- Email: [email protected]
Role of health information technology in optimizing pharmacists' patient care services
Association report
Role of health information technology in optimizing pharmacists’ patient care services APhA–APPM Rachelle F. Spiro APhA–APRS Jean Paul Gagnon APhA–ASP Alison R. Knutson
APhA–APPM Health information technology (HIT) and the use of computer information systems in pharmacies is nothing new to the profession. As the health care industry begins to aggressively adopt the use of electronic health records (EHRs), pharmacists in comSpiro munity pharmacies are often viewed as advanced users of technology. In the medication dispensing process, the pharmacy profession has led the way with the development of standards allowing real-time transmission of standardized prescription claim information. Also, in recent years, the transmission of electronic prescriptions (e-prescribing) and related transactions has become increasingly more common. In April 2009, the largest national e-prescribing network announced that more than 100,000 prescribers prescribed more than 134 million electronic prescriptions.1 Transmission and receipt of electronic billing information and electronic prescription information, however, is very different from exchanging clinical health information between health care providers. In February 2009, Congress passed the American Recovery and Reinvestment Act of 2009 (ARRA), which provides funding and calls for the implementation and meaningful use of a nationwide EHR system by 2014.2 For pharmacists to provide medication therapy management (MTM) to optimize outcomes from medications, they must have access to the information contained in patients’ EHRs that are maintained by other health care provid-
4 • JAPhA • 5 0 : 1 • J a n / F e b 2 010
4
ers, including pharmacists in other care settings, and the information contained in patients’ personal health records (PHRs). In addition, pharmacists need to be able to document the care provided using a standardized format, in order to permit the exchange of clinical documentation by pharmacists and ensure connectivity with the clinical health information exchange (HIE). Pharmacist responsibility in HIE The pharmacist’s role as a provider of MTM sets the stage and provides a per-
fect opportunity to exchange clinical health information electronically. Some pharmacy information systems are designed to capture clinical information (e.g., patient profile, allergies, diagnosis, laboratory results). According to Millonig,3 “Researchers found that documentation systems vary considerably. Documentation systems capture varying levels of detail in terms of patient clinical data, drug therapy problems, pharmacist documentation assessment and care plans, and prescriber concurrence with MTM recommendations. ... Exchanging standardized components of the EHR using industry-developed standards is the nationally adopted way for health providers to communicate health data including MTM information.” To facilitate the electronic communication of pharmacist-provided care, pharmacists must document their services in a uniform, consistent, standardized format using profession-defined standards. The pharmacy profession needs to be actively engaged in national HIT initia-
The Association Report column in JAPhA reports on activities of APhA’s three academies and topics of interest to members of those groups. The APhA Academy of Pharmacy Practice and Management (APhA–APPM) is dedicated to assisting members in enhancing the profession of pharmacy, improving medication use, and advancing patient care. Through the six APhA–APPM sections (Administrative Practice, Community and Ambulatory Practice, Clinical/Pharmacotherapeutic Practice, Hospital and Institutional Practice, Nuclear Pharmacy Practice, and Specialized Pharmacy Practice), Academy members practice in every pharmacy setting. The mission of the APhA Academy of Pharmaceutical Research and Science (APhA–APRS) is to stimulate the discovery, dissemination, and application of research to improve patient health. Academy members are a source of authoritative information on key scientific issues and work to advance the pharmaceutical sciences and improve the quality of pharmacy practice. Through the three APhA–APRS sections (Clinical Sciences, Basic Pharmaceutical Sciences, and Economic, Social, and Administrative Sciences), the Academy provides a mechanism for experts in all areas of the pharmaceutical sciences to influence APhA’s policymaking process. The mission of the APhA Academy of Student Pharmacists (APhA–ASP) is to be the collective voice of student pharmacists, to provide opportunities for professional growth, and to envision and actively promote the future of pharmacy. Since 1969, APhA–ASP and its predecessor organizations have played a key role in helping students navigate pharmacy school, explore careers in pharmacy, and connect with others in the profession. The Association Report column is written by Academy and section officers and coordinated by JAPhA Contributing Editor Joe Sheffer of the APhA staff. Suggestions for future content may be sent to [email protected].
