Commentary on Specialty Pharmacy Case Management
Spreadsheets, an electronic health record, a specialty pharmacy software platform, a billing system, several calendars, and a bundle of sticky notes. These were the areas (that we know of) that existed for our specialty pharmacy pharmacists and care coordinators to keep track of information for our patients. For the most part, these systems weren’t integrated and did not talk to one another. Needless to say, tracking all the pertinent information to coordinate a single patient was no small feat!
Our health system eventually decided it needed to create a system based within our integrated electronic health record. The major drivers were documenting with the rest of the patient’s chart and creating transparency with the physicians and office staff. We wanted to avoid having data ‘silos’, and we wanted the ability to offer specialty pharmacy services tied to the service itself instead of to a particular pharmacist or care coordinator. That way it would be easy for a patient to find the status of receiving their medication, or to get information on their clinical monitoring schedules.
The workload for specialty pharmacy staff often occurs at two levels: at the patient level and at the medication or prescription level. Most software available can easily accommodate a single instance of each meaning a single patient with a single prescription. However, hiccups in case management can occur with patients on multiple prescriptions. Consider tracking a patient on ledipasvir/sofosbuvir monotherapy. There would be one schedule for labs, one for a prescription, and one for a prior authorization. Now consider a patient with multiple specialty pharmacy prescriptions. The result is multiple sets of activities and dates to track.
There was also a need for the ability to track these medication-specific schedules in a patient-centric way. When a specialty pharmacy staff member had an interaction with a patient, that staff member wanted to easily and quickly be able to see if any other actions were due soon. A pharmacist performing a clinical review wanted to see when the next prescription or prior authorization was expiring. If that information was easily accessible, the pharmacist could act more proactively.
What we ended up doing at our health system was simple in concept: we created a dynamic list. The list, which was stored within the electronic health record, is made up of patients and pertinent dates which track all scheduled actionable items for the specialty pharmacy staff. Items like type of therapy, lab and procedure review dates, prescription and prior authorization expirations, and other notes are stored on the list.
For the list, our electronic health record stores the patient dates at the patient-level. However, that approach can be challenging for managing dispensing-based work. Going back to the example from earlier, we may have a patient on two separate specialty medications. This means there may be two prescription expirations and two prior authorization expirations. However, our list only allows the storage of one prescription expiration date and one prior authorization expiration date per patient. Our work-around is to store the soonest expiring dates.
We've had great feedback so far on our list in the ability to track and find patients, and to keep on top of actionable items. However, there is definitely room to improve-- especially in the realm of dealing with multiple prescriptions per patient. We’d be interested in hearing if your institution has had similar issues, or other issues related to specialty pharmacy software implementations, as well as how you've handled them.
Clem is a Clinical Application Analyst and Pharmacist at The University of Vermont Medical Center.
(Note: This is part of a series of posts from the SOPIT Section Advisory Group on Ambulatory Care Informatics.)