Shelly Spiro, RPh, FASCP

It all started back when physicians wrote directions to pharmacists in Latin. Latin was not widely understood by patients, making the language like a code between prescribers and pharmacists. In today’s electronic world, instead of Latin, standard terminology codes are used to ensure that medical information is communicated from one system to another. A good example of this is the use of National Drug Code (NDC) numbers and Drug Utilization Review coded messages within National Council for Prescription Drug Programs D.0 claims standards. The medical community uses International Classification of Diseases, 10th revision (ICD-10), codes for diagnosis and Current Procedural Terminology codes for medical claims.

Ideally, pharmacists document clinical or progress notes where important assessments and findings are assigned specific codes to capture and measure the value of the clinical care they provide. It is only a matter of time before system vendors program Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) codes into their systems. Doing so should help make pharmacists’ clinical encounter documentation more standardized. Not only will this allow for more efficient and precise billing for services, but it will also enable effective communication of patients’ medication-related problems, medication history, and associated service activities with other care team members.

As the need for more coding of clinical terms specific for documentation arose in the medical profession many decades ago, the medical community turned to SNOMED CT, one of a set of standards that the United States and other countries have designated for the electronic exchange of clinical health information. SNOMED CT codes are searchable and available for free from the National Library of Medicine (NLM) through the Unified Medical Language System Metathesaurus to anyone who registers for a license. Most clinicians are familiar with using ICD-10 codes to document diagnoses within claims and progress notes. Although SNOMED CT codes exist for diagnosis, but ICD-10 is more widely adopted for this purpose.

Claims-based data typically include procedure and diagnosis codes, but they have limited clinical context for aiding in future encounters and for use within the clinical record. The SNOMED CT licensing policy clearly states that SNOMED CT can only be used for clinical documentation, not for claims. For example, if a radiologist orders a magnetic resonance imaging study and submits the claim, the payer often requests an attachment to the claim in the form of a progress note. Embedded in the progress note are the SNOMED CT codes documenting the clinical care provided by the radiologist.

Although SNOMED CT is not currently being used in the pharmacy industry, there is opportunity for pharmacists to use SNOMED CT codes to support medication therapy management (MTM) claims. Attaching progress notes to claims helps to reduce the likelihood of false claims or to justify or document that the encounter took place as described in the claim. This is what is needed to increase payer confidence in MTM billing documentation. Unlike ICD-10 codes, SNOMED CT codes—according to the license agreement&mdash;are not to be used in a claim but can be added as an attachment to the claim. Large chain pharmacies, health-system pharmacies, independent pharmacies, managed care pharmacies, and accountable care organizations all will eventually use and need to electronically document clinical encounters using SNOMED CT as a way to capture value for the services they provide.

SNOMED CT is divided into concepts representing clinical meanings and organized into hierarchies of situations, procedures, and findings (Figure 1).

Each clinical term has a unique identifier represented as a number. An example of this concept is the use of NDC numbers, where the first segment represents the manufacturer, the second segment represents the product, and the third segment represents the package size. With SNOMED CT, the identification is just a number mapped to a clinical term or concept (Table). Each portion of the clinical term can have more than one description represented as a synonym that describes the same concept (eg, “medication” and “drug”), and all fall under the same code. For example, if one system uses “medication dose too low” and another system uses the term “drug dose too low,” the same SNOMED CT code would be used.

Table: Example of SNOMED CT Mapped Clinical Terms

				Medication reconciliation by pharmacist

SNOMED CT clinical concepts follow a hierarchical structure using general terms to represent the different levels in the hierarchy. For example, a “parent” term will have subterms known as “children,” and children will have subterms known as “grandchildren.” Subterms are more descriptive than their parent terms as one drills down deeper into the concept term. For example, the SNOMED CT identification for the parent concept “medication reconciliation (procedure)” is 430193006 and the identification for the child concept “medication reconciliation by pharmacist (procedure)” is 428701000124107.

Work of the Pharmacy Health Information Technology Collaborative

In 2010, 9 national pharmacy associations formed the Pharmacy Health Information Technology (HIT) Collaborative “to assure that pharmacists were integrated into the health care system to increase the quality of patient care, to advocate and educate key stakeholders regarding the meaningful use of HIT, and include pharmacists into a technology-enabled integrated health care system.”

