In community pharmacies, taking care of patients is a central part of the normal work day. Talking to patients about their health, educating them about a new medical diagnosis or explaining how a new prescription might affect their chronic conditions are just a few examples of daily interactions between staff and patients. These everyday services are what pharmacists are driven to do and are why they went to pharmacy school in the first place. Pharmacists and their staff are essential healthcare providers in their communities. It’s time they are recognized and reimbursed for the clinical roles only they can provide.
On average, community pharmacies interact with patients with chronic disease(s) 35 times per year. In comparison, patients may only visit their primary care physician four times per year1. This provides a huge opportunity for pharmacists to have an impact on their patients.
The existing payment model for pharmacies depends on how quickly and accurately staff can fill prescriptions. In the past, an increase in prescription volume meant an increase in profit. Is this still true? In some cases, yes, but those opportunities are changing due to direct and indirect renumeration (DIR) fees and other factors. Currently, there is a shift from a dispensing-payment model to a value-based payment model where pharmacists are paid for services rendered. In fact, “having pharmacists collect, document and share medication-related services with providers, payers, and care givers (as well as the patients themselves) will help validate the pharmacist’s role in patient care.”2
This concept is not new to the healthcare industry but is very new to the world of pharmacy. The Pharmacist eCare Plan was developed to allow pharmacists to document the clinical care they have always provided. Electronic versions of care plans are created in Consolidated-Clinical Document Architecture (C-CDA) or Fast Health Interoperable Resources (FHIR) format, which are standards developed by Health Level Seven®. One goal of eCare Plans is to generate and electronically share documents with other healthcare providers. The plan is generated using a set of standardized value sets from SNOMED Clinical Terms®, RxNorm and LOINC®. Each value entered into an eCare Plan will be linked to a code, and the data is coded in a way that allows multiple technology vendors to speak the same language. We are entering a new world of interoperability and integration that will help pharmacies coordinate with other healthcare providers to improve overall health outcomes.
Information Used to Create an eCare Plan
Patient Demographics: Pharmacists gather patient demographic information in order to coordinate care across platforms. Clinical information, including allergies and diagnosis information, as well as insurance information, is also included.
Encounters: Documents who performed it, when it took place, the reason for it and the Medication Therapy Problem (MTP). Associated medications can be linked to the MTP and a narrative of the encounter can be created.
Interventions: Shows multiple actions the pharmacy will take or recommend to the patient. Associated medications can be linked, and a narrative of the intervention can be created.
Education: Documents any educational services provided to the patient and the status of that educational opportunity.
Goals & Outcomes: Used as clinical notes where pharmacists can document their goals for a patient and the desired outcome. The status of the goals or outcomes can be updated after meeting with a patient.
Care Coordination & Referrals: Shows the collaboration with other members of a patient’s care management team, such as a caregiver or nutrition specialist. This enables staff to document any referrals scheduled and follow up with a patient afterwards.
As Community Pharmacy Enhanced Service Networks (CPESNs) continue to branch out across the country, the Pharmacist eCare Plan will create a new standard for pharmacist integration into patient healthcare teams.3
The healthcare industry is starting to recognize that preventative services and adherence are the best ways to lower healthcare costs and improve health outcomes. Community pharmacies are at the heart of that realization. Yes, pharmacists still need to dispense prescriptions quickly and accurately, but the focus is shifting to patient-centered care.
QS/1 understands the need for standardized documentation that facilitates the exchange of information between healthcare providers. It continues to be at the forefront of pharmacy innovation, becoming one of the first software providers to receive certification for Community Care of North Carolina (CCNC) Pharmacist eCare Plan.
1 Branham, Ashley, Pharm.D., BCACP and Joseph Moose, Pharm.D. Pharmacists as Influencers of Patient Adherence. Aug. 21, 2014. Web. 18 Oct. 2017. www.pharmacytimes.com/publications/directions-in-pharmacy/2014/august2014/pharmacists-as-influencers-of-patient-adherence-
2 Pharmacist eCare Plan Gains Momentum. Community Pharmacy Enhanced Services Network. n.d. Web. 20 Oct. 2017. https://cpesn.com/newsroom/pharmacist-ecare-plan-gains-momentum/
3,4 Pfeiffenberger, Trista. Use of the Pharmacists eCare Plan in a Statewide Community Pharmacy Network. June 23, 2017. Web. 20 Oct. 2017. www.asapnet.org/files/June2017/Presentations/ASAPJune17_Presentations06_Pfeiffenberger.pdf