The root cause of “administrative burden,” “pajama time,” and “physician burnout” can be directly traced to the EHR – technology that, according to a recent JAMA study, compels physicians to spend nearly two hours using outside of working hours each day. The study’s authors concluded that those same physicians spent a total of 125 million hours on documenting in the EHR outside of work in 2019!
Some analysts are quick to point to public and private payers as contributors to the documentation hoops providers are having to jump through. While that point is certainly valid (anyone else remember CMS’ “Patients Over Paperwork” initiative?), I can’t help but flip the script (or “scrip” in this case) and ponder the role pharma companies have to play in helping prescribers use EHRs more effectively.
Some pharmaceutical companies are beginning to realize they can work with customers to ease their EHR documentation burdens and assist in the adoption of new medications. For example, some have realized that supporting updating an order set is important. Even developing criteria to create a report to identify patients who may need treatment intensification is something that is becoming routine. Most account managers report back to us in our listening sessions that when an account runs a report identifying patients in need of a care intervention, the list is far longer than the account predicted.
Including new medications into existing treatment orders and plans is quickly catching hold. Many new drugs, especially those used to treat rare diseases, require diagnostic tests be included in systems to ensure patients are identified and complex treatment algorithms to identify appropriate patients and establish a workable treatment protocol for patients and staff.
EHR integration solutions, such as extension apps, hold the most/tremendous promise for pharma companies looking to help prescribers streamline documentation. Physicians are beginning to be familiar with the extension apps offered in marketplaces of EHR vendors like Epic, Cerner, athenahealth, and Allscripts, to name a few. As of 2020, there were nearly 600 unique apps available in the marketplaces of the top eight EHR vendors.* Talk about selection! Nearly 10% of those were devoted to ordering and prescribing, while others helped prescribers more efficiently access Prescription Drug Monitoring Program (PDMPs) and order medical equipment and imaging.
Ready-built apps available through these platforms help physicians use their EHRs more effectively, resulting in the ability to:
In our work with pharma companies, recent rare disease launches have prioritized EHR materials to assist health systems in adopting new treatment protocols for medications, especially those complicated treatments that required advanced testing to identify patients eligible for treatment, or complicated treatment regimens with multiple medications and rigorous testing during treatment.
In our work with specialists, our development of EHR extension apps has been well received because physicians, of course, have long realized the need for improved documentation. We’ve seen success especially with apps designed to improve documentation of specific conditions using standard measures, compare the patient’s treatment plan to guidelines, and assist in creating notes about the encounter to better document the treatment plan. We’ve also had quite a lot of success collecting patient-reported outcomes in advance of an encounter to help focus the physician/patient interaction on areas of the most importance and to reduce routine/redundant data collection of patient symptoms.
Pharma companies considering how to best design or leverage extension apps need to better understand current patient measures and compare those to the desired measures in society guidelines. Identifying that gap is critical to establishing priorities around engaging with providers interested in using existing EHR tools or designing new extension apps.
Education or lack thereof can also hold back these types of innovations. Pharma customer-facing teams, including account managers, medical science liaisons, and sales reps are not EHR experts. And yet they need to know about EHRs because these are the tools their customers use for hours each day.
There are also legal concerns about providing too much value or providing clinical decision support tools. There have been issues with pharma companies working directly with EHRs. Certainly, paying for inclusion of reminders to prescribe has been taken off the table. You can google “Practice Fusion settlement” for an example of what not to do.
While the EHR is a popular source of lament in the physician lounge these days, I’m sure you’d be hard pressed to find users willing to go back to the days of the paper prescription pad. These technologies still hold untapped potential in terms of advancing patient care and increasing physician productivity. Pharma companies can help prescribers unlock this potential in truly meaningful ways if they are willing to lead the way in innovative EHR integrations.
As a successful app developer, we are literally working on dozens of opportunities to provide care. We can put our experience to use for your pharmaceutical brands to improve care, streamline the identification of patients in need of treatment intensification, and introduce new products into large health systems complex EHR operations.
* Categorization of Third-Party Apps in Electronic Health Record App Marketplaces: Systematic Search and Analysis, JMIR Medical Informatics May 29, 2020.