The Progression of Immunization - Episode 2

Registries of Data Aggregation & Patient Identification

Troy Trygstad, PharmD, MBA, PhD; Mindy Smith, BSPharm, RPh; Brian Hille, BSPharm, RPh; and Ned Milenkovich, PharmD, JD, describe the culmination of registries data with dispensing claims data for patient identification.

Troy Trygstad, PharmD, MBA, PhD: And, now, Mindy, you’re in the data and decision support business. How do we help pharmacies, as sites of care, make this flow into the workflow and make it easy, so they can focus on the clinical aspects and the patient interaction, rather than looking up page 39 in a manual for the specific screening or reporting to a registry, etc? What does that look like in 2018?

Mindy Smith, BSPharm, RPh: It’s all about leveraging data—bringing pharmacists’ data to life or bringing data they don’t have access to readily, so that they have that information in front of them to potentially identify patients. And so, PrescribeWellness has the ability to culminate registry data with dispensing claims data and at least identify, based on CDC guidelines, every single day, actionable patient interventions such as vaccines, so that filling that prescription is 1 service you’re providing. What else are you providing that patient? And so, vaccinations are a missed opportunity in pharmacies every single day, and we need to make sure they have the tools in front of them so that they can take action and identify those patients or, as Brian said, recruit those patients into the pharmacy who aren’t thinking about that birthday they just had who now are eligible for a specific vaccine based on guidelines.

Troy Trygstad, PharmD, MBA, PhD: So, walk me through this. I’m a patient, I walk into 1 of John’s pharmacies or Brian’s pharmacies, I’m dropping off my prescription for amoxicillin, and I’m met with what, Brian?

Brian Hille, BSPharm, RPh: So, it even starts before that. We will do outreaches specifically to patients based off of the guidelines that are out there, proactively inviting them in. But certainly, during the period of time that we’re filling a prescription, we’re also identifying those same patients and queuing up an opportunity to have a conversation, is the way I phrase it. But it’s messaging through the system that lets the pharmacy staff know that this is a patient very specific to needing a specific kind of vaccination. It’s a little more difficult during flu season, right, because that’s basically what you said—everybody who walks through the door, they need one. So, you can identify high-risk patients, and that’s a good way of doing it, but pharmacists need to get to that point of understanding that everybody needs that recommendation for a flu shot.

Troy Trygstad, PharmD, MBA, PhD: And so, I want to switch myself from being in front of the counter to behind the counter. Somebody walks up to my counter, hands me a prescription for amoxicillin—what do the data systems look like or need to look like, Mindy, so that interaction is fruitful, easy, within workflow? Where do we need to go with these information management systems so that we can know what vaccinations they need, be able to counsel on the need for those vaccinations, interact with the insurance company effectively, talk to the PCP, and get it into the registry, so that the aspect of here’s a vaccine, here’s what it’s used for, I’m going to administer it—that part’s actually the easy part, right?

Mindy Smith, BSPharm, RPh: Right.

Troy Trygstad, PharmD, MBA, PhD: There’s all this other stuff. What does that look like behind the counter, in your mind?

Mindy Smith, BSPharm, RPh: I think it’s all about patient management—so, a patient management system that allows that pharmacist to pull up their patient profile, no different than a physician does with their electronic health record when they’re in front of you in the doctor’s office. And so, they can use that clinical data—those decision support tools—to be able to say, “Troy, you are eligible for these 3 vaccines, and I really don’t want you to leave the pharmacy before we take care of you, because it’s important, and I care about you.” And then being able to log that information and also automate and streamline not only the data coming to the pharmacy but also, if they have to report to the registry, automating that process, too. So, helping to streamline that process so that it is as simple as possible is really important to put in the workflow.

Troy Trygstad, PharmD, MBA, PhD: What I’m hearing from both of you is that we need to have systems in place for easy identification, engagement, and administration, so that we really can have a personal interaction and focus on the clinical.

Mindy Smith, BSPharm, RPh: Absolutely.

Troy Trygstad, PharmD, MBA, PhD: That’s no surprise, right?

Ned Milenkovich, PharmD, JD: If I could just add to that, I think one of the things that is challenging in immunization information systems is this barrier of interoperability, as well as the ability as a pharmacist to go into the database and to see what the patient has received in terms of care in another setting, particularly across state lines. So, if we could somehow create a national repository of information and create an interoperable network, I think that would go miles in streamlining. Now, whether that takes place through federal legislation or an association takes the reins of that and creates an interoperable network…it has been done in other settings within health care, particularly with respect to controlled substances. We see a lot of interoperability. It can easily be done with immunizations, as well.

Troy Trygstad, PharmD, MBA, PhD: So, that’s a good point. We did it within controlled substance reporting system, because the impetus really was a public health crisis.

Ned Milenkovich, PharmD, JD: Exactly.

Troy Trygstad, PharmD, MBA, PhD: So, why don’t we view 10,000-plus hospitalizations and deaths every year as a public health crisis, like we do with the opioid epidemic?

Ned Milenkovich, PharmD, JD: That’s a very good question. I don’t know the answer to that, but it’s a valid point and something that certainly bears thought and leadership on and that should be impressed upon our community of pharmacists who are obviously engaged in delivering patient care every day with respect to immunizations. Maybe Mindy has some thoughts on that.

Mindy Smith, BSPharm, RPh: I actually call registry data Swiss cheese, because the pharmacist always has to interview that patient. The Swiss cheese really has to do with pharmacists being probably the most mandated profession to report into the registries, but physicians and other providers do not. And so, you don’t have access to that data, which is a huge concern. But 1 thing that happened in my prior life: I was the state executive for the Arizona Pharmacy Association. We passed legislation that mandated pharmacists to report. The pharmacists did such a great job that the next year, the state came back and asked the age limit to be reduced, because they saw this surge of increased vaccination rates in the state. And the physicians were like “Well, we need to start reporting, as well.” And so, the recognition that everyone needs to be reporting from a surveillance perspective and public health perspective is so important.

Troy Trygstad, PharmD, MBA, PhD: So, it sounds to me like what you’re saying is that when I’m in the pharmacy and still in practice and I have to go in to that registry and enter the information, I shouldn’t be just thinking about the regulations, right, Ned? I should also be thinking about the public health implications of me sharing that data with other care team members. Because what goes around comes around, and if we want other people to help inform our clinical practice, we need to inform other people’s clinical practice.