Health IT Quality

It only makes sense that pharmacies and pharmacists would be playing an increasingly important role in our healthcare system. One basic reason is proximity. More than 90 percent of Americans live within five miles of a community pharmacy. Even in less-populated rural areas, a drugstore is normally close by. That’s not always the case with hospitals and clinics that provide comprehensive health services.

So, it’s very positive that we’re seeing an evolution of the role of the pharmacist in the nation’s healthcare system. More often than not, today’s pharmacy is more than just a place to pick up a bottle of pills. Chains like Walgreens, CVS and Wal-Mart, as well as independent community pharmacies, are increasingly offering wellness programs, health screenings, immunizations and disease management services. Many provide in-store health clinics. Pharmacies are transforming themselves into multi-purpose health centers.

This significant change is being empowered, in large part, by information technology. Interoperable data networks began improving the pharmacy component of the healthcare continuum through e-prescribing. Roughly 95 percent of the nation’s pharmacies are linked to the Surescripts interoperable network. This makes it possible for the rapidly rising number of physicians using e-prescribing technology to communicate digitally with pharmacists, improving both patient safety and medication adherence. Reduced drug-related medical errors and greater prescription adherence are also significantly reducing health system costs.

But we’ve only begun to tap into the potential of digital networking. As pharmacists begin offering more healthcare services, particularly through in-store clinics that can conduct physical examinations and offer routine immunizations, it becomes increasingly important to link those pharmacies with patients’ primary healthcare providers. This two-way electronic street over which patient information can flow enables the best possible care to be delivered wherever the patient happens to be – in the pharmacy, in the hospital, or in the physician’s examination room.

A research paper published by the consulting firm Booz and Company, written by the company’s global healthcare experts, noted that “pharmacies are uniquely positioned to help meet the top two goals of reform:  providing convenient, expanded access to medical care and controlling costs.”

This can only happen effectively if the pharmacy is linked electronically to the other players in the healthcare continuum. With that data linkage, the options for quality healthcare available to American patients and healthcare consumers are dramatically and beneficially expanded.

It’s always important to recognize the connection between principles and practice and, at the same time, the differences between the two.

Take, for example, e-prescribing. The principles behind e-prescribing are unassailable. Digitizing the information a physician provides to a pharmacist significantly reduces medication errors. It takes the guesswork out of pharmacists trying to read doctors’ handwriting. Studies have shown it also boosts medication adherence among patients. If a prescription goes electronically from the doctor to the pharmacy without going into a patient’s pocket, wallet or pocketbook in between, there is a much greater likelihood that prescription will be filled and utilized as the physician intended.

But in order for these e-prescribing principles to be effective, there must be constant vigilance in the way they are put into practice. And that’s why Surescripts created the White Coat of Quality program– to ensure that physicians who had adopted e-prescribing had done so in such a way that it yields increased care quality and patient safety.

This is an award presented to vendors who not only apply best practices to the use of e-prescribing technology, but also engage in continuous quality improvement and training of prescribers. There are four criteria involved in selecting White Coat of Quality recipients:

• It is essential for senior leadership of the organization to formally, in writing, affirm their commitment to a goal of zero electronic prescription content errors.

• Organizations must keep detailed metrics on their e-prescription content errors and report those findings to Surescripts.

• Vendors must be diligent in making necessary software changes in order to minimize any e-prescription clinical content errors.

• Organizations must provide educational programs to help e-prescribing users better understand and utilize the technology to minimize their own clinical content errors.

The effectiveness of evolving technologies must be mirrored by the commitment of the professionals who put those technologies into practice. That’s certainly Surescript’s intent with e-prescribing. We have never accepted the notion that simply having a good idea is good enough. Constant improvement must be part of the equation.

The good news is that we are not the only ones who recognize this, as evidenced by the fact that the number of White Coat awardees keeps rising, which means that the quality and safety of the care patients are receiving is improving... In which case, it seems to me that everyone wins.

Surescripts has published a newer version of the previously published Quality Guidelines document that outlines the expectations and requirements of a high quality electronic prescription.  This new version provides additional details on some of the key areas of clinical focus and concern observed during our ongoing review of new electronic prescriptions. This newer version of the Quality Guidelines attempts to set the measurement standard against which electronic prescriptions can be assessed for accuracy and completeness.

Recently, I sat down with EHR Intelligence Editor Kyle Murphy to discuss the Surescripts E-Prescription Network, the recent rise of e-prescribing adoption and utilization, challenges facing expanded use, network interoperability, data security and more. Head over to EHR Intelligence to read the full interview by clicking here.

I attended HealthCa.mp/dc and found it to be different and exciting. It was an "un-conference" which allowed the format to be flexible and dynamic. I presented a "4 by 4" talk on quality, which means four slides in four minutes. Watch the video below to hear some of my comments and observations on the day.