w w w.j a p h a . o r g
Journal of the American Pharmacists Association
1/12/10 11:14 AM
Association report
tives if pharmacists are going to have the capability to exchange clinical information with pharmacists in different care settings and other health care providers. For successful HIE, pharmacy information systems must be able to communicate with pharmacy information systems in other care settings, physician and other health care provider EHR systems, hospital and health system EHRs, and patient PHRs. Instead of simply having the ability to receive electronic prescriptions or serve as a database of medication history for EHRs, pharmacists must have access to EHR and PHR information to effectively provide patient care and optimize patient outcomes. Importance of EHR access by pharmacists Accessing other clinicians’ EHRs and the exchange of electronic clinical health information are critical components to the success and preservation of the profession. The government is providing incentives for health care providers to adopt the meaningful use of EHR and the electronic HIE; however, pharmacists have not been recognized by the government as providers who are eligible to receive those incentives because pharmacy information systems (outside of e-prescribing) have not been recognized by the Office of the National Coordinator for HIT as EHRs. Often, pharmacy is not included in HIE discussions for e-prescribing. Pharmacists must work with pharmacy information system developers and vendors to ensure that industry standards are developed and adopted that reflect the care provided by pharmacists and that pharmacists obtain the ability to access and communicate clinical information with other providers’ EHRs. These actions will help ensure that documentation of pharmacists’ patient encounters are communicated with other clinicians to improve and measure the quality of care received by our patients. Only then will pharmacists have a chance to be recognized as meaningful users of EHR outside of e-prescribing. Conclusion In the eyes of the government and other health care providers, pharmacists dispense prescriptions. As a profession, 6 • JAPhA • 5 0 : 1 • J a n / F e b 2 010
6
we know that pharmacists are health care providers, addressing medicationrelated problems encountered by patients, improving patient care, and optimizing medication use. In the world of HIT, pharmacists are viewed as technologically advanced because of advances achieved in the real-time billing of prescription information and for recent advances in e-prescribing. The pharmacy profession, however, is so much more, and now more than ever pharmacists are responsible for becoming technology leaders in the exchange of medicationrelated clinical information. As part of the “electronically connected” health care team, pharmacists must be able to use technology to document medicationrelated interventions provided through MTM. For this to occur, professionally accepted, industry-developed standards need to exist. The pharmacy profession must be the one to set the standards of practice for the electronic exchange of medication-related information, so that patients’ health care records are complete and reflect the care provided by all health care providers, including pharmacists. Rachelle F. Spiro, BPharm, FASCP President Spiro Consulting, Inc. Member Hospital and Institutional Practice Section APhA–APPM [email protected]
References 1. Surescripts. U.S. achieves major milestones in e-prescribing. Accessed at www.surescripts.com/container_pdf. aspx?name=downloads/press-releases/ NPR_Announcement_Final.pdf, December 1, 2009. 2. American Pharmacists Association. APhA legislative summary: the American Reinvestment and Recovery Act of 2009 (ARRA). Accessed at www.pharmacist.com/AM/Template. cfm?Section=Home2&TEMPLATE=/CM/ ContentDisplay.cfm&CONTENTID=18754. 3. Millonig MK. Mapping the route to medication therapy management documentation and billing standardization and interoperabilility within the health care system: meeting proceedings. J Am Pharm Assoc. 2009;49:e41–51.
