Electronic Health Record Adoption in Pharmacy Practice in Nebraska

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Electronic Health Record Adoption in Pharmacy
Practice in Nebraska

• Kevin T. Fuji, Pharm.D.
• Research Fellow and Instructor
• Creighton Center for
• Health Services Research and Patient Safety

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Objectives

• Provide background on the current health
  information technology movement with a focus on
  electronic and personal health records
• Present findings related to this movement for
  outpatient pharmacists in the state of Nebraska
• Propose a future research agenda

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Research Team

• Kimberly A. Galt, Pharm.D., Ph.D.(c)
• Members of the Creighton Center for Health
  Services Research and Patient Safety
• Alexandra B. Serocca, Pharm.D. candidate (student
  researcher)

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Background

• Electronic Health Records (EHRs)
• National focus
• 2014 mandate1
• Health Information Technology for Economic and
  Clinical Health (HITECH) Act2
• Few physicians have adopted EHRs3

• Incentives for the Use of Health Information
  Technology and Establishing the Position of the
  National Health Information Technology
  Coordinator/Title 3The President. Executive
  Order No. 13335, 69 C.F.R. 24059, 2007. Available
  at http//www.whitehouse.gov/news/releases/2004/04
  /20040427-4.html.
• House of Ways and Means. Health Information
  Technology for Economic and Clinical Health Act.
  http//www.google.com/url?satsourcewebctresc
  d4urlhttp3A2F2Fwaysandmeans.house.gov2Fmedi
  a2Fpdf2F1102Fhit2.pdfeiljHuSd7jNJaOMqu_5PAPu
  sgAFQjCNHIk1_JvztINrrexLnwGP4ci9n-Ow
• DesRoches CM, Campbell EG, Rao SR, et al.
  Electronic health records in ambulatory care -- a
  national survey of physicians. N Engl J Med 2008
  35950-60.

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Background

• Personal health records (PHRs)1-3
• Consumer-controlled health records
• Typically electronic-based
• Supported by health care providers, payers,
  employers, and patients

• Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ.
  Personal health records definitions, benefits,
  and strategies for overcoming barriers to
  adoption. J Am Med Inform Assoc 2006
  13(2)121-126.
• Ball MJ, Smith C, Bakalar RS. Personal health
  records Empowering consumers. J Healthcare
  Information
• Management 2006 21(1)76-86.
• 3. Detmer D, Bloomrosen M, Raymond B, Tang P.
  Integrated personal health records
  Transformative tools
• for consumer-centric care. BMC Med Inform
  Decis Mak 2008 845.

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Background

• Health information exchange nationally
• National Health Information Network (NHIN)
• Interoperable health information infrastructure
• Regional Health Information Organizations (RHIOs)
  or Health Information Exchanges (HIEs)
• Colorado, Nebraska, New York, Massachusetts.

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Project Aims

• Describe the adoption of EHRs and PHRs in
  community outpatient pharmacy practice
• Describe what pharmacists are using EHRs and PHRs
  for in community outpatient pharmacy practice
• Describe implementation strategies that
  pharmacists use to integrate EHRs and PHRs in
  their practice
• Describe pharmacy and facility readiness to
  implement health information exchange
  technologies not yet in place

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Project Aims

• Explore pharmacists perceptions of the impact of
  EHR and PHR use on patient safety and quality of
  care
• Explain how pharmacists experiences with EHRs
  and PHRs in community outpatient pharmacy
  practice relate to pharmacists perceptions of
  the impact of EHR and PHR use by pharmacists on
  patient safety and quality of care
• Develop research skills in survey development and
  administration, interview techniques, and
  qualitative, quantitative and mixed methods
  research.

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Funding Sources

• ACCP Ambulatory Care PRN Pilot Grant
• Nebraska State Board of Pharmacy Dyke Anderson
  Patient Safety Grant

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Methods

• Sequential, exploratory mixed methods design
• Mixed methods survey
• Modified Dillman technique1
• Distributed to all 2,195 number of licensed
  pharmacists in Nebraska
• Qualitative interviews
• 3 outpatient pharmacists (independent, retail,
  hospital)
• Selected from communities engaged in
  participation with the state RHIOs

1. Dillman, DA (2007). Mail and Internet
Surveys the Tailored Design Method. 2nd ed. New
Jersey John Wiley Sons.
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Results

