The essential value of HIEs in delivering patient-centered pharmacy care

Emerging multidisciplinary healthcare models, such as accountable care organizations and patient-centered medical homes, promise to elevate quality and lower costs by harnessing the power of provider, payer and patient collaboration. Often overlooked in the coordinated care equation, however, is the integral role pharmacists can play in delivering efficient and effective care.

Stationed in convenient locations, such as a drug or grocery store, pharmacists are among the most readily available healthcare service providers in their communities. Taking advantage of this accessibility, many pharmacies now offer a variety of value-added healthcare services, such as conducting basic medical screenings, providing disease management education and even administering vaccinations. But pharmacists who desire to leverage their medical training even further and become a pillar of the care team require connectivity on par with other healthcare providers, allowing them to share clinical information throughout the continuum.

EMRs and meaningful use drive collaboration
One legislative effort in particular is driving pharmacies’ technical prowess. The Health Information Technology for Economic and Clinical Health (HITECH) Act, a provision of the 2009 American Recovery and Reinvestment Act, includes a “meaningful use” mandate that provides financial incentives for healthcare providers who deploy an electronic health record and can prove they are using the platform in a meaningful fashion, such as recording medications via computerized physician order entry and electronically prescribing permissible medications.

The Centers for Medicare and Medicaid Services, charged with administering the program, split meaningful use into three stages, each with its own time frame and measurable objectives. The industry is currently in Stage 1 and recently received the final requirements for Stage 2. Subsequent stages will include different objectives that providers must achieve in order to receive a second round of funding. With objectives built on accomplishments from the previous stage, providers are expected to begin Stage 2 attestation in 2014. The Stage 3 timeline has yet to be determined.

It’s clear that HITECH is driving greater EHR uptake, even among smaller physician practices. While EHR penetration is still greater among groups with higher patient volumes and more physicians, EHR deployment at offices with one or two practitioners rose 6% to a total of 36.9% during the second half of 2011, according to a report by healthcare information and research firm SK&A. Its "Physician Office Usage of Electronic Health Records Software" report, which was based on an ongoing telephone survey of 240,281 U.S. medical sites, noted that EHR deployment in offices with 6 to 10 doctors rose only from 63% to 65%. Overall, the physician EHR adoption rate is 45.6%.

Meanwhile, the number of hospitals using EHRs has more than doubled in the last two years, according to the Department of Health and Human Services, which reported in February 2012 that more than 2,000 hospitals have implemented an EHR platform and received their first meaningful use incentive payment. Data also revealed that 85% of hospitals intend to take advantage of EHR incentives by 2015.

EHRs are expected to incite a deeper level of collaboration and coordination on patient care plans across the continuum. Pharmacies, therefore, must have the technology to not only accept electronic prescriptions, but also to facilitate information exchange of vital patient information with the broader clinical community—a capability that will help pharmacists reduce costs and medical risks associated with necessary tests, medication errors and preventable readmissions.

HIEs bring constituents together
Health information exchanges are emerging as the foundation for widespread data exchange, connecting physicians, hospitals, ancillary service providers and even payers throughout communities and beyond. They are an integral component of the United States’ developing health information technology infrastructure and the associated National Health Information Network.  Not bound by geography, HIEs come in all flavors, including state grantees, state-designed entities, statewide HIE networks, private HIE services, community-based HIEs, and integrated delivery networks and health systems.

HITECH’s meaningful use initiative has been structured to substantially promote the use of HIEs throughout the healthcare system. In Stage 2, providers will be expected to exchange information electronically with laboratories, other providers, hospitals, patients, public health agencies and, of course, pharmacies. To achieve seamless information flow among these diverse constituents, however, HIEs are employing new standards and advanced methods for harmonizing records and achieving interoperability between and across very diverse systems and technologies. These capabilities are offered in emerging interoperability platforms and powered by enterprise master patient index technologies that can recognize patients at all points of service, including the pharmacy.

A well-designed and populated EMPI has the potential to improve the quality of care by accurately locating and linking demographic information contained within hospital, practice management and other information systems. It will offer providers the ability to govern information and control patient privacy preferences across organizational boundaries with distributed data stewardship capabilities for improved workflow and a user interface to help staff manage tasks. And a shared EMPI has the potential to improve clinician satisfaction by providing more trusted and accurate patient identification at the point of care, accelerate the platform’s time to value and reduce its total cost of ownership.


Lathe Bigler
Senior director of clinical services, pharmacy services division
Lathe Bigler serves as Emdeon’s senior director of clinical services for the pharmacy services division. His focus on developing layers of competitive advantage and increasing market growth are instrumental in Emdeon’s advancement in the exchange of electronic prescriptions and other clinical information. Bigler has more than 15 years of experience in the healthcare and information technology fields, and has held roles in marketing, product management, business development and industry relations with such corporations as NDC Health, Midmark Diagnostics, DrFirst and AltaPoint Data Systems. Bigler has a bachelor’s degree in marketing and business administration.

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