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

BY Lathe Bigler

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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Walgreens introduces WellTransitions, a coordinated care model that works in tandem with hospitals

BY Michael Johnsen

 DEERFIELD, Ill. — Walgreens pharmacists are on the frontlines of a new transition of care program, WellTransitions, which brings hospitals and health systems together with Walgreens in a coordinated care model designed to reduce readmission rates and overall healthcare costs while improving patient health outcomes and medication adherence, Walgreens announced Tuesday. The WellTransitions program is being rolled out as thousands of hospitals nationwide face possible penalties from Medicare for patient readmission rates that are too high, under a new law that took effect Oct. 1.

“When a patient leaves the hospital with a new medication regimen, it can be overwhelming for both the individual and a caregiver,” stated Kermit Crawford, Walgreens president of pharmacy, health and wellness. “Readmissions can be costly for the patient as well as our healthcare system. Through this program, our pharmacists work closely with hospital staff to oversee medication therapies and to help make the discharge process smoother, providing the care patients need during — as well as after — being discharged.”

According to Washington Adventist Hospital in Maryland, of its first 48 high-risk patients enrolled in WellTransitions, only three were readmitted within 30 days of discharge.

Preventable hospital readmissions cost the U.S. healthcare system approximately $25 billion per year, Walgreens stated, citing a Pricewaterhouse Coopers’ Health Research Institute study. And according to a 2009 study published in the New England Journal of Medicine, nearly one in five Medicare patients is re-hospitalized within 30 days of discharge.

WellTransitions is now available to patients at a growing number of locations, including Sarasota Memorial Health Care System, Washington Adventist Hospital in Takoma Park, Md., and Marion General Hospital in Marion, Ind. As many hospitals and medicals centers place a greater emphasis on reducing patient readmissions, Walgreens aims to broadly roll out the program to other facilities throughout the U.S., including many of the more than 150 hospitals and health systems where Walgreens operates an outpatient pharmacy, the company stated. 

The WellTransitions program offers a number of services, including:

  • Medication review – pharmacists review patients’ prescriptions upon admission to the hospital and at discharge, and check for potential interactions and simplification of medication regimen;
  • Bedside medication delivery – Walgreens pharmacy staff member delivers medication the patient will need to take after discharge to the patient’s room, and offers medication education and instruction;
  • Patient counseling – pharmacists provide medication counseling to both the patient and caregiver and work in close communication with the medical staff;
  • Regularly-scheduled follow-up calls – pharmacists conduct regular calls to follow up on patient progress, discuss regimen and answer any questions or concerns; and
  • 24/7 pharmacist support – pharmacy staff is available to answer patient questions 24/7, either over the phone or online. 

Pharmacists also work with patients to ensure they’ve scheduled an appointment with their primary care physician and to reinforce important self-care principles, such as checking their weight daily and reporting any significant fluctuations to their doctor. 

Walgreens and Sarasota Memorial Hospital have collaborated to improve patient care through various programs since 2009. The hospital recently implemented a WellTransitions program, in which more than 180 heart failure patients have participated. The program provides patient services at key points during the critical first days following discharge, and while outcomes data is not yet available, hospital officials have recognized a trend of positive results. 

“From that beginning, our relationship has grown to Walgreens participation in medication education and reconciliation, discharge phone calls, and calls to the patients later in the 30 days post-discharge for follow-up,” stated Spence Hudon, clinical manager of Sarasota Memorial’s inpatient heart failure unit. “Walgreens has proven to be a reliable and helpful partner in our attempt to provide excellent care to our heart failure patients while preventing readmissions.”


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Sep-27-2013 07:41 pm

Preventable hospital readmissions cost the U.S. healthcare system approximately $25 billion per year - WOW! Crazy amount of money being lost every year.

A.Dentists says:
Jun-05-2013 01:07 pm

I think it is amazing that Walgreens would start a program like this. It seems like it is really geared toward actually helping people rather than trying to improve public image or turn a quick buck. If only more businesses would actually try to start helping people again.

will ofara says:
May-13-2013 08:09 pm

AS a pharmacist in Walgreen, it is a good program and works flawlessly!

Senior Drug User says:
Oct-17-2012 04:56 pm

Sounds good. Let's hope the companies and investors all are rewarded at the end. I meant the little companies. :)



NCPA Digest: Business climate tougher for indies, but they still represent better bang for healthcare buck

BY Michael Johnsen

 SAN DIEGO — The number of independents still is down from 2000, and margins of 2.9% represent the lowest in five years. However community pharmacists have proven resilient and helped reduce healthcare costs by dispensing a record high number of lower-cost generic drugs in 2011 and reported more frequent interaction with physicians to promote the appropriate use of generics, according to the 2012 NCPA Digest, sponsored by Cardinal Health.

“The 2012 NCPA Digest, sponsored by Cardinal Health, provides fresh evidence of how trusted community pharmacists are working with patients and their physicians to improve health outcomes while reducing costs,” stated NCPA CEO Douglas Hoey. “Independent community pharmacists shattered their previous record in frequency of dispensing lower-cost generic drugs by raising the bar even higher in 2011. In addition, these small business healthcare providers are counseling patients face-to-face on the proper use of and adherence to their prescription drug regimen — making a dent in the estimated $290 billion in healthcare costs attributed to nonadherence," he said. “Community pharmacists are working more frequently with physicians and continue to play a vital role in improving health outcomes while reducing costs.”

The NCPA Digest findings included: 

  • The number of total independent community pharmacies increased slightly from 23,064 to 23,106 but have still not recovered to 2000 levels, when they totaled 24,861;
  • The pretax net profit margin for the average independent community pharmacy fell to 2.9%, its lowest level in five years. Similarly, the number of independent pharmacies operating at a net financial loss increased slightly and continues to account for roughly 1-in-4 of these pharmacies;
  • As the last Digest also found, 92% of revenue was derived from the sale of prescription drugs;
  • Government-sponsored programs accounted for the largest share (49%) of their prescriptions;
  • Independent community pharmacies set a new high in generic drug utilization, increasing their generic dispensing rate to 76% from 72%;
  • Independent community pharmacists consulted with doctors about prescription drug therapy 7.9 times per day on average, marking a significant increase over prior years;
  • Half of these pharmacies now have a formal program to increase medication adherence, such as refill synchronization programs like Simplify My Meds;
  • To help remain competitive, independent community pharmacies found efficiencies to reduce their dispensing costs slightly, from $12.44 to $12.19 per prescription; and
  • The most common niche services offered by independents include same-day home delivery (82% of pharmacies offer it, most free of charge), compounding (66%), durable medical equipment (65%) and immunizations (60%). 

The Digest, a comprehensive survey of the current state of independent community pharmacies, was released Monday at NCPA’s 114th Annual Convention and Trade Exposition.


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