Pharmacy

Providers can now view a complete picture of a patient’s prescribing history to help combat doctor shopping.

Partners HealthCare, Triad Healthcare undertake separate initiatives focused on reducing costs with by delivering notifications to clinicians about patients not complying with treatment regimens.

NHS chief executive Simon Stevens has urged the NHS to go faster and further in building on its reputation as a ‘hotbed of innovation’. However it takes a special set of circumstances for this to happen, and the School of Pharmacy at Keele University is showing how it can be done. Its health technology innovations are transforming clinical education and, ultimately, patient care. BJ-HC found out more about two of its most compelling products, its augmented reality (AR) clinical simulator, and its avatar-based pharmacist training. Augmented reality enables better patient care The Keele Augmented Reality Environment (KARE) allows students to practice patient diagnostic and communication skills on virtual patient avatars that respond realistically to the drugs prescribed. In-house developers worked with clinicians to create a mobile app linked to a QR-style card. When scanned, students get to see a 3D pop-up patient to support clinical simulation and communication skills training. “We wanted to use real-world devices with a domestic use so that we could scale quickly,” said Luke Bracegirdle, Head of Digital and Business Analytics at the School. “We had already developed an on-site simulator, but this was limited to one student at a time. KARE can be used on any mobile device, by all our students.” PharmaCard playing card Students have been so impressed that they have invited peers from the British Pharmaceutical Students’ Association to show how they are using augmented reality.  Some even have cards printed on t-shirts, to scan on their phones and see a patient jump out at them. Fostering the right factors for innovation Such innovation is fostered by the special environment Keele has created. Developers work on campus with clinicians and students to understand real-life healthcare problems. They then apply the best technology to solve those problems. They work as part of non-hierarchical, interprofessional project teams and all contribute to the final product. Internal experts inform how the technology meets appropriate clinical standards, and PhD students and researchers are on hand to evaluate the clinical evidence base. This means that Keele School of Pharmacy has a fertile environment for innovation. It can ensure that it is creating solutions that meet the needs of end users, and can provide the evidence and accreditation that show how its innovations work in practice. Avatar-based pharmacist training sees better test scores The School also has impressive connections across health and pharma. These have helped inform its work with pharma giant Bayer on Virtual Patient. This avatar-based interactive training enables community pharmacists to simulate how they would advise a newly-diagnosed atrial fibrillation patient. Students are given options on how they would interact with a patient who comes into a pharmacy with a newly-prescribed oral anticoagulant. The wrong answers lead to a stern rebuke from the patient. Users can take the test until they get the perfect score, long before they need to do so in real-life. This innovation is seeing students helps improve patient communication. It is also helping pharma slash the cost and increase the availability of training, removing the need for staff to attend a physical session, using these technologies as part of distance learning for continued professional development. Luke Bracegirdle, Head of Digital and Business Analytics, Keele University An unofficial academic digital exemplar These are just two highlights of the work happening at the School of Pharmacy at Keele. Its ‘PharmaCard’ app allows students to use AR as a revision guide to explore drugs at a molecular level, by scanning playing cards that present 3D models of a drug. In earlier work, visualising drugs as 3D models led to students achieving 9% higher test results during assessment. It has also launched a Manage Your Health app for asthma patients, showing how its approach to digital health has created the right set of circumstances to enable it to deliver innovations with impact.  KARE, for example, can be used for more than just pharmacy training. “We are looking at how we can adapt it to model heart failure, for use by patients, students and others,” said Bracegirdle. “We could represent any type of clinical condition with a simple card.” When looking to fulfil the promise that the NHS is a hotbed of innovation, global digital exemplars might get the attention. But Keele’s School of Pharmacy is an unofficial academic digital exemplar that is delivering on this vision.

Diagnostic errors can lead to serious consequences, such as care gaps and unnecessary procedures, while opioid safety should be prioritized due to the seriousness of its side effects.

E-prescribing vendor DrFirst deploys cloud-based drug knowledge to support Nebraska's PDMP.

