Health data are everywhere, from medical records at a physician’s office, to prescription information at pharmacies, to test results at hospitals. The challenge with all this health data is that they’re not in a useful, shareable, quantifiable format. Samm Anderegg, PharmD, MS, BCPS, believes pharmacists can change that.
“The key to the future of our profession is data. Discrete data. Robustly stored, easily exchanged, [easily] displayed data. We can do so much with data,” said Anderegg, Pharmacy Manager of Oncology and Ambulatory Care Services at Georgia Regents Medical Center in Augusta.
Anderegg gave a presentation about leveraging technology across the care continuum at the 2015 American Society of Health-System Pharmacists Summer Meetings.
He kicked off his session by asking hospital pharmacists in the audience how they document clinical pharmacy services at their organizations. Responses included third-party systems, custom software added to the hospital’s electronic medical records system, and a software program called Progress Notes.
Anderegg surmised that most of those current documentation systems use free text, which is a typographic representation of data, where health professionals type in everything they know about the patient. “You can’t do too much with this information,” said Anderegg. For instance, with a Progress Note, all you can do is read it and print it, he noted. “This is the 21st century! We can do so much better than this,” Anderegg added.
He explained that instead of using free text to describe a patient’s condition, medication, and other information, “discrete data” should be used to “codify clinical information in a structured document.”
Anderegg showed how discrete data, such as whether medication reconciliation was performed at admission and discharge, could be pulled from a Progress Note. Discrete data are “black and white, yes and no data points,” he said.
Once you have discrete data points, you can perform calculations and see, for example, that 90% of patients had medication reconciliation completed at admission and 60% of patients had medication reconciliation completed at discharge, he explained. Discrete data can be compiled over time to identify patient trends.
According to Anderegg, to integrate pharmacists into the interoperability framework, we need to develop intervention codes that are specific to the care that pharmacists provide to patients. “Once you have the vocabulary, then you can build your system out so it’s exchange ready so you can share the information with other providers,” he said.
SNOMED CT codes are considered the gold standard for documenting clinical information. There are three types of codes: the reason you are providing the service, the action taken or procedure, and the outcome.
Using codes that correspond to discrete data allows health care providers to run reports, such as identifying the most common diseases at an institution or if patients are meeting their goals. “You can even break it down to see how many encounters a individual pharmacist conducted, how much time they spent with a patient, or see which pharmacists have their patients at goal,” said Anderegg.
The next step is to share discrete data across the care continuum. Clinical Document Architecture (or C-CDA) provides a common framework for the development of electronic clinical documents to capture, store, and transmit data from one institution to another.
For instance, if patients are discharged from the hospital and go to their community pharmacy with a slew of prescriptions, “wouldn’t it be nice to know what happened to them while in the hospital, what their medication list should look like, and their plan of care moving forward?” said Anderegg. “Think of the larger impact we could make as pharmacists if we could continue that care.”