In addition, with the help of the NLM, which manages the US SNOMED CT version, the Collaborative performed a gap analysis of over 330,000 clinical terms within the SNOMED CT international database and identified approximately 270 new MTM and pharmacy-related codes. Hepler and Strand developed the basic concepts and terms for what we now call MTM services and pharmaceutical care.

 These terms were used to identify the first set of MTM SNOMED CT codes. All these MTM codes are currently available in the SNOMED CT database under the classification “medication therapy.”

As a result, the Collaborative is the steward of MTM pharmacy-related SNOMED CT codes and, through the Collaborative’s Value Set Committee, has created a process to add and maintain a list of codes for the pharmacy industry. The Collaborative will also publish an implementation guide accompanying the pharmacy value sets to aid users in incorporating these codes into their respective HIT systems.

The Collaborative produced 2 guidance documents to help introduce pharmacists to SNOMED CT codes and educate those who provide MTM services in a team-based environment with examples of how SNOMED CT codes can be used to document patient care (Figures 2 and 3).

A value set often includes codified concepts from established standard vocabularies or nomenclature terminologies. For example, a value set for a patient’s symptoms may include a range of problems or conditions (eg, sore throat, dizziness, cough). This value set would be different from a list of diagnoses. A value set is defined as “a list of specific values (terms and their codes) derived from single or multiple standard vocabularies used to define clinical concepts (eg, patients with diabetes, clinical visit, reportable disease) used in quality measures and to support effective health information exchange.”

Articles

Ideally, pharmacists document clinical or progress notes where important assessments and findings are assigned specific codes to capture and measure the value of the clinical care they provide.

SNOMED CT Is Coming to Pharmacy: A Primer on Systematized Nomenclature of Medicine "Clinical Terms" Documentation (for Pharmacist and Pharmacy Services)

In this age of emerging technology, it more important than ever for community pharmacists to get plugged into clinical data sharing. Community pharmacy system vendors are developing new ways to document clinical information, and the adoption and implementation of these interoperable health information technology (HIT) solutions will help in the collection, documentation, and exchange of data on pharmacist-provided patient care services with other health care providers, patients, and payers. Though these emerging solutions present a new set of challenges for community pharmacy, they have the potential to transform health care and benefit all stakeholders.

Electronic prescribing (e-prescribing) is the first step in creating interoperability between pharmacists and prescribers. As interoperable prescription information improves from a one-direction transaction to a bidirectional exchange of information, the prescription process will become more seamless. The ability to exchange clarification requests with prescribers in real time will save pharmacists’ time and may decrease the risk of medication errors.

It is important for community pharmacists to understand these process-improvement opportunities and changes to ensure that they will not be left behind. As payment models move away from fee-for-service toward a value-based model, interoperable HIT solutions are paramount to keeping the practice of pharmacy integral to patient care.

According to the Healthcare Information and Management Systems Society, “Interoperability describes the extent to which systems and devices can exchange data and interpret that shared data. For 2 systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.”

Interoperability is a term used in HIT to define ways computer systems communicate with each other. An example of interoperability outside of health care is e-mail: an individual with an e-mail account from one provider can seamlessly send and receive messages from someone who uses a different provider. This is the same type of interoperable exchange that occurs today in health care over secure networks.

In 2015, the Office of the National Coordinator for HIT (ONC) prioritized interoperability to drive HIT adoption.

 In a letter in the ONC interoperability roadmap draft document, ONC National Coordinator for HIT Karen B. DeSalvo, MD, MPH, MSc, stated, “In the decade since ONC began its service to the nation, the United States has experienced remarkable progress in the digitization of the health experience. There has also been significant advancement of payment reform that is driving the need for better visibility of the care experience and demand for straightforward quality measurement. Consumers are increasingly expecting their electronic health data to be available when and where it matters to them, just as their data is in other sectors. And new technology is allowing for a more accessible, affordable, and innovative approach.”

Although physicians and hospitals are receiving financial incentives for adopting HIT, community pharmacy is not part of the incentive program; ONC recognized pharmacists as providers in order to meet the driving factor of interoperability without providing financial incentives for their participation. However, whereas the incentives of HIT implementation are not monetary for community pharmacy, there are still important advantages for adopting HIT into the community pharmacy practice model.

The ONC’s draft interoperability roadmap document recognizes the value of pharmacists, especially in the community setting, for sharing clinical information with providers, patients, and payers.