Michigan, like much of the rest of this country, is in the midst of an opioid crisis. The number of opioid prescriptions, individuals in substance use disorder programs and, worst of all, opioid-related drug overdose deaths have all increased from 2011 to 2015 in the state. Michigan has turned to health IT to try to accomplish two goals: prevent overprescribing and over-dispensing by health professionals, and improve patient care for individuals suffering from substance use disorders. “We are attempting to prevent overprescribing and over-dispensing in two ways,” said Kim Gaedeke, acting deputy director of the Department of Licensing and Regulatory Affairs for the State of Michigan. “First, equipping Michigan physicians and dispensers with real-time patient data to be viewed prior to prescribing and dispensing schedule 2-5 controlled substances and dissuading overprescribing through disciplinary and enforcement actions.” [Also: Senator proposes bill to incentivize states to share PDMP data with law enforcement] Michigan health officials selected specialized vendor Appriss Health for its substance use disorder system NarxCare. The vendor works with 46 states that are sharing PDMP data across state borders to inform physicians and pharmacists at the point of care of a patient’s Rx history to avoid overprescribing or those who are doctor shopping. NarxCare provides participating physicians and dispensers with an abundant amount of patient history and data to help determine the degree to which the patient is at risk for substance use disorder, Gaedeke added. This helps inform a health professional’s clinical diagnosis.   "In the past, it would take health professionals on average 5-10 minutes to pull up a patient report. The state has experienced a return on its investment with an annual savings of roughly $1 million in staff costs." Kim Gaedeke, State of Michigan “Additionally, we are able to use individual and statewide prescription and dispensing data to determine overprescribing and over-dispensing by health professionals,” she said. “The state uses this data to follow up with disciplinary actions against health professionals who are overprescribing or over-dispensing.” [Also: Joining opioid fight, North Carolina signs on to PDMP data sharing collective] The second way Michigan is attempting to prevent overprescribing and over-dispensing is through the system’s ability to determine the degree to which a patient is susceptible to substance use disorder and, if necessary, provide ways to help that patient. “The additional resources can be presented within the health professional’s clinical workflow,” Gaedeke said. “This assures that the patient immediately receives appropriate assistance during a visit. This technology has helped transform the traditional model of a Prescription Drug Monitoring Program to a more robust clinical, care management, analytical and prevention tool.” The NarxCare technology fits into the clinical workflow by being integrated into a physician’s electronic health record system or a pharmacist’s dispensation system. This direct integration of the systems allows for the physician or pharmacist to stay in the software, and if the same patient is also in the state’s PDMP, called MAPS for Michigan Automated Prescription System, the patient’s data in MAPS automatically appears in the health professional’s EHR or pharmacy dispensation system without requiring the practitioner to log in and out of two separate interfaces. “Once the provider clicks to view on the NarxCare report, the practitioner can see the full data set of the patient such as risk scores, Medical Morphine Equivalent, and history of schedule 2-5 controlled substances that have been prescribed and dispensed to the patient,” Gaedeke explained. “In addition, it includes any red flags such as whether the patient has gone to multiple doctors or pharmacies in a short period of time to obtain the same prescriptions, indicating possible substance use disorder or drug diversion.” Based on an interactive visualization of usage patterns to help identify potential risk factors, the physician or dispenser can determine the appropriate course of action for treatment, she said. Since implementing the Appriss Health technology in April 2017, Michigan has documented a decrease in the number of Michigan residents receiving an opioid prescription and decrease in the rate of doctor shopping by patients, she said. She added the state expects a drop in the total number of controlled substance prescriptions filled in Michigan from 2016 to 2017 once the data is tabulated and finalized. “Additionally, the improvement in technology has increased the number of health professionals using the new MAPS/NarxCare platform,” she explained. “The increase in the number of users further contributes to aggregated data that is collected and analyzed to better inform clinical diagnoses by individual health professionals and potential enforcement actions by our department.” The state’s Department of Licensing and Regulatory Affairs, where MAPS is housed, has also experienced overall efficiencies with the new system compared to the old system by instantly providing data in real time along with system reports in less than half a second for its users, she added. “In the past, it would take health professionals on average 5-10 minutes to pull up a patient report,” she said. “The state has experienced a return on its investment with an annual savings of roughly $1 million in staff costs. Prior to replacing the state-maintained system, the state went from 13.5 FTEs to now 4.25 FTEs.” And ultimately, Gaedeke said, with the innovations and efficiencies created with the new MAPS/NarxCare platform, the Department of Licensing and Regulatory Affairs has been able to better identify licensed health professionals who are overprescribing, over-dispensing and diverting drugs, which has allowed for improved regulatory actions and in many cases more swift action taken by the department and its licensing boards. “Technology plays a vital role in our fight against the opioid epidemic and substance use disorders in Michigan overall,” she said. “Technology allows health professionals to go beyond their individual instincts or preconceived notions by providing them with access to comprehensive real-time data with a single click in their existing electronic health records.” Twitter: @SiwickiHealthIT Email the writer: bill.siwicki@himssmedia.com

Medicomp Systems launches new addiction care management system and DrFirst unveils new mobile e-prescribing system.

The Every Prescription Conveyed Securely Act calls for mandated e-prescribing under Medicare Part D, starting in 2020.

Health IT is critical to deliver the right data to the right place at the right time and empower clinicians and pharmacists to make informed decisions.

The legislation, introduced by Sen. Bill Cassidy, is designed to help law enforcement better identify bad actors.