Improving Patient Care with Access to EMRs
Ms. Whitney is a PharmD Candidate at Lake Erie College of Osteopathic Medicine (LECOM) in Bradenton, Florida. Dr. Wilkinson is an associate professor and chair in the Department of Pharmacy Practice at LECOM.
The United States spends more on health care than any other industrialized country, yet falls behind on care quality, accessibility, and efficiency. One proposal for lowering health care costs and improving quality is the adoption of health information technology (HIT). President Barack Obama has pledged to invest $10 billion a year over the next 5 years in the development of electronic health information systems, including electronic medical records (EMRs).1 Researchers at the RAND Corporation estimated that successful adoption of EMRs could eventually save more than $81 billion annually by significantly improving health care efficiency and safety. They further predict that information technology-enabled prevention and management of chronic disease could double those savings.2
Government intervention may en courage and facilitate the development of electronic health information systems. The development of such systems will depend, however, on the collaboration and coordination of care providers and frontline workers. It will be extremely important for pharmacists to take part in the progression of EMRs to ensure that the profession is wellprepared, and no pharmacy is left behind.
In order to maximize the potential of HIT, all care delivery organizations must fully adopt the use of EMRs. A fully electronic environment will enable the instantaneous exchange of medical data among authorized health care providers within the community, state, and nation.3 Currently, community pharmacists have little or no access to a patient’s health records, making it difficult to collaborate and coordinate care with physicians and other health care providers. Although the lack of HIT is not the only factor, this technology will be essential if we wish to transform pharmacy from a productoriented profession to a more patientoriented one.
Community pharmacists, who ac count for the majority of pharmacists nationwide, are willing, able, and eager to collaborate with other health care providers in order to help patients achieve positive therapeutic outcomes. Patients and care providers could greatly benefit from pharmacists’ cognitive services, especially when relevant information about patients’ conditions is at hand.
The demand for health care services in the United States will increase in the coming years because of the aging population. The majority of Americans aged 65 years or older suffer from at least one chronic disease, which could be prevented with proper changes in lifestyle or managed with appropriate drug therapy.4 About 75% of the national health expenditure is on chronically ill patients.2 Unless chronic diseases are wellmanaged and preventive care measures become part of our daily routine, the cost of health care will continue to rise. Better coordination and communication across providers dealing with chronically ill patients and patients seeking preventive care could yield a better health care delivery system.
EMRs could grant community pharmacists access to a patient’s diagnosis, lab results, vital signs, allergies, treatment plans, desired treatment out comes, clinical progress notes, and social, health, and medication history. They could also provide room for documenting counseling sessions, observations, assessments, and recommendations, which can be instantaneously accessed by other authorized health care providers. Because community pharmacists encounter multiple patients daily, many of whom are regular, chronically ill visitors, they can use EMRs to more effectively screen, monitor, and provide counseling sessions. Additionally, they can provide appropriate recommendations to other health care providers.
Access to a patient’s social history could enable community pharmacists to practice preventive care measures by helping formulate plans that meet patients’ specific needs. For example, if a pharmacist wishes to provide smoking cessation counseling sessions to a patient who has tried to quit several times, it is more likely that the pharmacist will be successful if he is aware of previous difficulties or addiction tendencies recorded by other health care providers during past encounters with the same patient. The same could be said for pharmacists who wish to provide counseling services for the prevention of hypoglycemia, diabetes, obesity, and hypertension.
EMRs will facilitate the adoption and utilization of electronic prescribing (eprescribing). This system is expected to improve the quality of patient care by reducing handwritingbased errors and by providing warnings and alerts at point of prescribing. It will also provide prescribers with information about medications a patient is already taking, including those prescribed by other health care providers. This will help ensure that prescribers are aware of possible drug—drug and drug–allergy interactions, drug appropriateness, correct dosage, contraindications, and duplications.5
It has been estimated that eprescribing could save $27 billion annually and could prevent more than 2 million adverse drug events, from which more than 130,000 are life-threatening. 6 This estimate does not take into consideration the time that could be saved in community pharmacies by reducing clarification callbacks to prescribers, paperbased prescription dropoffs, fax or telephone refill requests, and interpretation of handwritten prescriptions. Freeing pharmacists from these tasks could eventually result in better patient care quality and reduced health care costs.
Although the US government may eventually finance the implementation of EMRs, other barriers may hinder its use in community pharmacy. Those barriers may include the following: (1) current models and policies in community pharmacies do not fully support pharmaceutical care practices, (2) community pharmacists do not get reimbursement for cognitive services, and (3) other health care providers may be unaware of the benefits of community pharmacy connectivity and thus may lack interest in sharing patient data.
HIT can improve the health care system by serving as a communication tool among health care providers. With an aging population and an increasing number of patients with chronic illnesses, the need for qualified, accessible health care professionals who can effectively coordinate care will also increase. Pharmacists are trained and ready to become truly involved members of the health care system. It is a pharmacist’s responsibility to collaborate with other health care providers to ensure the safe and effective use of medications, optimize and monitor disease therapy, and help prevent and manage chronic diseases. It is also a pharmacist’s responsibility to become informed of a patient’s condition in order to properly counsel and educate him/her.
EMRs will be the tool pharmacists can use to collaborate and coordinate care with prescribers and other health care providers. It is up to the profession to show interest and advocate for inclusion of community pharmacy in the development of electronic health information systems.