With HIEs, Knowledge Is Power
Pharmacy Practice NewsDate: September 12th, 2017Category: CORHIO in the NewsTopics: CORHIO Network, Medication Reconciliation, Pharmacy
With HIEs, Knowledge Is Power
Before Elizabeth Buxton, PharmD, gained access to Colorado’s largest health information exchange, she had a tough time getting vital health history details about her patients, such as lab results and medical histories.
“I called the doctor’s office and I begged and begged, and waited and begged and called, and basically made a nuisance of myself until they gave up and got me what I needed,” said Dr. Buxton, a clinical pharmacist manager for the specialty division of Good Day Pharmacy, an independent community chain, in Wellington. In some cases, she noted, “I was told as a nonpractitioner, I had no need for the information.”
The exchange, Dr. Buxton explained, is run by the Colorado Regional Health Information Organization (CORHIO) and originally was not open to pharmacists unaffiliated with hospitals or office-based providers.
Last fall, things changed for Dr. Buxton and other pharmacists statewide. CORHIO and Telligen, a quality innovation network-quality improvement organization for the Centers for Medicare & Medicaid Services, conducted a pilot project extending free access to the information exchange during the second half of 2016 to 20 pharmacists from different work settings. Pharmacists were asked to learn to use the PatientCare 360 web portal to access patient data and document and report back on their experiences. They also adjusted their workflow to accommodate checking the exchange, making sure pharmacists or a designated employee, such as a technician, did so before filling and dispensing prescriptions.
Pharmacists accessed CORHIO to help with medication reconciliation and medication therapy management; review records from prior doctor visits and verify information; check lab results; or look up comorbidities or previous hospitalizations, said Katy Brown, PharmD, a clinical pharmacy specialist and medication safety task coordinator with Telligen, in Iowa. “Most of them found it was very helpful to improve the care that they were able to provide patients.” Overall, 69% of pharmacists said their ability to provide care improved by having access to the exchange, according to Telligen data. This year, CORHIO invited pharmacists statewide to access the exchange at a discounted rate. Over 70 pharmacy members have enrolled, Dr. Brown said.
The project’s goal—demonstrating the value of pharmacist access to the exchange—was achieved, she said. “Pharmacists repeatedly reported that they were able to prevent adverse drug events and medication mishaps by having access to the exchange.”
A Daily Benefit
Dr. Buxton said she uses the exchange almost daily, for about 75% of all patients and 100% of those getting specialty medications. “It helps me get timely information on patients, check labs, histories, find out which practitioners are caring for my patients and provide better care.” She also can review diagnoses and notes from the most recent provider visit to help write a prior authorization or appeal letters for medications. For some medications, she needs to review patient information for the last 10 years. “It’s a faster way of accessing information without bothering a doctor’s office.”
Dr. Buxton has had cases in which a patient had a heart condition that wasn’t listed on the forms she had, or a medication that’s hard on the stomach prescribed for a patient with a history of stomach bleeds and a significant bowel resection. “CORHIO’s exchange allows pharmacists to be a more informed member of the patient care team. We’re not diagnosticians or trying to replace primary care specialists, but when we have access to more complete information, we’re able to better make recommendations.”
Better Access, Better Education
Leticia Shea, PharmD, BCACP, an associate professor of pharmacy practice at Regis University School of Pharmacy and a pharmacist with a primary care clinic called Regis Neighborhood Health, in Denver, also participated in the pilot. Information on some of her patients was not listed unless they received care at a large medical center participating in the CORHIO exchange, “but we did find [access] beneficial for many things: further educating the patient on why they were on one medication over another, helping them understand why they were switched over to another medication or why they were on a different dose, labs, the provider’s note as well as previous treatment failures.”
Some patients were angry because they wanted to remain on a particular drug, according to Dr. Shea, who was able to see notes explaining why they had been moved off a medication. She also identified potential drug interactions. “We could put more pieces together and it also really showed us what needed to be further discussed with a patient following the information given to them at the provider’s office, so that we are confident that they leave with a better understanding as to why they are on their medications and the corresponding doses. It helped us be an active member of the health care team versus being siloed out from important information in their drug regimen decision making.”
Attaining an ideal medication regimen “is a process,” Dr. Shea said, “and sometimes requires many changes until what is most appropriate for a patient is achieved. Pharmacists are often left with only a small piece of this puzzle. Having access to patient health records helps pharmacists provide the medication management and education we are trained to provide.”
Pharmacists are advocating for the exchange to allow them to input information, Dr. Brown said. Currently, they can only review existing data.
The sources reported no relevant financial relationships.