How ePrescribing Interoperability Solutions Mitigate Clinician Burden

Andrew Mellin, MD, MBA, a VP and chief medical information officer at Surescripts, wants healthcare to get rid of its fax machines. The archaic technology, which he called a universal inbox, should instead be replaced by health data exchange and ePrescribing tools he said are well-positioned to cut clinician burnout and support value-based care efforts.

“In many places, fax is like a dumping ground for anything that possibly needs to be communicated with the provider office,” Mellin explained in an interview with EHRIntelligence.

This may include a mixture of critical lab results, status updates on specialty medication, and non-clinical items such as the menu from the restaurant down the street, he noted.

Physician offices must sort the information in the inbox and figure out who it should be distributed to. But this system is inefficient and leads to clinician burden, Mellin said, offering an example of how this affects provider offices.

“There was nurse who was responsible for specialty medications,” he explained. “Twice a day, she had to get up and walk to another building across the parking lot, go to the fax machine, go through a stack of papers, and select the ones that were relevant. Then, she had to walk back and manually scan each paper and enter them into EHR.”

Mellin also noted that faxing data is not actionable. When the document gets scanned into the EHR, the data lives as an image, he explained. A human must work on the data to plug it into the right place in the clinical workflow or associate it with the other information in the system.

This adds to enormous physician frustration, Mellin explained.

“Instead of having a button that says, ‘Yes, change this medication to what the pharmacist might recommend’ like they could do with some of the new technologies, providers are manually retyping the data and reworking it,” Mellin said. “One process can take seconds. The other one takes minutes. When you do that tens or hundreds of times a day, it adds up.”

Mellin also emphasized how burdensome faxing processes negatively impact the patient experience, particularly timely care access.

When providers receive faxed patient health data, it often sits on the fax machine for hours or even days before it gets sorted, entered into the EHR, and routed to the right person, he explained. On the other hand, when an electronic message from a pharmacy goes directly into a providers’ in-basket, the provider is able to acknowledge and act on the information more quickly.

Additionally, Mellin explained that faxes are error prone. Sometimes data is indecipherable and certain fields are incorrect, such as a patient’s gender.

Interoperable, electronic health data exchange helps to eliminate these errors, Mellin said.

“We’ve made a huge amount of progress in the areas of interoperability to eliminate faxing in the world that we live in,” Mellin said.

Surescripts has worked to eliminate the use of faxing for pharmacy-provider communication to streamline administrative processes.

“There is a whole ecosystem of ways for physicians and pharmacists to communicate that eliminates the need for faxes and phone calls,” Mellin said.

Pharmacies can now make medication suggestions electronically if a prescription they are filling is off formulary.

Additionally, Mellin added that physicians can tell the pharmacy that a patient has discontinued use of a medication so that the pharmacy does not continue to automatically refill it without having to send a fax or make a phone call, he added.

These ePrescribing capabilities allow patients to receive their medications more quickly, Mellin said.

“We're seeing continued adoption in those areas and big savings,” he added.

As a former hospitalist, Mellin also emphasized the role interoperability plays in streamlining hospital admissions and discharges.

“When I discharged someone, my discharge summary was often faxed over to the provider's office and it would sit there for who knows how long,” Mellin said. “Now, there are ways for that provider to be automatically notified about the patient's discharge. Providers can act on this discharge information immediately, and it's routed to the right place and available to everybody that's working in the EHR.”

He noted that emerging interoperability efforts aim to streamline patient care event information from pharmacies and other providers, allowing care managers to act on critical events as soon as possible.

“This concept of care event notifications is another really exciting area of interoperability that changes the way care managers in the care team can interact and understand what's happening with patients in essentially real time,” Mellin said.

Mellin also emphasized the role interoperability plays in supporting value-based care efforts.

“With value-based care, there's a critical need to stay on top of the patients, to know where they are, to understand what care they're receiving, and to be alerted to critical events the moment that they happen,” Mellin said.

Mellin sees areas for health IT growth in modernizing specialty medication prescriptions. These medications require providers to send pharmacies additional clinical information called the enrollment information.

An emerging standard takes enrollment information that lives in the EHR and sends it to pharmacies electronically, Mellin explained. This data exchange allows the pharmacy to dispense these important medications safely and effectively, he noted.