Knowledge is power: Evidence-based clinical decisions lead to better patient care

Truven Health delivers unbiased information and analytic tools to hospitals, health plans, and other entities in the health care industry

One of the greatest things about practicing in pharmacy is that there are so many areas of specialization. From rounding with a multidisciplinary team up on hospital floors to medication reconciliation and discharge counseling, hospital pharmacists touch the lives of each patient they encounter. But what if one pharmacist could help millions of patients across the world? Pharmacists at Denver-based Truven Health Analytics are doing just that by providing hospitals with the latest, most relevant, and most important clinical information so that patients receive the best care possible.

Tina Moen, PharmD, Chief Clinical Officer at Truven Health Analytics, leads the Knowledge Development and Clinical Solution Executive teams within the organization.

Teams of pharmacy specialists at Truven Health scour more than 13,000 articles that are published every week in the medical literature to review and validate the best studies, practice guideline changes, and disease state information. Pharmacists summarize these important findings, which are then embedded in Truven Health’s Web-based software products. These products are purchased by health care organizations worldwide to help pharmacists and clinicians make therapeutic decisions. “The benefit of having pharmacists write the clinical content is that they understand all the nuances and can help review the literature in a useful way, which allows a pharmacist standing in front of a patient to make the best possible clinical recommendation,” said Tina Moen, PharmD, Chief Clinical Officer at Truven Health.

Formerly the health care business of Thomson Reuters, Truven Health delivers unbiased information and analytic tools to hospitals, health plans, and other entities in the health care industry. In addition to evidence-based clinical information, Truven Health also provides clinical profiling to help hospital pharmacists identify at-risk patients and meet meaningful use criteria. Truven Health’s technology products are currently implemented in more than 3,500 organizations in the United States and in approximately 1,800 organizations in 18 countries. “Improving the health of individual people is what improves the health of the population,” said Moen in an interview with Pharmacy Today. “The products across our segments work together to improve overall health worldwide.”

Kendra Grande, BSPharm, Moen, and Jennifer Avila, BSPharm (left to right), create, maintain, and deliver high-quality clinical decision support tools to enable improved patient care around the world.

Editorial process

Kendra J. Grande, BSPharm, an editorial manager at Truven Health, oversees a staff of 12 clinicians, including pharmacists, toxicologists, nurses, and a physician, who write all of the content for the company’s products. “Everything we write is read by pharmacists around the world who use this information to make their clinical decisions,” said Grande. “A big part of my role is making sure that [hospital pharmacists] are getting the most current information and the very best pieces of literature.”
Grande and her team cull through thousands of peer-reviewed studies each week to identify relevant drug and disease state information and practice guideline changes. The editorial team thoroughly researches and investigates the studies and their supporting evidence and statistics. “We don’t want to use a study that has not been validated and say it is the gospel truth because people will practice off that,” said Grande. “We spend a lot of time filtering the literature, looking at bias, looking at the stats, and focusing only on the pieces that clinicians really care about.”

The members of Truven Health’s editorial team are highly specialized. Each pharmacist is responsible for one area, such as psychopharmacotherapy, mental health, ambulatory care, oncology, pediatrics, and others. “We dive deep into the drug information and then discuss the literature write-ups and analysis,” Grande told Today.

She also oversees student pharmacists who come to Truven Health for summer internships or drug information rotations. “The students learn about medical publishing, writing, literature analysis, and how to write [an article] in a coherent manner,” said Grande.

Profiling patients

Once the editorial process is complete and the information has been reviewed and validated, the content is embedded within Truven Health’s clinical software. These products can be integrated into a hospital’s health information technology (HIT) and electronic medical records (EMR) system, providing hospital pharmacists and other clinicians with information about drug information, dosing, adverse effects, disease recognition and treatment, toxicology solutions and treatment, and alternative medications—all in one application.

Jennifer Avila, BSPharm, senior clinical implementation project manager, manages the implementation process once a hospital has purchased Truven Health’s surveillance product, Micromedex 360 Care Insights Suite, a solution that helps identify at-risk patients through patient-specific, single-source guided intervention and treatment. Avila specializes in the Pharmacy Intervention product of the 360 Care Insights Suite.

Avila first identifies all of the hospital’s players from the HIT side, the pharmacy side, and others who are involved in the development and launch process. “I’m a puzzle master and I like to solve problems,” said Avila, who worked as a hospital pharmacist for 15 years before joining Truven Health in 2001. She uses her pharmacy background and interest in technology to help set up the surveillance rules, teach clinicians how to use the tools, and troubleshoot the 360 Care Insights Suite.

A primary component of the software includes creating patient profiles. “A profile is a list of logic that identifies a set of patients that meet multiple, specific criteria,” explained Avila. “Patients that are identified by the profile are put on a daily rounding list for immediate care intervention.” Although profiles can be customized based on a health system’s needs, Truven Health offers prebuilt profiles in antimicrobial, anticoagulation, and glycemic monitoring; I.V. to “by mouth” conversions; narrow therapeutic monitoring; core measures and patient safety; and target medications—among others.

Avila, Grande, and Moen (left to right) evaluate clinical rules designed to alert pharmacists in real time of patients in need of intervention.

The real-time clinical surveillance allows pharmacists to monitor patients and their medications and treatment plans. For example, one day Avila was at a hospital on the West Coast training users how to create a profile to look for patients with high potassium levels who were receiving potassium supplements, which are contraindicated. “As we were building the profile, a patient popped up on that list,” Avila explained. “The pharmacist that I was training stepped away to tell another pharmacist to take a look at that patient and intervene in their therapy. There was no way they would have identified that patient without the surveillance system.”
The advantage of using electronic monitoring to create patient profiles is that instead of having “pharmacists spend a lot of time identifying patients that need to be physically monitored, this surveillance product brings that list to the clinician or care manager because they already built the logic into the profiles,” Avila explained.

Meaningful use applications

The 360 Care Insights Suite can also provide pharmacists with clinical decision support to meet meaningful use protocols. “From an editing standpoint, we pore through all of the [CMS] regulations and medical guidelines and figure out what the best practice is,” explained Grande. Once this information is embedded in the product, the software identifies specific patients and flags triggers for meeting meaningful use requirements. For example, Grande and her team researched all of the regulations for asthma and asthma treatment with inhaled corticosteroids. “We identified what was necessary to meet this core measure and we put it in a rule set [within] the profile so all [hospital pharmacists] have to do is plug this into their system and they get alerts and know when to intervene on those patients,” said Grande. Pharmacists can also document their actions to demonstrate meeting the core measure.

Pharmacists helping pharmacists

In addition to improving patient care through editorial content and clinical surveillance, pharmacists at Truven Health are also involved with educating hospital staff. “We partner with customers to help them maximize the value of our products and most effectively meet their objective to drive towards improved quality outcomes,” said Moen, who worked as a hospital clinical pharmacist before joining Truven Health in 2002. “My background, and the background of all the clinicians working at Truven, provides us a deep understanding of the day-to-day problems a pharmacist faces. We understand how to tie our products in to how we can help the customer be most effective in the delivery of exceptional patient care.”

From integrating clinical data into a hospital’s HIT system to providing accurate clinical content, the pharmacists at Truven Health have a passion for evidence and literature and a dedication to helping hospital pharmacists provide better, safer, high-quality care. “I’m proud of the work we do to find the best information and deliver it to pharmacists,” said Grande. “I know what it’s like to be a hospital pharmacist and wade through all the information and sort through the studies. Our goal is to make pharmacists better at their job so patients get the care they should.”