w w w.j a p h a . o r g
APhA–APRS Using HIT databases for comparative clinical effectiveness research Until February 17, 2009, everyone in health care assumed, because of inadequate federal funding, that the use of EHRs by health care professionals and researchers to improve patient health wouldn’t be possible for many years. On that date, with only Gagnon 2 months of congressional activity, the unexpected happened: President Obama signed ARRA. ARRA provides for approximately $30 billion for HIT investments. Most of the money will be available to hospitals and physicians who adopt qualified, certified EHRs and electronic medical records (EMRs) with the ability to exchange information with other sources and provide technology databases to produce meaningfully useful clinical management services. Providers with qualifying EHRs and EMRs can receive incentive payments through Medicare or Medicaid as early as 2011. The act also formed the Office of the National Coordinator of Health Information Technology (ONCHIT) under the Department of Health and Human Services (HHS), provided it with $2 billion, and established a permanent ONCHIT, headed by David Blumenthal as the National Coordinator. Most importantly, ARRA required ONCHIT to update a strategic plan to include among a list of objectives improving the quality of health care, reducing medical errors, reducing health disparities, improving public health, increasing prevention and coordination with community resources, and improving the continuity of care among health care settings.1 Despite survey results indicating that both hospitals and physicians were not using EHRs (e.g., results of a survey published in the New England Journal of Medicine revealed that EHR systems were present in very few U.S. hospitals), a general consensus exists that
Journal of the American Pharmacists Association
1/12/10 11:14 AM
Association report
the ARRA funds will accelerate the use of EHRs in health care systems.2 Implications of ARRA If use of EHRs increases, what will be the implications of ARRA funding and policy changes for researchers in the pharmaceutical sciences? According to Lynn Etheredge, “the existence of interoperable EHR/EMR/ eRx/PHR would produce rapid-learning systems that could be used to conduct comparative effectiveness research (CER) on pharmaceutical products, diagnostics, devices, procedures and services. Comparative clinical effectiveness research (CCER) coupled with a quality measurement system and payment reforms to reward high quality care might improve patient health in the U.S.”3 He feels that during the past several years, interest in rapid-learning health systems and CER, as well as in quality measurement and pay-forperformance systems, has increased. These separate developments are slowly coming together. Etheredge believes that new technologies should be a top research priority for a new system of clinical electronic databases. In the pharmaceutical therapy area, for example, an estimated 400 new anticancer drugs are in the pipeline, most of which are designed for cancers or patients with certain genetic characteristics, costing tens of thousands of dollars per patient.3 Databases are coming together. Recently, a project was announced that will use standards and network of the Nationwide Health Information Network (NHIN), which was created by HHS, to allow organizations like the Veterans Administration and the Department of Defense to partner with private sector health care providers to promote better, faster, and safer care for veterans.4 In response, the Department of Veterans Affairs (VA) and Kaiser Permanente are launching a pilot program to exchange EHR information using NHIN. The pilot program, which was slated to begin in mid-December 2009, will connect Kaiser Permanente HealthConnect and the VA’s EHR system, VistA—two of the largest EHR sys-
tems in the country. At the time this report was written, new CCER legislative authority and financing for CER, Medicare quality measurement, and payment reform was present in the health care reform bills being debated in Congress. The House’s Affordable Health Care for America Act and the Senate’s Patient Protection and Affordable Care Act would establish a new institute for CER and provide funding from Medicare Trust Funds. Pharmaceutical researchers should begin preparations for using aggregated EHR databases when they are available to conduct CER to better manage patient care. Both CER and HIT are receiving considerable funding under ARRA (CER received $1.1 billion), and CER will receive additional funds if the current health care reform legislation in Congress passes. Little doubt exists that the quality of CER will improve with the increase in funding and attention on developing rapid-learning methodologies to research aggregated HIT electronic databases. In time, effective rapid-learning CCER will become a major disruptor for contrasting and comparing technology, procedures, or health care services. The results from these analyses will be used by virtually connected teams of physicians, nurses, pharmacists, and other health care professionals to produce quality patient outcomes. Finally, pharmacy school or college graduate programs should consider the possibility of developing curricula for MS and PhD degrees in CER that focus on the use of evidence from randomized control trials, pragmatic clinical trials, systematic reviews, and rapid-learning techniques with large electronic databases to conduct CER for the purpose of delivering faster and better patient health care. Activity in developing CER educational programs will grow. Recognizing the need for a model CER curriculum, the PhRMA Foundation recently funded a group of CER researchers and faculty to meet and develop a model CER graduate curriculum for use by academic institutions to construct CER graduate programs.
Journal of the American Pharmacists Association
7
w w w.j a p h a . o r g
Jean Paul Gagnon, PhD Senior Director U.S. Policy and Strategic Advocacy Sanofi-aventis Member Economic, Social and Administrative Sciences Section APhA–APRS [email protected]
References 1. Echols H, Ward M, Sealander K, et al. HITECH Act: analysis of policy implications, requirements of health IT stimulus. Washington, DC: Bureau of National Affairs; 2009 2. Barclay L. Electronic health records present in very few US hospitals. Accessed at www.medscape.com/viewarticle/590189, December 1, 2009. 3. Etheredge LM. Medicare’s future: cancer care. Health Aff (Millwood). 2009;28:923–4. 4. Monegain B. VA, Kaiser plan to link electronic medical records. Accessed at www.healthcareitnews.com/news/ va-kaiser-plan-link-electronic-medicalrecords, December 1, 2009.
