Subscribe to RSS
A Statewide Medication Management System: Health Information Exchange to Support Drug Therapy Optimization by Pharmacists across the Continuum of Care
29 June 2017
10 November 2017
03 January 2018 (online)
Background While evidence generally supports the use of medication management technology, systems are typically implemented and evaluated piecemeal rather than as part of a comprehensive model for medication management. Systems to support drug therapy optimization, increasingly a key role of pharmacists in our healthcare system, have not yet been reported.
Objective Our objective is to describe the design, implementation, and use of health information technology to support the hospital and community pharmacists' management of medications for high-risk patients statewide in the “Pharm2Pharm” model of care. Our aims were to make it easier for the pharmacists to access information needed to identify and resolve drug therapy problems using best practices for medication management and communicate with other members of the care team.
Methods The pharmacist's roles and the medication management processes guided the design of the supporting technology, which was implemented after the Pharm2Pharm model was launched and the pharmacists' technology needs were assessed. Priorities for technology included sending care transition documents from hospital to community pharmacist securely and efficiently, access to medical records, including medications and laboratory results, documentation, and patient tracking. Implementation and use of the technology were documented.
Results Communications, medication management, and population management solutions were implemented to support the Pharm2Pharm model. The pharmacists delivering services through this model adopted and meaningfully used this technology to support their work.
Conclusion Implementing technology with value outside of the Pharm2Pharm model was a strategic approach to investment. This work emphasizes the importance of shifting the focus of technology from supporting a specific piece of the medication management process to supporting the goal of optimizing medication regimens. Health information exchange systems can provide important technology needed to integrate pharmacists into care teams as they are deployed to improve patient outcomes.
Keywordsdrug therapy optimization - pharmacists - medication reconciliation - health information exchange - health information technology
Protection of Human and Animal Subjects
This study was approved as exempt by the University of Hawaii Institutional Review Board.
The project described was supported by Funding Opportunity number CMS-1C1–12–0001 from Centers for Medicare and Medicaid Services, Center for Medicare and Medicaid Innovation. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.
- 1 Centers for Medicare and Medicaid Services. Available at: https://questions.cms.gov/faq.php?id=5005&faqId=2939 . Accessed May 4, 2017
- 2 Furukawa MF, Spector WD, Rhona Limcangco M, Encinosa WE. Meaningful use of health information technology and declines in in-hospital adverse drug events. J Am Med Inform Assoc 2017; 24 (04) 729-736
- 3 Gabriel MH, Smith JY, Sow M, Charles D, Joseph S, Wilkins TL. Dispatch from the non-HITECH-incented Health IT world: electronic medication history adoption and utilization. J Am Med Inform Assoc 2016; 23 (03) 562-569
- 4 McKibbon KA, Lokker C, Handler SM. , et al. The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc 2012; 19 (01) 22-30
- 5 Marien S, Krug B, Spinewine A. Electronic tools to support medication reconciliation: a systematic review. J Am Med Inform Assoc 2017; 24 (01) 227-240
- 6 Schnipper JL, Hamann C, Ndumele CD. , et al. Effect of an electronic medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch Intern Med 2009; 169 (08) 771-780
- 7 Nabovati E, Vakili-Arki H, Taherzadeh Z. , et al. Information technology-based interventions to improve drug-drug interaction outcomes: a systematic review on features and effects. J Med Syst 2017; 41 (01) 12
- 8 Joint Commission of Pharmacy Practitioners. Pharmacists' Patient Care Processes, May 29, 2014; Available at: https://www.pharmacist.com/sites/default/files/files/PatientCareProcess.pdf . Accessed May 4, 2017