 The pharmacist’s role as a health care provider is referenced throughout the 166-page document, which features an appendix on medication-therapy management (MTM). On April, 3, 2015, comments to the roadmap were submitted by the Pharmacy HIT Collaborative, which was formed in 2010 by 9 pharmacy professional associations and corporate stakeholders representing HIT initiatives for pharmacists providing patient care services in all practice settings.

 These comments reinforced ONC’s position on pharmacists’ relevance in the clinical exchange of information (eg, immunizations, e-prescribing, and MTM services). The interoperability roadmap identifies key process-improvement opportunities for community pharmacists who adopt HIT into their pharmacies. These mainly include interoperable solutions to e-prescribing, controlled substance abuse prevention, MTM services, and immunizations.

Community pharmacies today rely on their pharmacy management systems (PMS), which are designed with a dispensing work flow to fill prescriptions. E-prescribing is a key component of this interoperable work flow process for community pharmacies that have adopted HIT. The starting point in the PMS is the profile, which contains not only basic patient details and their medication list, but can also include clinical information such as lab results, diagnoses, allergies, and medication goals. Expanding the functionality of clinical information documentation starting with the patient profile can allow a more complete picture to be shared interoperably.

The missing piece in community pharmacy is a consistent process for the documentation of clinical information (eg, MTM, immunizations, medication reconciliation). Currently, there is no set of standards that is widely used for collecting, documenting, and exchanging clinical information in the community pharmacy setting. As pharmacists begin to provide more clinical services, their PMSs will need to be capable of adopting a clinical work flow following the Joint Commission of Pharmacy Practitioners’ Pharmacists’ Patient Care Process.

If information can be collected, documented, and exchanged in an electronic, standard, interoperable way, community pharmacies will have the potential to reduce staff and prevent medication errors, especially those related to transcription of information. In the future, community pharmacists may also play a more clinical role as care coordinators.

There are numerous challenges involved in adopting HIT solutions including, but not limited to, cost, limited value-based payment models that account for community pharmacists, quality measures, and lack of regulatory incentive. There has been limited published research showing the value of community pharmacists adopting electronic interoperable solutions; however, the interprofessional communication aspect of HIT solutions should be recognized as an added value not only to community pharmacists and payers, but, most importantly, to the patients they serve.

As reimbursement is increasingly tied to patient outcomes, payers and pharmacy benefit managers want to have high-performing pharmacies in their networks.

 The lack of interoperable technology solutions may keep high-performing pharmacies from appropriately documenting and reporting clinical services (eg, targeted invention programs, targeted medication reviews, comprehensive medication reviews). This lack of interoperability may lead to narrow payer networks and exclusion of these pharmacies from prescription dispensing and other service,s such as immunization.

There are 3 ways to drive HIT adoption: (1) regulatory requirements, (2) business need, and (3) quality measures. E-prescribing is an example of a regulatory requirement that is a nonfunded mandate for pharmacists; however, there are business benefits to adopting bidirectional e-prescribing solutions. Additional regulatory requirements, such as the adoption of electronic health records (EHRs), are frowned upon by community pharmacists because of nonfunded mandates. If we look at EHR adoption from a business perspective, it makes sense. Right now, payers are influenced by Medicare Part D Star Rating Quality Measures; HIT solutions will assist payers in meeting these quality measures and provide an opportunity for community pharmacists to show their value.

Currently, the major driving force for a community pharmacy to adopt HIT solutions is a business model, such as the accountable care organization (ACO). ACOs rely heavily on electronic clinical data using interoperable HIT solutions to demonstrate their reimbursement models. Community pharmacists have the potential to play a coordinating role in chronic care management and transitions of care, both key success factors for ACOs. The benefits outweigh the challenges for pharmacists to adopt EHR systems to collect, document, and exchange clinical information with other health care providers, patients, and payers.

E-prescribing has been a way for community pharmacies to become early adopters in receiving electronic clinical information and has been a major reason for prescribers to adopt EHRs and other emerging technologies.

In terms of e-prescribing, exchanging electronic prescription information bidirectionally allows for a safer and more robust process that may include medication reconciliation and adherence. This exchange is needed for transitions of care and MTM services, prevention of drug abuse, and identification of doctor shopping. The Centers for Disease Control and Prevention and state public health departments are adopting electronic solutions for immunization administration. Adopting HIT in an interoperable way helps support these population health solutions.