APhA–ASP Interactive television: student pharmacists embracing technology In 1892, the University of Minnesota College of Pharmacy began as a 2-year professional studies program. The program has changed dramatically over the Knutson years, but the most recent changes would not be possible without the use of information technology. The PharmD program expanded to the University of Minnesota Duluth campus in September 2003. This expansion added 50 student pharmacists to the college, creating a total 160 PharmD graduates per year. The dual-campus structure provides opportunities to serve Minnesotans in the urban, suburban, and rural areas of the state. This structure, however, is completely dependent on technology. A majority of the classes at the col-
J a n / F e b 2 010 • 5 0 : 1 •
JAPhA • 7
1/12/10 11:14 AM
Association report
lege are held through interactive television (ITV). This technology allows a faculty member from either the Duluth or Twin Cities campus to lecture to student pharmacists on both campuses simultaneously. Although more than 150 miles away, the lecturer can watch the opposite campus on a TV screen to see when students raise their hand and can hear when questions are asked. ITV allows student pharmacists to learn from expert faculty members regardless of campus, work together on projects from a distance, and embrace the importance of communication. In addition to the classroom, this technology is used with student organizations. The Minnesota Pharmacy Student Alliance (MPSA) is a professional umbrella organization at the University of Minnesota College of Pharmacy. This is the University of Minnesota chapter of APhA–ASP, as well as National Community Pharmacy Association, American Society of Health-System Pharmacists, and the state associations (Minnesota Pharmacists Association and Minnesota Society of Health System Pharmacists). During the previous 6 years, MPSA has taken advantage of the available ITV. Student pharmacists have embraced ITV, allowing them to work with a greater number of student pharmacists and impact a greater number of communities throughout Minnesota. With two campuses but one chapter, the direction of MPSA must be determined jointly. One thing learned throughout the years is that e-mail has its limitations. The leadership of MPSA
8 • JAPhA • 5 0 : 1 • J a n / F e b 2 010
8
uses ITV to spend valuable face-to-face time throughout the year on chapter planning. During the previous 3 years, the number of ITV executive board meetings has increased from two per semester, to monthly, and now to biweekly. This allows the executive board to have consistent discussions about the mission and vision of MPSA and ensure progress throughout the year. The membership of MPSA benefits from ITV on a weekly basis. MPSA holds chapter meetings each Thursday to provide student pharmacists opportunities for professional development. One focus of these meetings is to introduce various career paths within the profession. Pharmacists in nuclear pharmacy, managed care, and community MTM practice (to name a few) present to MPSA about their career, but regardless if they are from the Twin Cities or Duluth, all student pharmacists can participate. Students are able to hear about practices and interact with the pharmacists through question-and-answer sessions. Through the APhA–ASP policy process, student pharmacists from both campuses are allowed to debate issues currently important to the profession and the future of practice. ITV allows MPSA members a chance to communicate in a format that is not commonly used by student pharmacists. The culmination of the use of technology in the past year was the development of the first dual-campus health fair at the University of Minnesota. A committee of executive board members held ITV meetings to discuss the logistics of
w w w.j a p h a . o r g
a location for the health fair, services offered, volunteers needed, and advertising. The location selected was almost exactly halfway between Duluth and the Twin Cities. Student pharmacists traveled 75 miles from their respective campus to this milestone opportunity to provide screening and education for diabetes, cardiovascular disease, osteoporosis, and heartburn. Through the extensive use of technology in planning, student pharmacists were able to help a community that had not experienced patient care from a pharmacist and were able to work with peers who they might not have met otherwise. ITV allows student pharmacists, faculty, and staff from a distance to work together as if they were simply in the room next door. It allows for pharmacy education to affect a greater number of communities in the state of Minnesota. This technology also is an invaluable teaching tool both in the classroom through didactic training and outside the classroom through its use by student organizations. The current structure of the University of Minnesota College of Pharmacy would not be possible without these advances in technology. Alison R. Knutson Student Pharmacist College of Pharmacy University of Minnesota 2009–2010 APhA–ASP Speaker of the House [email protected] doi: 10.1331/JAPhA.2010.10500
