Why EMRs Don't Cut It and a Better Solution

When we set out to develop the Meds 360° medication management platform, we wanted to eliminate the information gaps, inconsistencies, and inaccuracies that contribute to patient harm resulting from medication nonadherence, medication errors, and adverse drug events.

Through first-hand experiences and discussions with clinicians nationwide, we knew about the medication management challenges facing practitioners and their patients today. The healthcare providers we spoke with all had stories about how the solutions intended to help them deliver safe, high-quality care had come up short concerning medication management.

In a series of articles that will be published in the coming months, we will describe common patient scenarios that demonstrate some of the challenges associated with medication management. We will also discuss how the shortcomings of technology used by organizations today and existing medication management processes further magnify these issues. The articles will then explain how Meds 360° helps solve these problems, elevating quality of care, reducing risk, and improving clinician and patient satisfaction in the process.

Before we dive into the scenarios, we will first briefly discuss in this article why the current solution relied upon by many organizations to address suboptimal medication management — electronic medical records (EMRs) — comes up short and then highlight some of the significant reasons Meds 360° is becoming the medication management solution of choice for a growing number of organizations.

Optimizing Medication Management (Part 1): Why EMRs Don’t Cut It and a Better Solution

Many believed that EMRs and their embedded clinical decision support tools would solve many, if not all of the challenges associated with medication management. EMRs have not only failed to live up to their promise but, in many instances, have created additional problems.

Three of the most significant EMR deficiencies are as follows:

1. They are transaction and billing focused. Clinical processes — including those pivotal to delivering the most appropriate care and keeping patients safe — are often an afterthought.
2. They are overly complicated and cumbersome. The desire to provide organizations with a comprehensive solution results in offerings and functions that rarely feel polished, are unintuitive, and are often incomplete. Furthermore, most clinicians want only the information they need to know at the point of care rather than everything that can be known.
3. They do not put user experience as a priority.

These failings make it more difficult for clinicians to perform proper medication management and are contributing to another substantial problem: epidemic levels of physician burnout. "Why Doctors Hate Their Computers," Atul Gawande's article in the New Yorker on physician burnout and EMRs, shares some eye-opening statistics and facts:

• 50% of physician time is now spent in front of a screen.
• This increase in screen time is directly correlated with changes in physician wellbeing.
• In 2014, 54% of physicians reported at least one of three symptoms associated with physician burnout — up from the 46% reported in 2011.
• The strongest predictor of burnout is the amount of time spent in front of computer, as per Mayo Clinic research.
• 40% of physicians screen positive for depression, while 7% manifest suicidal ideation. These are both almost double the rate of the general population.

Now let's touch on some of the core ways Meds 360° provides improved medication management and reduces screen time — and associated burnout — in the process.

The Meds 360° Difference

We break down the manner in which our comprehensive medication management solution delivers on these promises into two categories: identification and intervention.

Identification — Concerning identification and insights achieved through Meds 360° — such as the detecting of medication errors upon admission, missed therapeutic duplication, and missed medication non-adherence — one must first understand where we obtain the data to populate the platform. It is derived from paid pharmacy claims from all major pharmacy benefit managers (PBMs) and retail point-of-sale (POS) data — including cash transactions — for approximately 265 million patients.

Through a partnership with Prescription Advisory Systems & Technology (PAST), Meds 360° also provides vital national prescription drug monitoring program (PDMP) data to help combat the opioid epidemic. PAST's PDMP data and analytics from up to 41 states are integrated into Meds 360°. 

The application does not depend on e-prescribing data, allowing it to provide a cross-enterprise view.

Meds 360° is accessible through native iOS and Android applications as well as a web-based interface. In addition to providing clinicians with the critical medication information they need to make educated treatment decisions for their patients, the platform supports admission, discharge, and transfer (ADT)-based, real-time clinical event notifications and enterprise-grade secure messaging. This enables stakeholders, including patients, to intervene during transitions of care where the dangers of medication-related issues are highest.