Due to the increased regulatory requirements and higher physician adoption of e-prescribing, community pharmacies are seeing an increase in the volume of prescription information transmitted from the prescriber to the pharmacy; however, community pharmacists have been lacking a way to electronically communicate information back to the prescriber. The communication from the pharmacy to the physician has mostly been through phone and fax, which is a time-consuming process for the pharmacy and the prescriber.

As technology advances, we are now seeing the need for bidirectional exchange of prescription information. One of the first areas where this need is addressed is in the use of National Council for Prescription Drug Programs SCRIPT 10.6 Standard functions RxFILL, RxCHANGE, and RxCANCEL.

 These e-prescribing standards have not been used because the business need has not been there…until now. Each of these functions is meant to build a method to electronically exchange prescription information in an interoperable 2-way process:

		RxFILL is designed to let the prescriber know when the prescription was picked up for the patient.

		RxCHANGE is designed for the pharmacist to message the prescriber with changes to the prescription (eg, formulary changes, order clarifications, drug interactions).

		RxCANCEL is a function to allow the prescriber to cancel or discontinue a prescription.

With e-prescribing of controlled substances (EPCS), it is important for pharmacists and prescribers to securely communicate prescriptions that have the potential for diversion. State and federal regulations are driving expanded uses of data collected by prescription drug monitoring programs to prevent drug diversion. ECPS allows the pharmacist to be more engaged with the prescriber and to recognize drug abuse and doctor shopping. If pharmacists cannot achieve interoperability, especially with their documentation of clinical services (eg, transitions of care, chronic care management, and MTM), pharmacies could lose customers or be excluded from value-based payment models (eg, ACOs).

With physicians and hospitals being driven to adopt EHRs and to document clinical encounters, pharmacists have the opportunity to broaden their role in clinical care. Adopting pharmacist EHR systems will help to facilitate a more interprofessional approach to clinical care: pharmacist-provided patient care information that is electronically added into the physician work flow will be available to the physician for access during patient encounters. This is accomplished through a health information exchange utilizing interoperable standards for pharmacist and physician EHR systems.

The advantages of collecting, documenting, and exchanging clinical information interoperably are that it can improve patient care and facilitate pharmacists’ participation in a value-based payment model. These exchanges occur using interoperable standards that allow pharmacists to work in their own system and collect and exchange information using standard electronic structured documents for information such as discharge summary, lab results, patient care summary, immunization forms, medication action plans, and progress notes. These structured electronic documents can be viewed, downloaded, and transmitted in a process very similar to sending a secure e-mail.

Community pharmacists using interoperable HIT solutions have the opportunity to play an integral role in the new wave of health care information exchange. The traditional practice of pharmacy is evolving into team-based care models driven by value-based payments. Community pharmacists who rethink their practice models to implement HIT documentation of patient care services will solidify their role as providers on the health care team. It is important for these HIT models to fit into the community pharmacy work flow and to be interoperable with other health care providers, patients, and payers (see Figure 2). New models are using HIT to engage the patients in their care.

If pharmacists do not begin to adopt interoperable clinical HIT solutions, they will be left behind or eventually go out of business. Even though community pharmacists are challenged by a lack of regulatory requirements and financial incentive to adopt HIT, there are significant benefits for pharmacies who participate. Who better than the community pharmacists, who have a trusted and influential relationship with their patients, to improve medication-related care?

Figure 2: Shared Nationwide Interoperability Roadmap: The Journey to Better Health and Care

Shelly Spiro, RPh, FASCP, is executive director of Pharmacy HIT Collaborative. The Collaborative is an organization of the major national pharmacy associations and associate members focused on advocating and educating key stakeholders regarding the meaningful use of health information technology (HIT) and the inclusion of pharmacists within a technology-enabled integrated health care system. Spiro is active in national pharmacy associations, standards development organizations (NCPDP, HL7, and X12), and is a leader in pharmacy HIT, with a 2014 appointment to the Federal Advisory Committee’s Health IT Policy Committee’s Interoperability and Health Information Exchange Workgroup. She is past president of the American Society of Consultant Pharmacists (ASCP), ASCP representative member of the Long-term and Post Acute Care HIT Collaborative, and 2014 Archambault Award recipient.

Diana Quach, PharmD, CGP, is the executive vice president of Spiro Consulting, Inc, a national consulting company focusing on industry, HIT, long-term care, and hospital and ambulatory surgery center consulting. Her formal training involves a doctorate of pharmacy from Roseman University College of Pharmacy and an executive residency in association management from the American Society of Consultant Pharmacists. Dr. Quach currently practices in Nevada as a consultant pharmacist in long-term care and ambulatory surgery center clinical practice. 