Journal of the American Pharmacists Association
1/12/10 11:14 AM
Role of health information technology in optimizing pharmacists’ patient care services APhA–APPM Rachelle F. Spiro APhA–APRS Jean Paul Gagnon APhA–ASP Alison R. Knutson
APhA–APPM Health information technology (HIT) and the use of computer information systems in pharmacies is nothing new to the profession. As the health care industry begins to aggressively adopt the use of electronic health records (EHRs), pharmacists in comSpiro munity pharmacies are often viewed as advanced users of technology. In the medication dispensing process, the pharmacy profession has led the way with the development of standards allowing real-time transmission of standardized prescription claim information. Also, in recent years, the transmission of electronic prescriptions (e-prescribing) and related transactions has become increasingly more common. In April 2009, the largest national e-prescribing network announced that more than 100,000 prescribers prescribed more than 134 million electronic prescriptions.1 Transmission and receipt of electronic billing information and electronic prescription information, however, is very different from exchanging clinical health information between health care providers. In February 2009, Congress passed the American Recovery and Reinvestment Act of 2009 (ARRA), which provides funding and calls for the implementation and meaningful use of a nationwide EHR system by 2014.2 For pharmacists to provide medication therapy management (MTM) to optimize outcomes from medications, they must have access to the information contained in patients’ EHRs that are maintained by other health care provid-
4 • JAPhA • 5 0 : 1 • J a n / F e b 2 010
4
ers, including pharmacists in other care settings, and the information contained in patients’ personal health records (PHRs). In addition, pharmacists need to be able to document the care provided using a standardized format, in order to permit the exchange of clinical documentation by pharmacists and ensure connectivity with the clinical health information exchange (HIE). Pharmacist responsibility in HIE The pharmacist’s role as a provider of MTM sets the stage and provides a per-
fect opportunity to exchange clinical health information electronically. Some pharmacy information systems are designed to capture clinical information (e.g., patient profile, allergies, diagnosis, laboratory results). According to Millonig,3 “Researchers found that documentation systems vary considerably. Documentation systems capture varying levels of detail in terms of patient clinical data, drug therapy problems, pharmacist documentation assessment and care plans, and prescriber concurrence with MTM recommendations. ... Exchanging standardized components of the EHR using industry-developed standards is the nationally adopted way for health providers to communicate health data including MTM information.” To facilitate the electronic communication of pharmacist-provided care, pharmacists must document their services in a uniform, consistent, standardized format using profession-defined standards. The pharmacy profession needs to be actively engaged in national HIT initia-
The Association Report column in JAPhA reports on activities of APhA’s three academies and topics of interest to members of those groups. The APhA Academy of Pharmacy Practice and Management (APhA–APPM) is dedicated to assisting members in enhancing the profession of pharmacy, improving medication use, and advancing patient care. Through the six APhA–APPM sections (Administrative Practice, Community and Ambulatory Practice, Clinical/Pharmacotherapeutic Practice, Hospital and Institutional Practice, Nuclear Pharmacy Practice, and Specialized Pharmacy Practice), Academy members practice in every pharmacy setting. The mission of the APhA Academy of Pharmaceutical Research and Science (APhA–APRS) is to stimulate the discovery, dissemination, and application of research to improve patient health. Academy members are a source of authoritative information on key scientific issues and work to advance the pharmaceutical sciences and improve the quality of pharmacy practice. Through the three APhA–APRS sections (Clinical Sciences, Basic Pharmaceutical Sciences, and Economic, Social, and Administrative Sciences), the Academy provides a mechanism for experts in all areas of the pharmaceutical sciences to influence APhA’s policymaking process. The mission of the APhA Academy of Student Pharmacists (APhA–ASP) is to be the collective voice of student pharmacists, to provide opportunities for professional growth, and to envision and actively promote the future of pharmacy. Since 1969, APhA–ASP and its predecessor organizations have played a key role in helping students navigate pharmacy school, explore careers in pharmacy, and connect with others in the profession. The Association Report column is written by Academy and section officers and coordinated by JAPhA Contributing Editor Joe Sheffer of the APhA staff. Suggestions for future content may be sent to [email protected].
