Collecting and sharing data in specialty pharmacy
For health systems to survive in the changing health care landscape, data are crucial. Hospital programs and departments must continually prove their worth to payers, vendors, and patients by demonstrating positive revenue and patient outcomes. Specialty pharmacies are no exception. How they choose to collect and share that data is of paramount significance.
Specialty pharmacies might build the appropriate software internally, purchase it from a third-party vendor, or configure their existing electronic health record (EHR) platform to capture the desired data. The route that the department takes depends on several key considerations, which panelists discussed in the session Applying Informatics in the Specialty Pharmacy Arena at the 2015 American Society of Health-System Pharmacists (ASHP) Summer Meetings in Denver.
Defining specialty pharmacy
How a specialty pharmacy chooses to collect data and what data it chooses to collect depend in large part on how that health system defines its specialty pharmacy.
“When it comes down to it, day to day, our specialty pharmacy operates like any other medical specialty,” Jack Temple, PharmD, MS, told Pharmacy Today in an interview after the meeting. Temple is manager of information technology and medication use systems at University of Wisconsin Hospital and Clinics.
“You have a patient with a specific disease state, you look at both diagnosing and treating them, you do longitudinal follow-up with that patient over the course of the therapy, and at times you need to send recommendations back to their primary care provider after they receive that specialty care,” Temple said.
Seeing the specialty pharmacy as a medical specialty rather than a pharmacy means that certain informatics systems will be more suited to the specialty pharmacy than others.
Determining the data to collect
Specialty pharmacies may be driven to report on revenue alone, but in the long run, patient outcomes demonstrate the department’s worth, said Andy Pulvermacher, PharmD, specialty services supervisor for University of Wisconsin Hospital and Clinics, during his presentation at ASHP.
“Outcomes are the only reason we’ll be able to stay in specialty pharmacy 3 to 5 years from now. If we can’t report on what we’re doing for our patients, on the quality that we’re providing our patients, we’re going to be carved out of contracts with payers and with manufacturers,” Pulvermacher said.
Specialty pharmacy leaders should bear in mind that multiple entities will be interested in the data they collect. Each party—including payers, providers, industry, and health-system chief officers—wants different information in a different format.
Standard marketplace metrics, such as telephone wait times, prior authorization approval rates, and time to initiation, don’t necessarily capture the data that a specialty pharmacy wants to collect. “These metrics are in place within the specialty pharmacy arena, but they don’t really speak to the quality of the interventions that pharmacists can make on behalf of patients,” Pulvermacher told meeting attendees. He advises specialty pharmacies to collect data that demonstrate quality.
The bottom line, he says, is that the data one chooses to collect and report should fill an identifiable gap.
Identifying the right platform
Some specialty pharmacies build a program for data collection internally, others purchase a third-party platform, and still others configure the health system’s existing EHR to fit the pharmacy’s needs. All these options bring advantages and challenges.
The EHR is already integrated into the health system. This allows pharmacists to access existing information on patients, such as labs, current medications, and doctor visits. Pharmacists may also identify tools in the EHR that they can put to use in the specialty pharmacy.
“We saw a lot of tools that other departments were using that we could fold in and use in our own patient management—patient portals, electronic prescribing, communication within the EHR, and referral tracking,” Temple told ASHP attendees during the session.
However, the tools in an EHR are typically broad and often dependent on other functions in the EHR to work properly. They are most likely not ready for immediate use in a specialty pharmacy. Clinical pathways that a specialty pharmacy might like to see in its informatics system need to be built into the system from scratch. Labor-, resource-, and time-intensive configuration and customization are usually required before a specialty pharmacy can use an EHR for its own data collection.
In many third-party systems, the tools are specific enough for specialty pharmacies and the clinical pathways are already present. For these reasons, customization and enhancements to the system can happen quickly. But stand-alone third-party systems can be a challenge to integrate with informatics platforms already in use in the health system. Users may need to integrate and manipulate the data manually, which requires more time and resources.