Intervention — Concerning the intervention component of the platform, let's focus on two of our most significant current capabilities: incentive-based adherence and telepharmacy. Our interventions are based on the premises that 1) time limitations often impede a physician's ability to provide optimal drug therapy management for their patients and 2) pharmacists are optimally positioned to carefully evaluate and make recommendations on optimizing medication management.

In addition to medication reconciliation, Cureatr, in collaboration with Wellth, delivers a patient-facing mobile app that encourages medication and treatment adherence. How? By paying patients to take their medicine. The major driver underpinning this application is behavioral economics.

Here's how this works: Patients are provided an upfront opportunity to earn up to several hundred dollars for treatment plan compliance. They receive reminders on their smartphones when medication dose is required. Patients use their smartphone's camera to snap a picture of the medications that they are about to take. When medications are taken at the appropriate time, patients keep their allocated money for that day. If medications are missed, patients lose a specified amount. This approach is called "loss aversion." Behavioral economic research has demonstrated the approach is 50% more effective than paying patients to perform a desired behavior and has been applied to several other health initiatives. Furthermore, studies have shown that the intervention achieves noteworthy improvements in medication adherence (e.g. 89%+ dose compliance), reductions in acute stays, and an impressive return on investment for the risk-bearing provider organization.

Our other noteworthy intervention strategy is pharmacy clinical services. There are multiple studies — including this study in the American Journal of Health-System Pharmacy and this study in Pharmacy & Therapeutics — that indicate pharmacists and technicians should be playing a more significant role in drug therapy management. Their expanded involvement has been shown to reduce readmission rates, deaths, potential medication errors, and overall medication reconciliation discrepancies.

Not only are pharmacists often experts at identifying medication errors and optimizing medication regimens, they also are uniquely positioned to provide patient education and resolve potential medication adherence barriers. There is ample evidence that pharmacists:

• produce substantially more accurate medication histories than nurses;
• boost Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for medication-related questions;
• reduce readmissions when supporting care transitions; and
• drive improvements in nurse and physician satisfaction when they take on medication-related tasks.

Many organizations are hesitant to invest in hiring pharmacists to fill these roles because of the upfront cost. We believe they shouldn't be. Our research on medication reconciliation shows that the upfront cost is typically offset — and quite quickly — thanks to the savings associated with prevented medication errors and associated readmissions, improved care team efficiency, and reduced drug expenses. Download our savings calculator to discover the potential ROI of investing in pharmacy-led comprehensive medication management by clicking here.

Our telepharmacy-based, comprehensive medication management enables the following:

• assessment of medication-related needs — e.g., how the patient is actually taking medications versus what was prescribed;
• greater understanding of patient knowledge, expectations, and therapy goals with respect to medications, appropriateness for conditions, medication gaps, appropriate dosages, drug-drug interactions, therapeutic duplications, side effects, adherence, deprescribing opportunities, and other areas; and
• development of medication care plans and personalized education based on individual patient needs.

We believe there is an opportunity to mix and match these intervention strategies when non-adherence is the issue. The digital therapeutics intervention is less costly and thus more attractive as a starting point. Patients who fail to achieve acceptable proportion of days covered (PDCs) in target therapeutic areas using digital therapeutics can then be shifted into the more costly telepharmacy approach.

Coming Up: Serious Medication Error on Hospital Admission

Now that we have outlined some of the core reasons organizations struggle with medication management and how Cureatr and Meds 360° improve clinician performance, clinical outcomes, and patient and physician satisfaction, we'll help you better envision the way it accomplishes these worthwhile objectives starting with our first scenario.

It will tell the tale of 70-year-old Joe and how a serious medication error made upon his admission to a hospital leads to significant health complications, an extended length of stay, and additional costs for the health system. And it will explain how these difficult and expensive complications could have been avoided if the admitting organization and its clinical staff relied upon Meds 360°.