w w w.j a p h a . o r g
Journal of the American Pharmacists Association
1/12/10 11:14 AM
Association report
tives if pharmacists are going to have the capability to exchange clinical information with pharmacists in different care settings and other health care providers. For successful HIE, pharmacy information systems must be able to communicate with pharmacy information systems in other care settings, physician and other health care provider EHR systems, hospital and health system EHRs, and patient PHRs. Instead of simply having the ability to receive electronic prescriptions or serve as a database of medication history for EHRs, pharmacists must have access to EHR and PHR information to effectively provide patient care and optimize patient outcomes. Importance of EHR access by pharmacists Accessing other clinicians’ EHRs and the exchange of electronic clinical health information are critical components to the success and preservation of the profession. The government is providing incentives for health care providers to adopt the meaningful use of EHR and the electronic HIE; however, pharmacists have not been recognized by the government as providers who are eligible to receive those incentives because pharmacy information systems (outside of e-prescribing) have not been recognized by the Office of the National Coordinator for HIT as EHRs. Often, pharmacy is not included in HIE discussions for e-prescribing. Pharmacists must work with pharmacy information system developers and vendors to ensure that industry standards are developed and adopted that reflect the care provided by pharmacists and that pharmacists obtain the ability to access and communicate clinical information with other providers’ EHRs. These actions will help ensure that documentation of pharmacists’ patient encounters are communicated with other clinicians to improve and measure the quality of care received by our patients. Only then will pharmacists have a chance to be recognized as meaningful users of EHR outside of e-prescribing. Conclusion In the eyes of the government and other health care providers, pharmacists dispense prescriptions. As a profession, 6 • JAPhA • 5 0 : 1 • J a n / F e b 2 010
6
we know that pharmacists are health care providers, addressing medicationrelated problems encountered by patients, improving patient care, and optimizing medication use. In the world of HIT, pharmacists are viewed as technologically advanced because of advances achieved in the real-time billing of prescription information and for recent advances in e-prescribing. The pharmacy profession, however, is so much more, and now more than ever pharmacists are responsible for becoming technology leaders in the exchange of medicationrelated clinical information. As part of the “electronically connected” health care team, pharmacists must be able to use technology to document medicationrelated interventions provided through MTM. For this to occur, professionally accepted, industry-developed standards need to exist. The pharmacy profession must be the one to set the standards of practice for the electronic exchange of medication-related information, so that patients’ health care records are complete and reflect the care provided by all health care providers, including pharmacists. Rachelle F. Spiro, BPharm, FASCP President Spiro Consulting, Inc. Member Hospital and Institutional Practice Section APhA–APPM [email protected]
References 1. Surescripts. U.S. achieves major milestones in e-prescribing. Accessed at www.surescripts.com/container_pdf. aspx?name=downloads/press-releases/ NPR_Announcement_Final.pdf, December 1, 2009. 2. American Pharmacists Association. APhA legislative summary: the American Reinvestment and Recovery Act of 2009 (ARRA). Accessed at www.pharmacist.com/AM/Template. cfm?Section=Home2&TEMPLATE=/CM/ ContentDisplay.cfm&CONTENTID=18754. 3. Millonig MK. Mapping the route to medication therapy management documentation and billing standardization and interoperabilility within the health care system: meeting proceedings. J Am Pharm Assoc. 2009;49:e41–51.
