How Health IT Supports Data Exchange for Specialty Medications

Health IT from Surescripts aims to improve clinical data exchange for specialty medication dispensing to decrease clinician burden and speed up time to treatment.

When providers send prescriptions for traditional medications to the local pharmacy, the prescription is typically processed and dispensed within hours. But for a specialty medication, the fill process is much more complex.

“When we look at specialty medications, what sets them apart is just the overall amount of clinical information that's needed to dispense them,” Cecelia Byers, PharmD, specialty pharmacy clinical product manager at Surescripts, told EHRIntelligence in an interview.

The first hurdle to specialty medication dispensing is getting the prescription to the right pharmacy, Beyers noted. Physicians sometimes send the prescription to the local retail pharmacy before it is forwarded to a specialty pharmacy.

Once the specialty prescription gets to the correct place, pharmacists require specific clinical information to be able to dispense the medication to the patient depending on what the prescription is.

“If it's weight-based medication, they need the patient’s weight,” Byers explained. “Sometimes they need clinical information about the status of the condition that the patient has, along with general information about the patient to make sure that therapy is correct. They also need the clinical status, making sure that the indication is correct for the given medication that the prescriber has written for.”

Byers explained that because specialty prescriptions require so much clinical information, only 50 percent of those prescriptions are currently sent electronically. Providers and pharmacists often use fax machines and phone calls to share clinical information related to specialty medications, which Byers pointed out is an error prone process.

“When providers are sending prescriptions to pharmacies, if clinical information is not sent along, it requires that pharmacy to pick up the phone and call to get that information,” Byers explained. “Oftentimes, pharmacists and technicians are calling and leaving voicemails for the provider's office to try to make sure they understand the request, so there's a lot of back-and-forth phone calls.”

Many specialty pharmacies have enrollment forms online that providers can fill out and send in via fax for the pharmacy staff to review and enter into their system. While this aims to eliminate the issue of phone-tag, there are a lot of opportunities for pharmacists to make mistakes in enrollment documentation due to manual data entry.

Surescripts’ specialty patient enrollment tool aims to mitigate clinician burden and speed up time to treatment by automatically sending clinical information for specialty medications.

The product, which is embedded within contracted EHRs, grabs the clinical information needed to fill the specialty medication and sends it to the pharmacy via FHIR resources along with the electronic prescription. The pharmacy can then take that message apart and put the information into the correct areas of their dispensing system.

This eliminates the need for fax communication. However, Byers noted that the vendor meets pharmacies where they are at, as not all pharmacies are able to do a full product integration.

“We generate a fax for some of those pharmacies, but in a full integrated fashion, we'd be able to deliver that electronically so that they're able to digest that clinical information,” Byers said. “That's really the ideal situation that we want our data to be presented in, because that's coming straight from the source where that prescription was written.”

Byers said that Surescripts recognizes that it will take time to build a network between pharmacies and EHRs for widespread implementation of its specialty patient enrollment tool. For that reason, the vendor also offers a specialty medications gateway tool, which allows a pharmacy to initiate a request for clinical information for a specific patient within the confines of Carequality infrastructure.

“They're able to get a patient weight if they need it for a weight-based medication or get to a patient's medication list if they're needing that information,” Byers said. “It's another opportunity for a pharmacy to be able to request information through that interoperability framework.”

Byers said that these health IT tools are helping address clinician burden and boost clinical efficiencies.

“In terms of the overall workflow for the pharmacy, they're not having to call as often,” she noted. “Decreasing those calls creates more efficiencies within the pharmacy because they're not having to pick up that phone or send another fax out to that prescriber as they're trying to get the medication filled for the patient.”

Automated data exchange between prescribers and pharmacies also helps patients begin their new specialty medication sooner, which impacts medication adherence, Byers said.

“As soon as we start having more of those manual outreaches, we start to see time adding on,” Byers said. “Patients are often not able to start their specialty medications promptly, as these manual data exchange processes can take anywhere from days to weeks.”

Byers noted that as the digital health transformation continues, Surescripts is excited to expand specialty patient enrollment to more EHRs and work with pharmacies on fully electronic implementations rather than fax machines to streamline efficiencies for electronic specialty prescribing.