Community pharmacists don’t necessarily know when their patients are admitted to the hospital. They don’t have universal access to patients’ labs. If patients use multiple pharmacies, community pharmacists may not have a complete list of their medications. These pieces of information, however, are crucial to patient safety and outcomes where prescribing and dispensing are concerned.
“For pharmacists to perform their functions, they have to have the appropriate information. That includes labs, indication for use of the medications, the problems that the patient shows, allergy information, functional assessment information such as cognitive abilities, and functional abilities, such as whether they can swallow or whether they can pick up their medications,” said Shelly Spiro, BSPharm, FASCP, Executive Director, Pharmacy HIT Collaborative.
Pharmacists can help improve patient outcomes in numerous ways when armed with complete information about their patients. Accessing that information, however, may be easier said than done. The level of access—if any at all—that state, local, and regional health information exchanges (HIEs) grant pharmacists varies widely from state to state.
Tennessee-based pharmacist Samantha Boldin, PharmD, accesses the East Tennessee Health Information Network (etHIN) every day at independent Belew Drugs in Knoxville.
“The main reason I signed up was to help patients coming home from the hospital—to see what happened while they were in the hospital [and] what changes were made to their medications,” said Boldin. “Unless the pharmacist asks for that information, we’re out of the loop.”
Pharmacists with HIE access can make a major impact on patient care during hospital-to-home transitions. And the benefits of HIEs don’t end there. Boldin uses etHIN during medication therapy management sessions to educate patients on why they are taking a particular medication, and to confirm through lab results whether a medication is working, among other uses.
The type of information access that Boldin enjoys in Tennessee, however, is the exception and not the rule. “They did years of groundwork at the Tennessee Pharmacists Association to ensure that happened,” said Spiro.
While the Office of the National Coordinator for Health Information Technology recognizes pharmacists as health care providers, many HIEs are governed by the Social Security Act’s definition of health care providers, which excludes pharmacists. As such, the HIEs exclude pharmacists as well. Some exceptions exist where pharmacists are granted access to immunization registries or prescription drug monitoring programs in order to share information, but not necessarily to receive it.
While the barriers to access are substantial, the benefits are, too. “It leads to optimizing medication therapy management services [and is] critical for comprehensive medication reviews that are needed on patients, especially those who are in the Medicare Part D program or in the aging population,” said Spiro.
The National Alliance of State Pharmacy Associations and Pharmacy HIT Collaborative serve as resources to state associations that are fighting for access for their constituents. “If you have interest in this area,” Spiro said, “contact your state pharmacists association and get involved.”