w w w.j a p h a . o r g
APhA–APRS Using HIT databases for comparative clinical effectiveness research Until February 17, 2009, everyone in health care assumed, because of inadequate federal funding, that the use of EHRs by health care professionals and researchers to improve patient health wouldn’t be possible for many years. On that date, with only Gagnon 2 months of congressional activity, the unexpected happened: President Obama signed ARRA. ARRA provides for approximately $30 billion for HIT investments. Most of the money will be available to hospitals and physicians who adopt qualified, certified EHRs and electronic medical records (EMRs) with the ability to exchange information with other sources and provide technology databases to produce meaningfully useful clinical management services. Providers with qualifying EHRs and EMRs can receive incentive payments through Medicare or Medicaid as early as 2011. The act also formed the Office of the National Coordinator of Health Information Technology (ONCHIT) under the Department of Health and Human Services (HHS), provided it with $2 billion, and established a permanent ONCHIT, headed by David Blumenthal as the National Coordinator. Most importantly, ARRA required ONCHIT to update a strategic plan to include among a list of objectives improving the quality of health care, reducing medical errors, reducing health disparities, improving public health, increasing prevention and coordination with community resources, and improving the continuity of care among health care settings.1 Despite survey results indicating that both hospitals and physicians were not using EHRs (e.g., results of a survey published in the New England Journal of Medicine revealed that EHR systems were present in very few U.S. hospitals), a general consensus exists that
Journal of the American Pharmacists Association
1/12/10 11:14 AM
Association report
the ARRA funds will accelerate the use of EHRs in health care systems.2 Implications of ARRA If use of EHRs increases, what will be the implications of ARRA funding and policy changes for researchers in the pharmaceutical sciences? According to Lynn Etheredge, “the existence of interoperable EHR/EMR/ eRx/PHR would produce rapid-learning systems that could be used to conduct comparative effectiveness research (CER) on pharmaceutical products, diagnostics, devices, procedures and services. Comparative clinical effectiveness research (CCER) coupled with a quality measurement system and payment reforms to reward high quality care might improve patient health in the U.S.”3 He feels that during the past several years, interest in rapid-learning health systems and CER, as well as in quality measurement and pay-forperformance systems, has increased. These separate developments are slowly coming together. Etheredge believes that new technologies should be a top research priority for a new system of clinical electronic databases. In the pharmaceutical therapy area, for example, an estimated 400 new anticancer drugs are in the pipeline, most of which are designed for cancers or patients with certain genetic characteristics, costing tens of thousands of dollars per patient.3 Databases are coming together. Recently, a project was announced that will use standards and network of the Nationwide Health Information Network (NHIN), which was created by HHS, to allow organizations like the Veterans Administration and the Department of Defense to partner with private sector health care providers to promote better, faster, and safer care for veterans.4 In response, the Department of Veterans Affairs (VA) and Kaiser Permanente are launching a pilot program to exchange EHR information using NHIN. The pilot program, which was slated to begin in mid-December 2009, will connect Kaiser Permanente HealthConnect and the VA’s EHR system, VistA—two of the largest EHR sys-
tems in the country. At the time this report was written, new CCER legislative authority and financing for CER, Medicare quality measurement, and payment reform was present in the health care reform bills being debated in Congress. The House’s Affordable Health Care for America Act and the Senate’s Patient Protection and Affordable Care Act would establish a new institute for CER and provide funding from Medicare Trust Funds. Pharmaceutical researchers should begin preparations for using aggregated EHR databases when they are available to conduct CER to better manage patient care. Both CER and HIT are receiving considerable funding under ARRA (CER received $1.1 billion), and CER will receive additional funds if the current health care reform legislation in Congress passes. Little doubt exists that the quality of CER will improve with the increase in funding and attention on developing rapid-learning methodologies to research aggregated HIT electronic databases. In time, effective rapid-learning CCER will become a major disruptor for contrasting and comparing technology, procedures, or health care services. The results from these analyses will be used by virtually connected teams of physicians, nurses, pharmacists, and other health care professionals to produce quality patient outcomes. Finally, pharmacy school or college graduate programs should consider the possibility of developing curricula for MS and PhD degrees in CER that focus on the use of evidence from randomized control trials, pragmatic clinical trials, systematic reviews, and rapid-learning techniques with large electronic databases to conduct CER for the purpose of delivering faster and better patient health care. Activity in developing CER educational programs will grow. Recognizing the need for a model CER curriculum, the PhRMA Foundation recently funded a group of CER researchers and faculty to meet and develop a model CER graduate curriculum for use by academic institutions to construct CER graduate programs.
Journal of the American Pharmacists Association
7
w w w.j a p h a . o r g
Jean Paul Gagnon, PhD Senior Director U.S. Policy and Strategic Advocacy Sanofi-aventis Member Economic, Social and Administrative Sciences Section APhA–APRS [email protected]
References 1. Echols H, Ward M, Sealander K, et al. HITECH Act: analysis of policy implications, requirements of health IT stimulus. Washington, DC: Bureau of National Affairs; 2009 2. Barclay L. Electronic health records present in very few US hospitals. Accessed at www.medscape.com/viewarticle/590189, December 1, 2009. 3. Etheredge LM. Medicare’s future: cancer care. Health Aff (Millwood). 2009;28:923–4. 4. Monegain B. VA, Kaiser plan to link electronic medical records. Accessed at www.healthcareitnews.com/news/ va-kaiser-plan-link-electronic-medicalrecords, December 1, 2009.