To some degree, specialty pharmacies need to integrate data from multiple sources regardless of the primary platform used for data collection and reporting. “Our value proposition is our data, and the only way we’re going to be able to provide that data is by looking at the systems we have and integrating that data from multiple sources together to provide meaningful reporting,” Pulvermacher said.
Putting informatics into practice
Platforms in use in specialty pharmacies run the gamut from the systemwide EHR already in place in the hospital to a collection of third-party and internally developed applications used in conjunction with the EHR, each for different functions in the department’s workflow.
The specialty pharmacy at Uni-versity of Wisconsin Hospital and Clinics built out the existing EHR for use in the pharmacy.
“The tools that have already been developed for outpatient ambulatory visits in a health care system, and even some of the tools on an inpatient acute care hospital side, would deliver the same functionality we wanted to have in our care of patients in our specialty pharmacy program,” Temple told Today .
Using the EHR allows UW’s specialty pharmacy to see a patient’s visit history across health-system departments, the patient’s labs, and other medications among the abundant other information that pertains to a patient in a health-care system.
“It came down to being able to leverage care and documentation in our health-care system that wasn’t specific to the medication itself, for a holistic view of the patient care and how the patient is doing,” he said.
UW’s system, organized by disease state rather than by medication, is designed for enhancements over time. The platform is set up for multimodal visits as the pharmacy anticipates increasing the number of e-visits and in-person visits, in addition to the customary telephone consultations, in the coming years. Users have access to a number of other “plugin” components that they can put into use as the pharmacy innovates and evolves.
The specialty pharmacy at Vanderbilt University Medical Center took a different tack. Their clinic uses the hospital EHR in addition to internally developed and third-party applications. Will Walker, PharmD, an informatics pharmacist at Vanderbilt, explained the system to ASHP attendees.
“There were little pieces of all of them that we liked, so we’ve molded something together that works for us,” Walker said during the session.
Vanderbilt Specialty Pharmacy developed an opportunity management system internally. This platform allows the pharmacy to track all patients who come into the hospital already on specialty medications. The system allows for logging of the patient’s insurance information, demographic information, and medication list.
Walker added, “The opportunity management system was meant to be a short-term solution. We were going to use it for a month, learn from it, and then abandon it, but in that month’s time, we found so much value in it that it’s still with us today.”
Walker noted during his presentation that systems developed in-house are ideal for the pharmacy that wants to learn what kind of data to collect as it goes. “If you’re not sure what you need yet, the best thing is a homegrown application,” he said.
Vanderbilt Specialty Pharmacy uses a referral management system purchased from a third party. This platform assists pharmacists and technicians in scheduling refills and records and reports information that payers require. The department also uses the hospital EHR, dispensing software, and an electronic prescription writer.
Toward an effective platform
The data collection and reporting methods at Vanderbilt University and University of Wisconsin represent two among many possible solutions. An effective platform will allow specialty pharmacies to collect data that fills a gap, inform the diverse interested parties, and demonstrate the quality care that pharmacists can provide patients.
ICD-10: Newer procedures and diagnoses
ICD-10 includes more than 68,000 unique codes compared with ICD-9’s approximately 13,000 codes. This expansion allows for a specificity unseen in ICD-9.
A forearm fracture coded “S52.521A” specifies “torus fracture of lower end of right radius, initial encounter for closed fracture.” Here, the up-to-seven character notation specifies the type of fracture, the side, and more precise location, in addition to information about the visit.
“You’re able to drill down into the area of a nerve that’s affected by the disease,” said Samm Anderegg, PharmD, pharmacy manager of the oncology service line at Georgia Regents Medical Center in Augusta. Anderegg is a member of the Coding Workgroup in the Pharmacy Health Information Technology (HIT) Collaborative, a coalition of pharmacy organizations, including APhA, working to ensure that the pharmacist’s role in patient care is integrated into HIT.
ICD-10 codes can also describe comorbidities or secondary diagnoses, such as “diabetes mellitus with associated neuropathy.” “With this level of specificity, you’re able to understand better how these disease states affect one another,” Anderegg said.
Because ICD-9 was in use for nearly 40 years, it does not reflect the newer procedures and diagnoses. ICD-10 allows for new procedures and diagnoses to be added as they arise.