		What is interoperability? Healthcare Information and Management Systems Society website. www.himss.org/library/interoperability-standards/what-is. Published 2013. Accessed June 13, 2015.

		Interoperability. HealthIT.gov website. http://healthit.gov/policy-researchers-implementers/interoperability. Updated May 1, 2015. June 13, 2015.

		Office of the National Coordinator for Health Information Technology (ONC). 

Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap

. Washington, DC: ONC; 2014:4. www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf. Accessed June 13, 2015.

Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, Draft Version 1.0.

 Washington, DC: ONC; 2014:4. www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf. Accessed June 13, 2015.

		Spiro S, Rosato E, Vlasses P, et al. Comments on connecting health and care for the nation: a shared nationwide interoperability roadmap draft version 1.0. Pharmacy Health Information Technology Collaborative website. www.pharmacyhit.org/pdfs/collaborative-outreach/Final%20Pharmacy%20HIT%20Coll%20ONC%20Roadmap%20Comments%204-3-15v1.pdf. Published April 3, 2015. Accessed June 13, 2015.

		Spiro S, Franz R, Anderegg S, et al. Workflow of pharmacist clinical documentation process in pharmacy practice settings. Pharmacy Health Information Technology Collaborative website. www.pharmacyhit.org/pdfs/workshop-documents/WG3-Post-2014-03.pdf. Published July 28, 2014. Accessed June 13, 2015.

		Connor K. Clinical performance: a prove-it moment for independent pharmacies. Smart Retailing Rx website. http://smartretailingrx.com/patient-care-counseling/clinical-performance-prove-moment-independent-pharmacies/. Published August 25, 2014. Accessed June 21, 2015.

		2015 edition health information technology (Health IT) certification criteria, 2015 edition base electronic health record (EHR) definition, and ONC health IT certification program modifications: e-prescribing transactions or segments. 

 website. www.federalregister.gov/articles/2015/03/30/2015-06612/2015-edition-health-information-technology-health-it-certification-criteria-2015-edition-base#h-64. Published March 30, 2015. Accessed June 13, 2015.

In this age of emerging technology, it more important than ever for community pharmacists to get plugged into clinical data sharing. 

Interoperability: Plugging Community Pharmacy into the Clinical Data Superhighway

Standardizing the steps of medication therapy management can help facilitate the seamless exchange of clinical information.

Imagine somebody being released from the hospital and the reconciled medication list is electronically available with a medication action plan (MAP) at the pharmacy prior to their showing up to pick up their discharge medications.

The pharmacist would be able to counsel the patient, document any feedback, and reinforce discontinuation of duplicate prescriptions or interaction with non-prescription medications. These actions would help to reduce the possibility of hospital readmission due to medication errors. All this documentation would be electronically exchanged with other health care providers and sent to the patient’s electronic personal health record (PHR) through a health information exchange (HIE).

Pharmacists working in all types of practice settings collect, document, and exchange clinical information differently. Even the pharmacy management systems we use are individually geared to our own work flow. Other care providers, especially physicians and hospitals, are moving toward a standard electronic way of capturing and exchanging health information. A good analogy is how we receive e-mails. Each person uses their own e-mail system (Outlook, Google, Microsoft), and although we write an e-mail in these proprietary systems, somehow we get the e-mail and can read it. This is because the e-mail is transported using standards.

In pharmacy, we see this with standard electronic claims, electronic prescribing, electronic submission of immunization/registry information, and the formation of state HIEs to transport the standard message (eg, laboratory data, discharge summaries, patient care summaries). As in our e-mail analogy, imbedded within the e-mail we receive attachments (eg, word documents, PDFs, spreadsheets, pictures). These structured documents follow standards so they can be read by any computer system that has the functionality to read the attachment. The same is true for the HIT environment.

In the fall of 2010, 9 pharmacy professional organizations formed the Pharmacy HIT Collaborative (

). In the following year, the collaborative published “The Roadmap for Pharmacy Health Information Technology Integration in U.S. Health Care” 

(www.pharmacyhit.org/pdfs/11-392_RoadMapFinal_singlepages.pdf

), which outlined goals, objectives, and strategies pharmacy as an industry should follow through 2015. This year, the collaborative vision, mission, and strategic focus are around pharmacists’ clinical role in health information technology (HIT) through access, connectivity, and quality.

