Many pharmacists are unaware that implementing health information technology has been a big strategic push on the part of the Federal government since 2004. At that time, former President George W. Bush appointed the nation’s first chief technology officer, David Brailer, and created the Office of the National Coordinator for Health Information Technology, or ONC. Flash forward seven years, and the ONC is now on its fourth leader and its third strategic plan. Nearly $20 billion in funding has been provided through the 2009 HITECH Act (the stimulus bill) to help move the vision forward that Bush outlined:
“We will make wider use of electronic records and other health information technology to help control costs and reduce dangerous medical errors.” — President Bush, January 31, 2006
Health IT efforts are directed at improving quality and reducing costs by creating a system of electronic health records, or EHRs, that can exchange information between various health care entities through state and regional health information exchanges (HIEs). Monies have been directly provided to hospitals and physician practices to change their systems from paper or practice-specific electronic medical records to a system of interoperable EHRs. The systems must be used to achieve meaningful health outcomes, or “meaningful use” in order to qualify for payments. Meaningful use goals are very specific and include outcomes for a number of chronic diseases. For more information, see https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp. The Federal government has paid institutions and individual practices $872 million through September 2011. Prior to the HITECH Act, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) established a five-year program of incentive payments along with some payment adjustments to eligible professionals when they ePrescribe for Medicare patients seen in their offices. It is widely believed that ePrescribing will encourage HER adoption. The 2011 program provides a combination of incentives and payment adjustments for individual eligible professionals and group practices to encourage successful electronic prescribing. The 2011 incentive program provides for a bonus payment to eligible professionals who successfully ePrescribe in 2011 equal to 1% of the total Medicare payments for the year. The incentive is reduced each year that a physician chooses not to participate, starting in 2012.
In spite of these efforts, the President’s Council of Advisors on Science and Technology issued a report in December 2010 saying these efforts were not moving health technology as fast as technology advancements are occurring in the consumer sector or in other industries. A detailed set of recommendations was provided; including changing the way data is sent and received to rely on more Web-like technology. They suggest tying changes to the CMS meaningful use requirements. Further, the Office of the National Coordinator and the Department of Health and Human Services have begun the regulatory rulemaking process to move forward with the recommendations, including the creation of a “universal exchange language.”
What does all this mean for pharmacy? A few things. First, while pharmacies have been the most widely computerized operations among all health care entities for decades, the systems they have in place may not integrate into the EHR systems and/or HIEs that are being created and implemented by other entities. A key part of the 2010 health care reform bill (the Accountable Care Act) calls for the creation of integrated “accountable care organizations” (ACOs) or “medical homes” that are responsible for providing care to patients and achieving meaningful use outcomes. From studies outlining successful outcomes from pharmacist-provided patient care services, it can be inferred that hospitals and physicians will have difficulty achieving all the CMS meaningful use goals without including pharmacist-provided patient care services, including MTM services, as part of the care process. That said, pharmacy services are not mentioned in the reform bill’s discussion of ACOs or medical homes. Additional, no monies are set aside for health IT activities by pharmacists in any of this legislation or regulation.
Pharmacy must ensure that pharmacists that provide patient care services are able to receive information from and input to EHR systems. To that end, nine pharmacy organizations led by APhA, NCPA and the Academy of Managed Care Pharmacists met and formed the Pharmacy e-Health Information Technology Collaborative in 2010. The Collaborative’s purpose is to assure the pharmacist’s role of providing patient-care services are integrated into the National HIT interoperable framework. There are a number of initiatives and committees that pharmacists should consider serving on and pharmacists should keep up on the Collaborative’s efforts, see www.pharmacyhit.org for more information.
So what should today’s independent pharmacy owner do when looking at the pharmacy operation’s use of technology to make it more efficient and effective? There are a number of suggestions offered by pharmacy technology followers Bill G. Felkey and Brent I Fox. Felkey and Fox write a regular feature in Computer Talk Magazine. The magazine has been covering technology trends for more than 30 years and provides contemporary information for retail, hospital, and homecare pharmacy. In the annual Computer Talk Magazine Buyers Guide, published in April 2011, Felkey and Fox offer several recommendations for pharmacy owners:
- Determine the problems that are being addressed or goals the pharmacy is trying to achieve
- Avoid automating the old process, rather look at system integration opportunities, other stakeholders and the bigger picture
- Design, control, and measure the impact of the IT investment
- Routinely monitor a new technology purchase to see if it is delivering what was promised
- Look at the pharmacy management system as the operation’s “hub,” with other purchases being able to add on or be integrated to the hub
- Think of technology vendors as integral partners in the practice, especially when considering HIPAA and patient privacy concerns
- Gather price quotes, return on investment data, and other related maintenance fees/acquisition costs
- Talk to others who have used the technology, and consider a site visit.
Computer Talk has worked with the NCPA Technology Committee to launch a Pharmacy Technology Resource Center. The site has a self-assessment that pharmacist/owners can use to determine opportunities for new technology in the practice. Computer Talk Magazine’s annual Buyers Guide provides a wealth of comparative information on all types of pharmacy technology and is a unique resource for pharmacy owners.
But as the President’s Commission has noted, technology outside of health care has exploded and continues to rapidly evolve. The use of smart phones, iPads, and related health applications are becoming commonplace among all consumers. Pharmacies need to ensure their Web sites and operations consider how smart phones and iPad applications can interface with their technology and what consumers want to see them offer. A technology roundtable at the NCPA Annual Meeting held in October 2011 that focused on iPad applications was sold out. IBM has just released a report that 15% of people who visit a retailer’s website in November 2011 will do so via a mobile device. Total online sales in November will experience growth of 12% to 15% over the same period in 2010.
And increasingly, consumers are using their mobile devices for health care applications. Manhattan Research’s Cybercitizen Health® U.S. Study released in mid-October 2011 shows 26% of adults have used their mobile phones for health information or tools in the past 12 months. The mobile health population has more than doubled since 2010, when 12% of consumers conducted health activities on their mobile phones. Information-gathering, whether by searching for health information or consuming health news, remains the most common mobile health behavior. However, there has been an increase in consumers using their mobile phones to manage their care or treatment in the past year. For example, 3% of consumers used prescription drug refill or reminder services on their mobile phones in 2010, while 8% did so in 2011.
Many pharmacy technology vendors are incorporating mobile applications into their systems to help pharmacist/owners use the technology to touch consumers via text, email, or phone using the consumer’s preference. The bottom line is that today’s pharmacy owner must continually assess the technology tools used in the pharmacy to help achieving business goals. Technology advancements are happening at an explosive rate and independent pharmacists can’t afford to be left behind.
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