- 9 Nelson SD, Poikonen J, Reese T, El Halta D, Weir C. The pharmacist and the EHR. J Am Med Inform Assoc 2017; 24 (01) 193-197
- 10 Chisholm-Burns MA, Kim Lee J, Spivey CA. , et al. US pharmacists' effect as team members on patient care: systematic review and meta-analyses. Med Care 2010; 48 (10) 923-933
- 11 Lee JK, Slack MK, Martin J, Ehrman C, Chisholm-Burns M. Geriatric patient care by U.S. pharmacists in healthcare teams: systematic review and meta-analyses. J Am Geriatr Soc 2013; 61 (07) 1119-1127
- 12 Pellegrin KL, Miyamura J, Taniguchi R, Ciarleglio AE, Barbato A, Scott Holuby R. Using International Classification of Diseases Codes to track medication-related hospitalizations of older adults. J Am Geriatr Soc 2016; 64 (03) 651-653
- 13 Pellegrin KL. The Daniel K. Inouye College of Pharmacy Scripts: Pharm2Pharm: Leveraging medication expertise across the continuum of care. Hawaii J Med Public Health 2015; 74 (07) 248-252
- 14 Pellegrin KL, Krenk L, Oakes SJ. , et al. Reductions in medication-related hospitalizations among older adults with medication management by hospital and community pharmacists: a quasi-experimental study. J Am Geriatr Soc 2017; 65 (01) 212-219
- 15 Pellegrin KL, Lee E, Uyeno R, Ayson C, Goo R. Potentially preventable medication-related hospitalizations: a clinical pharmacist approach to assessment, categorization, and quality improvement. J Am Pharm Assoc (2003) 2017; 57 (06) 711-716
- 16 Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice – The Patient Centered Approach to Medication Management. 3rd ed. New York, NY: McGraw Hill; 2012
- 17 Isetts BJ, Schondelmeyer SW, Artz MB. , et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003) 2008; 48 (02) 203-211 , 3 p following 211
- 18 Ramalho de Oliveira D, Brummel AR, Miller DB. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm 2010; 16 (03) 185-195
- 19 Smith M, Giuliano MR, Starkowski MP. In Connecticut: improving patient medication management in primary care. Health Aff (Millwood) 2011; 30 (04) 646-654
- 20 Orrico KB. Sources and types of discrepancies between electronic medical records and actual outpatient medication use. J Manag Care Pharm 2008; 14 (07) 626-631
- 21 Hawaii State Data Center. Detailed Languages Spoken at Home in the State Hawaii. Available at: http://files.hawaii.gov/dbedt/census/acs/Report/Detailed_Language_March2016.pdf . Accessed May 4, 2017
- 22 Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res 2007; 42 (02) 727-754
- 23 Schnipper JL, Kirwin JL, Cotugno MC. , et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med 2006; 166 (05) 565-571
- 24 Vora J. Access to a health system's electronic medical record. Pharmacy Times September 2015. Available at: http://www.pharmacytimes.com/publications/health-system-edition/2015/september2015/access-to-a-health-systems-electronic-medical-record
- 25 Smith MA, Spiggle S, McConnell B. Strategies for community-based medication management services in value-based health plans. Res Social Adm Pharm 2017; 13 (01) 48-62
- 26 Medicare Payment Advisory Commission. “Medication therapy management programs under Part D”. Available at: http://www.medpac.gov/docs/default-source/comment-letters/02282014_partd_comment.pdf?sfvrsn=0 . Accessed May 4, 2017
- 27 Viswanathan M, Kahwati LC, Golin CE. , et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med 2015; 175 (01) 76-87
- 28 US Department of Health and Human Services, Agency for Healthcare Research and Quality. Available at: https://www.ahrq.gov/professionals/prevention-chronic-care/improve/system/pfhandbook/mod20.html . Accessed May 4, 2017
- 29 Loo TS, Davis RB, Lipsitz LA. , et al. Electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Intern Med 2011; 171 (17) 1552-1558
- 30 US Office of the Federal Register. Available at: https://www.federalregister.gov/documents/2014/02/06/2014-02280/clia-program-and-hipaa-privacy-rule-patients-access-to-test-reports . Accessed May 4, 2017
- 31 Kierkegaard P, Kaushal R, Vest JR. How could health information exchange better meet the needs of care practitioners?. Appl Clin Inform 2014; 5 (04) 861-877
- 32 Joseph T, Hale GM, Eltaki SM. , et al. Integration strategies of pharmacists in primary care-based accountable care organizations: a report from the Accountable Care Organization Research Network, Services, and Education. J Manag Care Spec Pharm 2017; 23 (05) 541-548