The potential for pharmacists to contribute to the federally defined “meaningful use” of the electronic health record (EHR) continues to grow, but the money is another story: pharmacy groups do not know of any pharmacist arranging to share in the related incentive payments for which physicians and hospitals are eligible.
Pharmacists can help physicians and hospitals meet their meaningful use requirements, said Rachelle F. Spiro, BSPharm, FASCP, Executive Director of the Pharmacy e-Health Information Technology (HIT) Collaborative. “There are huge opportunities for pharmacists to get involved in the process,” she added, citing aspects of meaningful use such as immunizations, transitions of care, medication reconciliation, and engaging patients to give them access to their medical records.
Asked for hypothetical circumstances under which community pharmacists could navigate the incentive process, Spiro replied, “There really is no process in place to do that. There would have to be an agreement between the hospital or clinic or physician’s office that would bring the pharmacist into that model.”
The story is similar on the hospital side. “There’s really no limit here, I think, for pharmacist involvement,” said Karl F. Gumpper, BSPharm, BCPS, FASHP, Director of the Section of Pharmacy Informatics and Technology, American Society of Health-System Pharmacists (ASHP). “Ensuring that the hospital is receiving the optimal reimbursement would benefit the institution in the long run. Maybe not that pharmacist specifically, but overall the institution.”
On September 4, CMS and the Office of the National Coordinator for HIT published final rules to govern the second stage of the Medicare and Medicaid EHR Incentive Programs and to update certification criteria and standards, respectively.
Meaningful use is the set of standards defined by the programs for the use of EHRs. The goal of meaningful use is “to promote the spread of [EHRs] to improve health care in the United States,” according to HealthIT.gov. The CMS regulations define the minimum requirements that providers must meet through their use of certified EHR technology to qualify for bonus payments.
Aimed at physicians and hospitals, the meaningful use regulations continue to implement the Health Information Technology for Economic and Clinical Health Act, part of the American Recovery and Reinvestment Act.
At Marshfield Clinic in Wisconsin, stage 2 of meaningful use “is currently under review, but the requirements are greater,” noted Gary S. Plank, PharmD, Corporate Director of Pharmacy Services at the clinic. “The role of pharmacy in supporting the meaningful use of an [EHR] will continue to expand.”
Because Marshfield Clinic developed its own EHR, pharmacists there collaborate in both the development and the deployment of the e-prescribing platform, including key clinical decision support initiatives, according to Plank.
The Walgreens chain, meanwhile, plans to have an EHR installed in all of its nearly 8,000 stores by the end of next summer. In a deal announced August 22 by Greenway Medical Technologies Inc., Walgreens pharmacists will be able to see the patient’s prescription profile and health testing and immunization history in a single view.
In the hospital setting, pharmacists are involved in the implementation of the computerized provider order entry (CPOE) system, clinical decision support, clinical quality measures with medication-related parameters, e-prescribing, med rec, and the requirement for the electronic medication administration record in real time, Gumpper explained.
Meaningful use has had a “huge impact” on day-to-day work, based on data from annual national surveys by ASHP, according to Gumpper. In 2011, 50% of hospitals had done bar code med administration, and another 34% had done CPOE. The 2012 numbers are even better—66% for bar code med administration, and 54% for CPOE. “I would assume much of that [increase] is related to meaningful use,” he said.
As institutions move toward meaningful use, “pharmacists are getting pulled into more directions, with more responsibility of making sure that all pieces of the record work,” Gumpper said. “They may not put it together that it’s meaningful use, but that’s part of the motivator by the institution.”