Pharmacists should use FHIR to engage as value-based providers.
Drivers such as changes in reimbursement and need for greater care coordination are fueling adoption.
FHIR and NCPDP standards will work collaboratively to optimize medication management.
Heads up, ambulatory and acute care pharmacies. Health Level Seven’s (HL7’s) novel Fast Healthcare Interoperability Resources (FHIR) standard is rapidly being adopted in the national and global health care marketplaces. Drivers are strong and the changeover is inevitable, which is why we urge pharmacies to act sooner rather than later to remain competitive. As health care providers and payers are moving to better care coordination and adopting new value-based models of care, interoperable data exchange has become the linchpin for everything from delivering personalized care to managing population health. FHIR has become the go-to standard to enable streamlined and efficient access to health information and real-time communication.
To date, ambulatory and acute care pharmacies have operated within two standards-based silos. They typically use standards from the National Council for Prescription Drug Programs (NCPDP) for electronic prescribing and other functions, such as billing, dispensing and inventory control. Pharmacies in large health systems and health maintenance organizations use HL7 standards to handle pharmacy orders and discharge prescriptions. While NCPDP standards will continue to play a vital role for key pharmacy functions, FHIR compatibility will be the path forward for pharmacists to engage as value-based providers in this new era of interoperable health care. However, many pharmacy systems — especially those on the ambulatory side — are slow to recognize the need for FHIR.
Drivers for change. Drivers for the inclusion of FHIR in pharmacy systems are varied and compelling. They include:
1. Changes in reimbursement. Value-based contracting (VBC) and other pay-for-performance arrangements are profoundly impacting the need to track medication costs and patient outcomes. VBC relies heavily on clinical data — captured and transmitted electronically — to create metrics for their reimbursement models, which may require clinical content to be sent with the prescription so progress and outcomes can be monitored and quantified. Current standards don’t support clinical data exchange whereas FHIR does. FHIR can also be used to document contracting changes involving medications. The data exchanged affects how reimbursement and shared savings are calculated and distributed — among providers as well as participating pharmacies.
2. Care coordination. Pharmacy today is evolving into team-based care models driven by value-based payment arrangements. Clinical pharmacists are taking on a larger role in care coordination, often as part of an interdisciplinary team. There, clinical pharmacists provide clinical and therapeutic interventions for individual patients as well as collaborate with providers on medication-related activities and desired patient outcomes. As a result, clinical pharmacists need to have the same tools and electronic platforms as other clinicians to capture and share data on the clinical and medication needs of patients, both as part of the team and in support of other health care providers, patients, caregivers and payers.
A key tool is the FHIR-based Pharmacist eCare Plan (PeCP), a standardized electronic means to document and exchange information on clinical services and medication management goals delivered and recommended by pharmacists. It is an innovative way to capture clinical documentation by pharmacists as well as an interoperable way to coordinate medication management with other health care providers. This standards development project was sponsored by the Office of the National Coordinator for Health Information Technology (ONC) and has been embraced by NCPDP and HL7.
3. Payer-Provider System Adoption and Coordination. Provider systems are already on board with FHIR to capture, analyze and share clinical content and patient data. In fact, FHIR is the standard of choice for electronic health record (EHR) vendors, with 87% of hospitals and 69% of eligible clinicians having products certified to any FHIR version. On the payer side, FHIR is quickly becoming a necessary tool to capture and exchange clinical data. Claims data — long the mainstay of payer decision making — are not enough anymore. A couple of examples come to mind of how payer systems are being transformed using FHIR. Medicare’s Blue Button 2.0 is set up for FHIR-based application programming interfaces (APIs) to connect to beneficiary data, thus creating new capabilities for providers and patients to share and analyze personal health information.
Another compelling industry driver is the HL7 Da Vinci Project, which has gained traction and public attention for its collaborations, progress and promotion of FHIR. It is a leading example of industry efforts (in this case by payers) that is driving FHIR adoption. Da Vinci’s open business model process enables payers, health systems and other industry participants to identify and enumerate use cases that involve managing and sharing clinical and administrative data among industry partners. Such requirements will bleed over to pharmacies, which then will have to use FHIR to provide the needed clinical and administrative information. One of the first Da Vinci use cases is for FHIR-based prior authorization transactions. No doubt, use of FHIR by such large stakeholder groups will drive demand for FHIR adoption in pharmacies.
4. International Influences and Outcomes Reporting. Increasing global interoperability of health information technology and continuing foreign innovations in pharmaceuticals means that pharmacies in the United States (US) must have the same tools to monitor and report information on the efficacy, efficiency and safety of drugs. This will become increasingly important as biosimilars and digital therapeutics are developed and approved, especially since pharmacy systems outside the US use HL7.
Conclusion. While inclusion of pharmacies in value-based models of care and new reimbursement models may seem far off, it’s hard not to see the obvious implications for specialty medications, specialty medications, which will account for half of total U.S. drug spend by 2020. The prescribing process for specialty prescriptions consistently requires clinical and other information to be shared between providers, payers and pharmacies. While the process is largely unautomated, specialty automation is ripe for pharmacy leadership to build the interoperable transactions and platforms to support a streamlined prescribing process and the means for pharmacist-provider coordinated care for these often complex medication therapies. While NCPDP is already working on ways to automate this process, pharmacies should consider efforts to align with industry adoption and use of FHIR for medication management across providers and payers. Addressing interoperability is top of mind in all sectors of health care, and pharmacy is no exception. FHIR is viewed as a game changer, being the go-to building block for clinical information in new and existing clinical workflows in electronic health records and mobile applications. Including FHIR in pharmacy systems will dovetail with the numerous ongoing efforts in the public and private sectors to improve interoperability.
Key takeaways. Point-of-Care Partners (POCP) has been active for more than a decade in the standards arena and issues related to medication management. Based on our expertise, we see the following takeaways for acute and ambulatory pharmacies:
The use cases for FHIR in pharmacy exist and are ready to be tapped. As FHIR adoption continues to grow among providers and payers, this will drive demand for FHIR in pharmacy systems.
While FHIR supports a majority of health care use cases, it does not support everything needed by pharmacy. FHIR and NCPDP standards will need to work collaboratively to optimize medication management and meet the requirements of all facets of value-based care.
Acute and ambulatory pharmacies need to embrace FHIR adoption within their systems. Inaction could have adverse effects on reimbursement or result in exclusion from various value-based care programs.
Pharmacies may need help in planning and implementing the FHIR changeover in their systems. •
Strictly Necessary Cookies
Strictly Necessary Cookie should be enabled at all times so that we can save your preferences for cookie settings.
If you disable this cookie, we will not be able to save your preferences. This means that every time you visit this website you will need to enable or disable cookies again.