• Response rate
• 535 (24) of all licensed pharmacists who
  indicated that they are actively practicing
• 312 outpatient pharmacists
• Demographics
• Average of 21.5 years in practice
• 55.3 female, 44.7 male
• Independent pharmacy 40.1
• Traditional chain pharmacy 38.5
• Grocery chain pharmacy 21.5

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Survey Results from PharmacistsHealth
Information Management

• Patients are primarily keeping track of health
  information through written means
• 90.4 keep a written list of medications
• 51.0 keep a written list of medical conditions
• Few patients utilizing electronic means
• 11.5 access an online PHR
• 0.6 carry a PHR on a flash drive
• 9.6 of patients are not using any kind of
  record-keeping mechanism

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Survey Results from Pharmacists aboutPersonal
Health Records (PHR)

• 46.5 report their pharmacy assists patients with
  using their PHR
• 22.1 are able to access information in the PHR
  to help the patient
• 6.4 can transfer information from the pharmacy
  record to the patients PHR
• 5.1 can transfer information from the patients
  PHR to the pharmacy record

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Survey Results from Pharmacists about Electronic
Health Records (EHR)

• 6.4 have used an EHR in the past
• 2.6 currently use an EHR
• 9.9 are planning to adopt
• 65.4 are not planning to adopt
• 15.1 do not know what plans are

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Survey Results from Pharmacistsabout Pharmacy
Records

• Pharmacists report keeping the following
  information in their pharmacy record
• Allergies (92.6)
• Chronic conditions (38.8)
• Pregnancy (34.0)
• Renal impairment (18.3)
• Liver impairment (16.3)
• Lactation (14.4)
• Smoking status (4.2)
• Weight (2.6)
• Height (2.2)
• Alcohol consumption (2.2)

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Survey Results from Pharmacistsabout Health
Information Exchange

• 77.9 believe they should have access to EHRs
  created by other providers
• 2.6 actually have access to EHRs created by
  other providers
• 51.0 believe there are circumstances in which a
  patients health information should be shared
  without the patients express consent
• Emergency situation
• If the patient is unconscious

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Survey Results from PharmacistsHealth
Information Exchange

• Information pharmacists should share with other
  providers
• Medication history 95.2
• Allergies 92.6
• Health history 72.1
• Immunizations 61.9
• Laboratory data 57.4
• Progress notes 51.0

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Interview Results with Pharmacists

• Demographics
• Average of 22 years in practice
• 2 males, 1 female

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Interview Results with Pharmacists about PHRs and
EHRs

• Few patients using PHRs
• Primarily using written means to keep track of
  personal health information

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Interview Results with Pharmacists about
Electronic Health Records (EHRs)

• Hospital outpatient pharmacist uses an EHR system
• Independent pharmacist is in a community where
  the health system has an EHR
• Community pharmacist does not have an EHR system
  and is not in a community where the health system
  has an EHR

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Interview Results with Pharmacistsabout Health
Information Exchange

• Hospital outpatient pharmacist has access to
  information not previously available (e.g. lab
  results)
• Independent pharmacist has increased problems
  no electronic exchange between health system and
  pharmacy

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What Does It All Mean?

• Pharmacists want to participate in EHR and PHR
  information exchange
• However, pharmacies are not adopting EHRs, and
  patients are not adopting PHRs
• Difficult to assess impact on patient safety and
  quality of care

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What Does It All Mean?Physicians and Electronic
Health Records

• Despite national focus adoption still low in
  physicians
• Nebraska physicians report a 30 adoption rate
• Until physicians adopt and make records
  available, pharmacy may be unlikely to adopt
  (where is the benefit?)

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What Does It All Mean?Physicians and Personal
Health Records

• Nebraska physicians report seeing similar ways of
  patient health information record-keeping
• Unclear if patients are ready or willing to
  engage with this technology

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What Does It All Mean?Health Information Exchange

• Interoperability is still far from being realized
• No standardization of data and technology

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Future Research Agenda

• What is the impact of PHRs on patient safety and
  quality of care?
• What are patient barriers to PHR adoption?
• What is the impact of EHRs on patient safety and
  quality of care for pharmacists?
• What are barriers to EHR adoption from the
  pharmacy perspective?
• How can information be standardized to exchange
  between professionals?

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• Questions?
• Email kfuji_at_creighton.edu
• Presentation available at
• http//chrp.creighton.edu