Domain

Learning Health System

Type

Empirical Study

Theme

effectiveness; operations

Start Date

7-6-2014 2:55 PM

End Date

7-6-2014 4:15 PM

Structured Abstract

Introduction:

Currently there is little empirical evidence of the efficacy of use of electronic prescribing software and improvement in formulary compliance, use of generics or reductions in costs. Research is limited to a review of historical data and estimated savings or improvements. This paper reports on an innovative approach to combine use of empirical data analysis with interviews, direct observation and training to increase the e-prescribing rate of primary care providers from less than 50% to more than 90% within 90 days of intervention.

Methods

Prescribing data from more than 700 primary care physicians for a twelve month period was reviewed to determine prescribing costs and formulary compliance for primary care physicians who both electronically and non-electronically prescribed medications. Primary care physicians were placed into cohorts based on e-prescribing rates, interviewed, and observed to determine barriers and best practices to lower average medication costs and high formulary compliance. Researchers developed a grid of best practice patterns and barriers to be addressed through follow up training programs. After identifying six key cohort issues and preparing remediation plans for each group, 50 high volume, low e-prescribing primary care providers were provided onsite interventions to address barriers to e-prescribing and formulary compliance.

Findings

Researchers hypothesized that low e-prescribing among providers was attributed to lack of proper electronic prescribing technology installed at the practice. Further, low e-prescribing providers were anticipated to have low formulary compliance due to the lack of technical availability of the formulary in the electronic health record product. Through data analysis of more than 240,000 prescriptions, no correlation was found between levels of e-prescribing and formulary compliance. In fact, neither average cost, nor percentage of formulary prescriptions correlated to the e-prescribing rate of the providers. Through the use of targeted interviews and direct observation, researchers uncovered common challenge themes such as “EHR feature mistrust” contributed to the lack of formulary compliance and that pharmacy fulfillment workflow was responsible for underreported e-prescribing rates among the provider cohorts. These challenges themes were addressed by the health plan, technology vendor and through onsite training meetings with 50 target providers and pharmacies. Monthly data was reviewed for three months post intervention to determine if the e-prescribing volume increased and formulary compliance improved.

Lessons Learned

The interpretation of empirical data conducted without contextual input from the primary technology users led to a significant misinterpretation of both the problem and the solutions. Combining data analysis with direct observation along with qualitative and quantitative analysis of collected data through interviews, allowed researchers to uncover a level of detail necessary for problem definition that would not have been possible had these methods not been combined in the sequence carried out by researchers.

Call to Action

Analysis of data can assist health plans gain insight in areas for improvement or greater adoption of heath technologies to achieve better patient outcomes, cost reductions, and practice efficiencies, but careful study and observation of user experience with technology is necessary to fully assess barriers to adoption and inform solutions for goal attainment.

Acknowledgements

Research was funded by the Inland Empire Health Plan.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Share

COinS
 
Jun 7th, 2:55 PM Jun 7th, 4:15 PM

Innovative EPrescribing Analysis and Improvement Models for Providers serving a MediCaid Population in Southern California

Introduction:

Currently there is little empirical evidence of the efficacy of use of electronic prescribing software and improvement in formulary compliance, use of generics or reductions in costs. Research is limited to a review of historical data and estimated savings or improvements. This paper reports on an innovative approach to combine use of empirical data analysis with interviews, direct observation and training to increase the e-prescribing rate of primary care providers from less than 50% to more than 90% within 90 days of intervention.

Methods

Prescribing data from more than 700 primary care physicians for a twelve month period was reviewed to determine prescribing costs and formulary compliance for primary care physicians who both electronically and non-electronically prescribed medications. Primary care physicians were placed into cohorts based on e-prescribing rates, interviewed, and observed to determine barriers and best practices to lower average medication costs and high formulary compliance. Researchers developed a grid of best practice patterns and barriers to be addressed through follow up training programs. After identifying six key cohort issues and preparing remediation plans for each group, 50 high volume, low e-prescribing primary care providers were provided onsite interventions to address barriers to e-prescribing and formulary compliance.

Findings

Researchers hypothesized that low e-prescribing among providers was attributed to lack of proper electronic prescribing technology installed at the practice. Further, low e-prescribing providers were anticipated to have low formulary compliance due to the lack of technical availability of the formulary in the electronic health record product. Through data analysis of more than 240,000 prescriptions, no correlation was found between levels of e-prescribing and formulary compliance. In fact, neither average cost, nor percentage of formulary prescriptions correlated to the e-prescribing rate of the providers. Through the use of targeted interviews and direct observation, researchers uncovered common challenge themes such as “EHR feature mistrust” contributed to the lack of formulary compliance and that pharmacy fulfillment workflow was responsible for underreported e-prescribing rates among the provider cohorts. These challenges themes were addressed by the health plan, technology vendor and through onsite training meetings with 50 target providers and pharmacies. Monthly data was reviewed for three months post intervention to determine if the e-prescribing volume increased and formulary compliance improved.

Lessons Learned

The interpretation of empirical data conducted without contextual input from the primary technology users led to a significant misinterpretation of both the problem and the solutions. Combining data analysis with direct observation along with qualitative and quantitative analysis of collected data through interviews, allowed researchers to uncover a level of detail necessary for problem definition that would not have been possible had these methods not been combined in the sequence carried out by researchers.

Call to Action

Analysis of data can assist health plans gain insight in areas for improvement or greater adoption of heath technologies to achieve better patient outcomes, cost reductions, and practice efficiencies, but careful study and observation of user experience with technology is necessary to fully assess barriers to adoption and inform solutions for goal attainment.