healthcare team,” one participant said.
Pilot Participants Share Successes
Leticia A. Shea, PharmD, BCACP, Assistant Professor, Pharmacy Practice at Regis University School of Pharmacy, used the CORHIO HIE to locate lab values and medical histories to better communicate with patients.
"Labs are valuable information for pharmacists to understand which drugs are most appropriate for our patients and often we don’t have access to this information. Pharmacists often rely on patients to provide them with the rationale for their medication therapy, but if patients are confused or don’t remember everything from their appointments, this information is lost in translation.” she said. “The HIE provides me with patient labs and previous procedures so I am fully aware of a patient’s history and disease progression. In particular, I had patients express confusion about why they were changed to new medications and with the information from the HIE, I was able to provide more complete medication counseling.”
Neda Leonard, MS, PharmD, BCGP, BCPS, Owner of Consult A Pharmacist, LLC, also found the information in the CORHIO HIE helpful for comprehensive medication reviews. Prior to face-to-face interviews with patients and their families, she logged onto the HIE to look up the reason for hospital admission or escalation of care and to see if it was medication-related, to search for labs related to medications, and to find evidence of comorbidities within the medical history.
“There was a time I was able to explain to my client's daughter the reason for a medication dose change by looking up a lab value (INR) from a recent clinic visit and therefore convincing the client to comply with the new dose regimen,” she said.
“Overall, CORHIO helps me connect the dots. So often, older adults are placed on so many medications by various well-meaning prescribers, which causes problems with medication interactions and poly-pharmacy,” she says. “My role is to clean up their medication profile and help them advocate for themselves. The information from other admissions, clinic visits, labs, previous medications and other comorbidities allowed me to manage a more comprehensive and educated medication reviews for my clients.”
Two Medication Initiatives on CORHIO Roadmap
Prescription Drug Monitoring Program (PDMP) – The PDMP database of prescribed and dispensed controlled substances plays a vital role in helping providers identify at-risk patients. CORHIO and the Colorado Department of Health Care Policy and Financing (HCPF) are partnering to give CORHIO’s network of providers access to data in the PDMP via our web portal PatientCare 360. This project is in the initial pilot phase and is expected to be concluded in 2018.
Medicaid Prescription Claims – CORHIO is also working on an exciting project to make data from Medicaid prescription claims available to our HIE participants. The pharmacy fill data would populate in the Community Health Record, making it easily accessible for providers to use in medication reconciliation, understanding patient history, and informing interventions for at-risk patients. This work is expected to be concluded in 2017.
Pharmacists Invited to Join CORHIO
Because of the success of this pilot and the completion of the up-front policy work that was accomplished, CORHIO would like to invite more pharmacists to participate in the network. Please Contact Us if you are a pharmacist interested in connecting to CORHIO.
*Telligen brings healthcare providers, communities and people with Medicare together to improve healthcare quality for Medicare beneficiaries in Colorado, Illinois and Iowa as a Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for the Centers for Medicare & Medicaid Services (CMS). Telligen’s mission as a QIN-QIO is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries through healthcare quality improvement initiatives that increase patient safety, make communities healthier, better coordinate post-hospital care, and improve healthcare quality. To learn more about Telligen, visit www.telligen.com.