The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.


The Expanding Role of Pharmacists: Out of the Basement and Into the Spotlight

By Truven Staff
Tina Moen imageWhat does it mean to be a pharmacist in 2014? I recently presented at the to a room full of pharmacy leaders from across the country. We discussed the evolution of the practice of pharmacy, the things we have seen change over the years, and the opportunities (and challenges) we see on the horizon. Throughout the conference, many attendees shared stories of how their responsibilities as a pharmacist have evolved throughout their careers. Our conclusion is that now – more than ever – there are visible, meaningful changes to our role as it relates to patient care, collaboration with our peers, and in leadership participation in the healthcare community.

Clinical pharmacy services, as we know it, are a result of continuous evolution of the historical pharmacy role – namely dispensing medications from behind the counter or in the basement. This evolution has taken many years. Pharmacists now deliver enhanced value to their organizations and their patients with a focus on quality, safety, and efficacy of medication therapies. Programs such as enhanced Medication Therapy Management continue to highlight the impact pharmacists can make on reducing adverse effects and improving efficacy of a patient’s medication regimen. Additionally, pharmacists contributing to Medication Reconciliation and specialty services, like Anticoagulation or Diabetes Clinics, continue to demonstrate that rounding out the care team to include a medication specialist improves patient outcomes and enhances the practice and performance of clinical peers. And recently, I have seen emerging cross-functional leadership teams working toward goals such as the IHI “Triple AIM,” begin to include Pharmacy; tying personal goals and incentives for DOPs to these efficiency and quality objectives.

Clearly, great progress has been made in the practice of pharmacy, and I for one am proud of the role pharmacists play in enhancing the patient experience and outcomes. So, what's next? Here are the things that come to mind when I ask myself this question.

Healthcare IT
A recent article in advocated for pharmacists playing a larger role in EHR strategy. As a pharmacist who works within the healthcare IT industry, I couldn’t agree more. What percentage of patients in a hospital has at least ONE medication order? I would venture to say “most.” It’s an obvious conclusion that the profession charged with the safe and effective use of medications should have a significant role in the development, selection, and implementation of tools used to properly care for those patients. And then there is Meaningful Use. How many of the Meaningful Use Objectives are related to medications and the services in which pharmacists participate? Who better then to take the lead in organizational efforts for Stage II attestation and Stage III planning?

Care Collaboration
Cross-departmental coordination for initiatives that span hospital leadership continues to grow in scope and importance. Benefits of pharmacists as integral members of rounding teams within the inpatient setting are . With organizations designing and implementing Population Health and ACO strategies, pharmacy leaders can capitalize on the combination of data analytics and clinical insight that are the hallmarks of pharmacy practice. As Population Health initiatives evolve – who better than a pharmacist to guide trends in medication recommendations in treating high-risk conditions and ensuring safe, cost-conscious practice remains top of mind?

Quality Patient Care
Providing quality patient care has always been a focus of healthcare providers. Today’s environment adds a variety of incentives and penalties to drive quality. How are pharmacists contributing? In many ways! Pharmacists are well-suited to lead the charge on initiatives like Antimicrobial Stewardship, a quality and a cost management initiative. The importance of medication education and adherence in the improvement of HCAHPS scores and the reduction of readmissions are additional examples how pharmacists can and should use their skills as medication specialists to drive improved patient care. Because results summaries from nation-wide HCAHPS surveys indicate that Medication Safety and Pain Management questions are still amongst the lowest performing areas – shouldn’t pharmacists’ input at the patient care level be paramount?

As I said during my visit to Health Connect Partners, it’s good to look back occasionally to see the progress that has been made and to help motivate us for the challenges and opportunities ahead of us. What is next? What have I missed? I would love to hear from my fellow pharmacists on where the practice of pharmacy will be in the next 10 years. What are you doing today to move the needle in the evolution of pharmacy?

Tina Moen, PharmD
Chief Clinical Officer

Digital Health Records: Lower costs, better quality – eventually

By Truven Staff
Bill Bithoney imageBetween 2011 and 2012 the federal government spent over $9.2 billion for Meaningful Use (MU) incentives, which are part of a comprehensive plan to decrease the cost of healthcare as well is improve its effectiveness and quality. As of December 2012 just over half of US hospitals have attested to MU Stage I, and an additional $9 billion in incentive payments will go out as the remaining half reach this milestone.
Meaningful Use I, and later MU II, should be viewed as laying the groundwork for electronic health record interventions which may ultimately result in improved health care. For now, though, growing adoption of digital health records seems to be accompanied by higher provider charges: CMS has documented increases approaching 4%.  This may be due in large part to electronic health records’ ability to quickly document more precisely and completely all types of care provided, and to generate bills at the highest possible level of reimbursement.  CMS and other health insurers are actively investigating this issue.

How will we measure the endpoints for Meaningful Use goals?

By Truven Staff
Michael R. Udwin imageThe , directed at population and patient health as well as reduced costs, are to be commended.  Of course the challenge lies in the details as providers successfully navigate each of the envisioned Stages, including data acquisition, process management and improved outcomes. 

As the breadth and depth of such information expands how will we determine and more importantly measure best practice?

To date, rating organizations have relied on the combination of administrative billing data, core measures and patient satisfaction scores.  As our goals and data tracking capabilities have evolved, extended measures have been incorporated, including readmissions and 30-day mortality.  Yet, Meaningful Use encompasses both patient and population health.  How shall we assess an organization’s ability to manage care for a community?   

The answer to this question may be close at hand.  The Healthcare Effectiveness Data and Information Set (HEDIS) provides an analytic roadmap to quantifying our nationwide objectives, with broad categories including “Effectiveness of Care”, “Access/Availability of Care”, “Experience of Care”, and “Utilization and Relative Resource Use”.  Such content cuts across multiple aspects of our delivery system, including inpatient and outpatient encounters, preventive care and population health.

So as we embrace the spirit of Meaningful Use and specifically the goals of reducing cost and promoting a healthy patient and population, identifying “wellness” leaders may hinge on the successful integration of traditional and evolving healthcare data sets. By doing so, we may shine a light on those attributes critical to the creation of a vibrant healthy community of tomorrow.

Michael R Udwin, MD, FACOG
Medical Director