As health care moves into a value-based system and pharmacists begin providing more patient care services, the incentive for pharmacists to begin documenting their clinical workflow in order to get paid will be critical. In line with this thinking, Walgreens announced in late August that it has implemented an electronic health record (EHR) system—the Walgreens Cloud EHR—that will give Walgreens pharmacy staff at more than 8,200 locations a single, complete view of a patient’s prescription, immunization, and health testing records.
“Most systems in pharmacy have been steered to really fill prescriptions quickly, accurately, and then bill for those prescriptions,” said Nimesh Jhaveri, BSPharm, MBA, Divisional Vice President of Healthcare Solutions Group at Walgreens. “What our Cloud EHR does is really enable Walgreens pharmacists to begin to document clinical interactions and clinical services in a system that is interconnected.”
The federal meaningful use EHR incentive program for early adopters of the technology, which incentivizes the use of EHRs through financial payments, did not include pharmacists directly as eligible providers. The health care reform law promotes accountable care organizations (ACOs)—an emerging model that aligns financial incentives to coordinate patient care—but does not explicitly include pharmacists as eligible professionals to form ACOs who can share in an ACO’s cost savings. Still, pharmacists have found ways to participate in ACOs. Walgreens has established ACOs in which Walgreens pharmacists provide medication therapy management services.
According to Shelly Spiro, BSPharm, FASCP, Executive Director of the Pharmacy HIT Collaborative, patient interventions performed by pharmacists are currently not codified in the prescription claim. But as a payer, an ACO needs clinical documentation from providers that is standardized in an EHR.
“Your basic pharmacy claims–based information doesn’t necessarily equate to the outcomes that can be measurable for ACOs,” Spiro told Pharmacy Today.
Although ACOs are growing—there are more than 400 Medicare, Medicaid, and private payer ACOs in the United States—they are not the only reason pharmacists should be using EHRs, or other HIT systems for that matter, to document clinical information.
Financial incentives aside, pharmacy stakeholders agree that the move by Walgreens to implement a systemwide EHR is part of a bigger push to align pharmacists with team-based care and ultimately improve patient care and cost savings for the health care system.
CVS Health has been using its own proprietary EHR system for some time. But nurse practitioners at the chain’s walk-in clinics access the EHR, not pharmacists. This will remain the case when CVS transitions to EpicCare’s EHR, which the company announced earlier this year, connecting them to roughly 274,000 physicians in hospital networks, health systems, and physician groups that use Epic. This year, CVS Health also announced a new clinical affiliation with MedStar Health, which operates 10 hospitals in the Maryland and Washington, DC, area.
“We are moving quickly to a world in health care where practitioners should have applicable information regardless of where the patient goes,” said Jhaveri. “In order for us to get there, we have to standardize the information so we can transfer and send that information to other practitioners.”
To date, the Pharmacy HIT Collaborative has created roughly 300 codes for clinical documentation that will standardize information as it is sent from one system to the next. As in e-prescribing, the information is standardized and embedded in the document using coding.
Hospitals—the entity currently affected most by value-based incentives in today’s health care environment—recognize that patients get discharged, and at some point, they visit their local pharmacy.
“There are more hospital administrators who are recognizing that we need to work together, and the best way to do that is to integrate on an EHR level,” Andy Hochradel, PharmD, Director of Specialty Pharmacy at Prescriptions Plus in West Allis, WI, told Today.
While independent pharmacists may not be affiliated with a large health system currently, they have an opportunity to be connected with independent physician practices that cover large patient populations.
“Independent pharmacists are good at adapting technology within their own workflow. But we are at a point where we have to take a step back and use that same forward thinking and say, ‘How do I create a workflow in my community with the same networking principles?’” said Hochradel.
Looking at the bigger picture, if all providers, including pharmacists, focus on better communication, they have a better chance of keeping patients healthy and out of the hospital.
Jhaveri said the Walgreens EHR infrastructure is in place so that if they want to send out information to a patient’s provider in the future, they can.