APhA–ASP Interactive television: student pharmacists embracing technology In 1892, the University of Minnesota College of Pharmacy began as a 2-year professional studies program. The program has changed dramatically over the Knutson years, but the most recent changes would not be possible without the use of information technology. The PharmD program expanded to the University of Minnesota Duluth campus in September 2003. This expansion added 50 student pharmacists to the college, creating a total 160 PharmD graduates per year. The dual-campus structure provides opportunities to serve Minnesotans in the urban, suburban, and rural areas of the state. This structure, however, is completely dependent on technology. A majority of the classes at the col-
J a n / F e b 2 010 • 5 0 : 1 •
JAPhA • 7
1/12/10 11:14 AM
Association report
lege are held through interactive television (ITV). This technology allows a faculty member from either the Duluth or Twin Cities campus to lecture to student pharmacists on both campuses simultaneously. Although more than 150 miles away, the lecturer can watch the opposite campus on a TV screen to see when students raise their hand and can hear when questions are asked. ITV allows student pharmacists to learn from expert faculty members regardless of campus, work together on projects from a distance, and embrace the importance of communication. In addition to the classroom, this technology is used with student organizations. The Minnesota Pharmacy Student Alliance (MPSA) is a professional umbrella organization at the University of Minnesota College of Pharmacy. This is the University of Minnesota chapter of APhA–ASP, as well as National Community Pharmacy Association, American Society of Health-System Pharmacists, and the state associations (Minnesota Pharmacists Association and Minnesota Society of Health System Pharmacists). During the previous 6 years, MPSA has taken advantage of the available ITV. Student pharmacists have embraced ITV, allowing them to work with a greater number of student pharmacists and impact a greater number of communities throughout Minnesota. With two campuses but one chapter, the direction of MPSA must be determined jointly. One thing learned throughout the years is that e-mail has its limitations. The leadership of MPSA
8 • JAPhA • 5 0 : 1 • J a n / F e b 2 010
8
uses ITV to spend valuable face-to-face time throughout the year on chapter planning. During the previous 3 years, the number of ITV executive board meetings has increased from two per semester, to monthly, and now to biweekly. This allows the executive board to have consistent discussions about the mission and vision of MPSA and ensure progress throughout the year. The membership of MPSA benefits from ITV on a weekly basis. MPSA holds chapter meetings each Thursday to provide student pharmacists opportunities for professional development. One focus of these meetings is to introduce various career paths within the profession. Pharmacists in nuclear pharmacy, managed care, and community MTM practice (to name a few) present to MPSA about their career, but regardless if they are from the Twin Cities or Duluth, all student pharmacists can participate. Students are able to hear about practices and interact with the pharmacists through question-and-answer sessions. Through the APhA–ASP policy process, student pharmacists from both campuses are allowed to debate issues currently important to the profession and the future of practice. ITV allows MPSA members a chance to communicate in a format that is not commonly used by student pharmacists. The culmination of the use of technology in the past year was the development of the first dual-campus health fair at the University of Minnesota. A committee of executive board members held ITV meetings to discuss the logistics of
w w w.j a p h a . o r g
a location for the health fair, services offered, volunteers needed, and advertising. The location selected was almost exactly halfway between Duluth and the Twin Cities. Student pharmacists traveled 75 miles from their respective campus to this milestone opportunity to provide screening and education for diabetes, cardiovascular disease, osteoporosis, and heartburn. Through the extensive use of technology in planning, student pharmacists were able to help a community that had not experienced patient care from a pharmacist and were able to work with peers who they might not have met otherwise. ITV allows student pharmacists, faculty, and staff from a distance to work together as if they were simply in the room next door. It allows for pharmacy education to affect a greater number of communities in the state of Minnesota. This technology also is an invaluable teaching tool both in the classroom through didactic training and outside the classroom through its use by student organizations. The current structure of the University of Minnesota College of Pharmacy would not be possible without these advances in technology. Alison R. Knutson Student Pharmacist College of Pharmacy University of Minnesota 2009–2010 APhA–ASP Speaker of the House [email protected] doi: 10.1331/JAPhA.2010.10500
Journal of the American Pharmacists Association
1/12/10 11:14 AM