Our discussion of the transformation of the healthcare system continues with changing how doctors and pharmacists exchange vital medical information. When direct professional dialog does not occur, practitioners are forced to make decisions using poor quality information. This creates unnecessary disruptions with numerous communications back and forth between the pharmacy and doctor’s office. Ultimately, as a last resort, the patient is brought in to intermediate between the pharmacist and doctor when the issue persists unresolved after numerous failed attempts for either healthcare party to connect.
The woefully inadequate communication infrastructure
Let’s begin by understanding how our healthcare system attempts to solve this issue today. In my previous article, I mentioned medication therapy management as a yearly tool to help provide a comprehensive list of recommendations to doctors, but it has several drawbacks:
- It can be overly focused on clarifying information rather than addressing pure clinical issues.
- It is a relatively time-consuming activity per patient for the pharmacy.
- It has to be implemented completely independent of a dispensing workflow.
- It can generate more unnecessary patient appointments for doctors.
How does pharmacy communicate those recommendations or medication questions with the rest of the healthcare team today? That’s right, the antiquated fax machine or the mind-numbing landline phone. In this advanced day and age where you can deposit checks via your smartphone or collaborate with a colleague half-way around the world via video, healthcare still relies heavily on these ancient ways of communication due to the overwhelming fear of an HIPAA data breach or lack of interoperability between machines.
Sure, a majority of medications are sent to pharmacies electronically but ask any community pharmacy how to present a clinical medication issue to a doctor digitally and all you will hear is crickets. And, despite doctors being able to send prescriptions electronically, it is almost impossible to directly inform a pharmacy electronically that a medication has been discontinued. Providers are forced to place those messages as a note within a prescription for another medication and hope that it gets read. This is merely one of many examples of how pharmacy and medicine have to work around the system to communicate and keep our fingers crossed it makes it to the other party with our intended meaning intact.
We need a new system
Clearly, we need a system that addresses direct communication among all members of the patient care team, but we also need one that shares high-quality data. Current data aggregation and analytics platforms utilized by pharmacies to address medication adherence issues or complete MTM services have major limitations. Data is often months-old, and executing the tasks within these platforms often necessitates stopping the usual pharmacy workflow or increasing staffing levels. This leads to poor quality data being shared with doctors about medication non-adherence or changes in a patient’s medication regimen by other specialty providers.
This reactionary system does not provide practical solutions for patients who need help, instead, it continues the legacy siloed care model that we see in many healthcare interfaces. Hopefully, there is an agreement that we need a system that gives pharmacy better quality data, shares visibility to vital medication information from the EMR, and allows for direct two-way communication. This should lead to fewer mixed messages, less calls, and pharmacy only needing to provide clinically relevant information to doctors.
Let’s talk about an idea that can address these issues with near real-time data while seamlessly integrating with existing pharmacy workflows. I envision a health plan, self-insured employer, or pharmacy benefit manager utilizing the valuable data repositories currently available to push alerts to a “pharmacy hub,” defined as the pharmacy where a majority of a patient’s prescriptions have been filled. These alerts would direct the pharmacy staff to contact the patient for a targeted pharmacy service and then allow for quick documentation that could be transmitted to the doctor if needed.
A few simple initial alerts could include non-adherence, medication reconciliation secondary to a hospital discharge, and a pre-appointment medication assessment. Here is what they would look like:
- Just-in-time adherence alerts would utilize a daily claims analysis process and notify the dispensing pharmacy of a member who has not picked up a chronic medication that is due for refill. Once notified, the pharmacy would contact the patient and counsel them accordingly. Next, the pharmacy would document the reason for non-adherence as well as address any modifiable issue with the patient or fill the medication. The pharmacist could select an option to immediately inform the physician of any clinically relevant reasons for non-adherence via the EMR and direct the patient to follow up with the physician if needed.
- Medication reconciliation alerts would notify the pharmacy that a patient has recently been discharged from a hospital stay. The pharmacy, after patient consultation, would reconcile any changes in the medication regimen, and then notify all the patient’s doctors of the most current medication list. The platform would allow the pharmacist to share this information via the EMR to reduce the number of calls to the doctor’s office.
- Pre-appointment alerts would involve assessing medications for high-risk chronic conditions immediately prior to a scheduled doctor’s appointment. This alert would present the pharmacy with medical and medication data from the EMR for review against the medication list at the pharmacy. The pharmacist, after patient consultation, would then forward a few recommendations and any medication refills needed to the doctor one to two days before a scheduled visit. This should optimize the patient visit to the doctor by having a confluence of factors aligned and eliminate the need for annual comprehensive recommendations from an MTM session.
How would this change things?
The key differences between this new platform and existing services are the proactive daily claims analysis, integration into existing pharmacy workflow, shared medical data from EMR to the pharmacy to ensure medication monitoring and regimen accuracy, as well as direct communication between healthcare professionals. This, in turn, could help minimize refill denial responses from doctors, multiple calls to and from the doctor’s office to clarify prescriptions, comprehensive laborious clinical recommendations from pharmacists to physicians, and incomplete active medication lists in the EMR.
Visibility to pertinent patient medication information and useable real-time non-adherence data would empower the pharmacist on the patient care team to accurately monitor medications for safety and efficacy and to provide his or her expertise via meaningful clinical recommendations to doctors. This ensures that every ancillary member of the patient care team is allowed to work at the top of his/her license and, ultimately, enables the doctor to make the best decision in guiding therapy to support the patient toward optimal outcomes.
Improving fundamentals are core to my strategy
Working on the fundamentals is at the core of my strategy to help our unintended dysfunctional system of misaligned care. That means focusing on these key issues:
- Sharing medical and pharmacy information
- Collaboration instead of siloed care
- Utilizing healthcare data from payers ready to support us
- Significantly changing reimbursement for pharmacy and medicine
- Putting optimal patient care first
Implementing a simplified economically sustainable reimbursement strategy and a new data sharing platform between medicine and pharmacy are the two important solutions we should develop to help solve the foundational weaknesses in our healthcare system. Let’s liberate our frontline pharmacists and physicians from the need to focus on drug pricing and appointments simply to sustain their practices and allow them to truly focus on comprehensive and collaborative patient care. The tools and components to make this happen exist today. It’s only a matter of investing time, energy, and focus on this problem to solve it.
Who is ready to join me in this revolution of the medical care system to reintroduce the community pharmacist as an active and informed participant of the patient team for the benefit of doctors and patients?
Vinay Patel, PharmD
Vinay Patel is the Pharmacist Director of Clinical Operations at a regional home delivery pharmacy, serving over 10,000 low-income patients in 5 states. He has 10 years of combined management and clinical experience, which includes leading cross functional healthcare teams to implement innovative clinical programs across medicine and pharmacy. His impact in medicine includes managing chronic care for over 2,000+ patients face-to-face within many primary care clinics by integrating within a healthcare team with nurses, physicians, social workers, dietitians, and mid-level providers. His management experience includes engineering an effective clinical operations strategy to help a managed Medicaid client successfully meet Asthma and Diabetes HEDIS program measures. He is passionate about bringing simple solutions that can help our dysfunctional healthcare system and emphasizing how healthcare professionals can work as a team for optimal patient care. He lives in Morrisville, NC with his wife and 2 children and is always looking to partner with other healthcare innovators to create the future of medicine.