To be successful, we need to standardize the steps of medication management, and then use technology solutions to collect information and document that information so that others outside of our pharmacy management system can understand the care that the pharmacist provides. Nationally, through the work of the Office of the National Coordinator for Health IT (ONC), incentives have been paid to physicians and hospitals to adopt an electronic health record (HER) in a meaningful way. This includes using standardized electronic structured documents and standardized coding to document capture the terminology in a consistent manner.

The time is ripe for pharmacy to follow ONC’s national electronic initiatives of moving standardized clinical data between health care providers and engage the patients in their care. One of the first steps was to push the adoption of e-prescribing. A useful article can be found in “Where in the US are EHR and e-prescribing adoption strongest and weakest?” (Baum S. Where in the US are EHR and e-prescribing adoption strongest and weakest? 

http://medcitynews.com/2013/08/where-in-the-us-are-ehr-and-eprescibing-adoption-strongest-and-weakest-infographic/#ixzz2f9zqw5K3

Pharmacists do so much more that just accept an electronic prescription for dispensing. According to 2013 MTM Digest, “Medication therapy management is on a growth curve with 70% of providers who replied stating that they have more patients receiving MTM in 2012 than in 2010.Thirty-four percent of providers also say that they expect an increase in the number of contact opportunities in 2013.” (

www.pharmacist.com/sites/default/files/files/MTMDigest_2013.pdf

). Now is the time to standardize the process and prepare the pharmacist providing MTM interventions to be electronically exchanged with other health care providers and patients.

Through National Council for Prescription Drug Programs (NCPDP), the collaborative is working on structured clinical documents that will be imbedded in an e-mail-like transport system, mainly an HIE. These standardized electronic structured documents will transport pharmacy care notes using an electronic progress note standard, MAP following an electronic care plan standard, and pharmacy transition of care document following continuity care document standard. Since these electronic structured documents follow standards, they can be exchanged with any health care provider’s EHR and even the patients themselves through a PHR.

The pharmacy management system is the missing link that has the ability to connect with an HIE and the functionality to read and create these standard electronic structured documents. The collaborative worked with the standards development organizations defining a standard pharmacist EHR that has this ability and functionality to collect and exchange electronic standard structured documents. As pharmacists, we need to think about the process of care—how we collect, document, and exchange clinical information with other health care providers and the patients.

The Pharmacy HIT Collaborative continues to take the lead to create a standard for system vendors to use an electronic version of the MTM Medicare Part D January 2013 “take away” document. These standards follow the same standards all eligible providers receiving the incentives for the meaningful use of the EHR are mandated to use to exchange clinical documents (eg, patient care summaries, discharge summaries, and care plans). The Centers for Medicare & Medicaid Services (CMS) Medicare Part D 2014 Call Letter encourages Part D plans to adopt the use of the electronic version of the “take away” structured document and the use a set of standardized clinical terms (SNOMED CT codes). (

www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/Memo-Contract-Year-2014-Medication-Therapy-Management-MTM-Program-Submission-v040513.pdf; pages 11-12

CMS recognizes the importance of using standardized codes as a way to demonstrate the value of MTM services for quality measurement. The same way pharmacists use National Drug Codes numbers to electronically document which medication was dispensed, these MTM SNOMED CT codes will be used to document the clinical care provided by pharmacists providing MTM services.

Now is the time for pharmacists to take their place in electronically documenting and exchanging clinical information using standardized HIT. With the support of the 9 pharmacy professional organizations, the Pharmacy HIT Collaborative is focused on ensuring that HIT supports pharmacists in health care services delivery, achieves pharmacists’ integration with health information exchange, and supports national quality initiatives enabled by HIT. These goals of access, connectivity, and quality will secure the role of pharmacists as a key part of patient care.

Shelly Spiro, RPh, FASCP, is executive director of the Pharmacy Health Information Technology (HIT) Collaborative and president and chief executive officer of Spiro Consulting, Inc. She has more than 30 years of experience in pharmacy and has worked as a pharmacy clinician, teacher, operations manager, and corporate administrative executive. Shelly is the Work Group 10 Pharmacy Professional Services co-chair for the National Council for Prescription Drug Programs and has served as president of the American Society of Consultant Pharmacists. She is a registered pharmacist in Illinois, Colorado, Nevada, Virginia, and Texas.

Standardizing the steps of medication therapy management can help facilitate the seamless exchange of clinical information.
