As the specialty pharmacy boom continues to grow, the need for effective reporting processes and systems becomes imperative within a healthcare organization. As a general term, “specialty pharmacy” can capture a variety of disease states and medication classes. Some of the disease states most commonly associated with specialty pharmacy include Cystic Fibrosis, Hepatitis C, HIV, Multiple Sclerosis, Oncology, and Transplantation. Due to the high costs of these medications, there can be increased demands for medication utilization data from both inside and outside of your organization. In addition to new medications, the electronic health record (EHR) vendor landscape continue to change with respect to specialty pharmacy features. Often the desired specialty pharmacy information exists in separate EHR systems such as an inpatient EHR for order entry and another EHR for outpatient pharmacy dispensing. Therefore, one common challenge to specialty pharmacy reporting is the merging of information from separate EHR systems such as inpatient versus outpatient pharmacy systems. The key to addressing this challenge is asking the right questions of your available data.
A helpful approach to asking the right questions of your data is to take a stepwise approach to extracting information from your databases of interest. Here are four general steps to assist in executing a medication data query from an EHR database.
- Identify the target data to extract and group information together as needed
- Execute the database query
- Validate the query results
- Repeat as appropriate
Grouping specialty medication data together in the database search criteria can assist with asking the right questions of your data. There are a variety of approaches and strategies for assigning medications into groups. Medications can be organized by pharmaceutical classifications. Vendor drug information systems such as FirstDatabank® and MediSpan® have proprietary classification systems to assist with grouping specialty pharmacy medications for the purpose of reporting. In addition, the US National Library of Medicine provides RxNorm® to assist with normalizing drug information across vendor platforms. The American Society of Health-System Pharmacists publishes the American Hospital Formulary System (AHFS®), now available as the new AHFS Clinical Drug Information, which is another resource to group medication concepts together.
Once the desired information medications and/or groupings are established, the next step is executing the database queries that will return the desired results. Database searching is an iterative process and may take many attempts to refine the search to answer the primary question(s) at hand. Also, feel free to reach out to other reporting subject matter experts within your organization, as they often have expanded knowledge of database structure. A quick phone call with a local database expert can often save much time and frustration.
After validating your query results, it is time to present the information to your end users and shareholders. When presenting large data sets to both clinical and non-clinical users, it is critical to keep your audience in mind to meet their desired objectives. Format charts, tables, and graphs to help solve their questions and address the primary issues at hand.
Here are some questions we are using at UF Health Jacksonville to help survey the current specialty pharmacy landscape within our organization. Our goal in asking these questions of our data is to understand the current utilization of specialty medications among our patient population.
- What is the current volume of specialty medication orders?
- What clinic(s) are the source of specialty orders?
- What pharmacies are the destination of electronic prescriptions of specialty orders?
As specialty pharmacy continues to grow at UF Health Jacksonville, we are continually learning about new approaches and insights by asking questions of our medication data within our various electronic health record (EHR) systems across the care continuum. Our goal is to be continually refining analytics processes to remain flexible in the dynamic world of specialty pharmacy. To assist with reporting in your specific organization, take note of the current offerings provided by your EHR and drug information vendors. See what reporting features are standard within EHR systems before investing the resources into creating custom reports. It is also helpful to have a pharmacist be heavily involved or take the lead in specialty pharmacy reporting projects since medications are integral to the process.
In closing, I would encourage others who are also beginning these new analytics ventures to start where you are and make the most of the resources currently available to you. Reporting is a trial and error process that takes time to refine. The technologies and tools available to ask the right question of our data are going to continue to evolve and improve. It is an exciting time to stand at the intersection of patient care and data science to advance patient care.
Jay Dorris, Pharm.D.
Clinical Informatics Pharmacist
UF Health Jacksonville
Part of a blog series by SOPIT Section Advisory Group on Ambulatory Care Informatics' Workgroup on Specialty Pharmacy