Medically Integrated Specialty Pharmacies Can Leverage Electronic Medical Records to Improve Quality of Care

Ben Urick, PharmD, PhD, is the Health Outcomes Research Principal at Prime Therapeutics, LLC, in Chapel Hill, North Carolina. Urick joins Pharmacy Times at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 Conference (October 16 through 19) in Orlando, Florida, to discuss medically integrated specialty pharmacies. Urick takes a deep dive into how these pharmacies are working to leverage access to electronic medical records and improve quality patient care, reduce medication waste, and provide opportunities for closer patient monitoring.

PT Staff: What technologies or systems do medically integrated specialty pharmacies use to improve efficiency and patient outcomes?

Ben Urick, PharmD, PhD: So, 1 thing that differentiates medically integrated pharmacies from traditional mail or pharmacies for specialty is that medically integrated pharmacies have access to the electronic medical record (EMR). And this access provides a lot of benefits.

So not only do you have things like therapeutic monitoring, because you can see levels and you can see things like kidney function and liver function to ensure that therapy is appropriate, but you can also see, for example, when upcoming assessments are being scheduled. So members, especially if they're early in their treatment for oncology, have routine assessments. And oftentimes those assessments can lead to a change in therapy. So, a pharmacist and a medically integrated pharmacy can look at the EMR, see if there's an upcoming assessment, make an assessment for themselves (on whether or not the member has enough supply on hand to make it through that assessment window), wait that period to then make sure that, after that assessment occurs, the therapy should be continued as was originally prescribed. So, the EMR is 1 of the key technologies with that.

And then the EMR can be leveraged in a variety of different ways. So, there are some pharmacies that likely use the EMR better than others. One thing that makes a big difference is using the EMR to track the impact of pharmacy services. if a pharmacist is making a decision to delay a refill of a therapy, they can note that in the EMR and then that note can be used, for example, as a part of quality improvement or can be used to communicate value of pharmacies. Again, leveraging the EMR is something that that differentiates a medically integrated pharmacies from others.

PT Staff: How do medically integrated pharmacies improve oncology outcomes and how can pharmacists be involved with these quality measures and making improvements?

Ben Urick, PharmD, PhD: Medical integrated pharmacies can improve quality of care for oncology and a number of different ways. One of the key ways they could do this is through closer patient monitoring. So around things, for example, like side effects and toxicity, it is of critical importance for the pharmacy as well as the provider to be aware of these things as soon as possible. So medically integrated pharmacies tend to be quite in touch with their patients. And when they are making outreach calls to these patients, they can ask specific questions around toxicity and side effect management.

There's good examples of pharmacists implementing programs like that. When that pharmacy hears that a member may be experiencing toxicity from a medication, they can send that information directly back to the provider through the EMR that has the capability that traditional mail-order specialty pharmacies simply do not have. And through that greater monitoring for side effects, as well as toxicity in addition to efficacy, pharmacies can potentially improve cost of care.

Another key way in which member care can be improved as to waste reduction. So no member wants to have a vial of medication sitting at home that they've used half of that cost them hundreds of dollars and is now toxic…just sitting around on their shelf [and] not knowing how to dispose of it and regretting the fact that they have hundreds of dollars worth of medication that they can no longer use. If pharmacies are engaged in assessing whether a refill needs to occur before a patient assessment, the pharmacist, working closely with the provider, can try to reduce medication waste that reduces that burden on members in addition to reducing cost in terms of hard dollar savings through reduced medication waste.