Health Records
Loren Bonner
As pharmacists play a more prominent role in a patient’s health care, having medical record access is a necessary component. Take Paxlovid, for example. Pharmacists have been given the authority to prescribe Paxlovid to treat COVID-19–positive cases, but not being able to see a patient’s medical record data has been a noticeable barrier.
“We can prescribe this medication, but I need access to a patient’s kidney and liver labs,” said Rannon Ching, PharmD, president and chief pharmacy officer at Tarrytown Pharmacy in Austin, TX.
These lab tests are part of the process to ensure a patient can safely take Paxlovid.
More concretely, giving pharmacists access to medical record data is a way to prepare pharmacists and the entire health care system for the next pandemic.
Faculty and staff at the University of Texas at Austin recognized this and have dedicated funding to a program called Texas PharmCare, which will help resolve some barriers to obtaining medical records and allow pharmacists to easily access the information necessary to assist patients with their needed medication treatment.
Samuel Poloyac, PharmD, PhD, dean of UT Austin’s College of Pharmacy, said they are working with Tarrytown Pharmacy, located close to the university, on the initial implementation of the program, and then plan to partner with H-E-B Pharmacy on future regional expansion.
Poloyac and other program leaders are currently collaborating with two software companies to integrate a patient’s medical record data into a pharmacy workflow system.
Evidence and data
Poloyac said the program is currently being geared toward diabetes and hypertension management, where evidence clearly points to a pharmacist’s ability to improve patient outcomes for these disease states. Other diseases could be added down the road.
“We know how to improve diabetes for patients, but we don’t know how compliant patients are with their care,” said Poloyac. That’s where medical record information would come in.
Prior research has found that MTM outcomes could be improved with medical record access for pharmacists. According to a JAPhA study from 2019, when community pharmacists completed MTM interventions for patients, the EHR information was enough to have led to completion of 39% of cases—without patient or prescriber contact, based on a case-by-case determination by the researchers.
The study authors concluded that “community pharmacists performing MTM interventions are hindered by lack of access to patient health information, imprecise patient targeting by MTM platforms, and cumbersome communication between pharmacists and prescribers.”
Another study published in JAPhA from 2011 found that pharmacists in patient-centered care practices, such as those providing MTM activities, were more likely to adopt an EHR for medication history and laboratory values, whereas pharmacists whose practice was focused on medication dispensing primarily used an EHR for patient demographic and dispensing records. The research study took place in Edmonton, Canada, at independent and chain community pharmacies, grocery store pharmacies, and in long-term care settings.
Once the Texas PharmCare program expands out to H-E-B, Poloyac said he hopes to have more concrete patient data. Ideally, and depending on funding, he said the program could serve as a template not only within Texas, but for other states across the nation.
Workflow
Poloyac emphasized that the medical record information pharmacists would have access to must be integrated into a pharmacist’s workflow.
A pharmacist wouldn’t see a complete patient medical record in their workflow management system, however. The goal is to integrate specific information while also being compliant with health record data ownership.
Ching said the integration of the medical record would be similar to the current bidirectional nature of immunization records—where they can see the patient’s immunization records in addition to contributing to them. ■