Background: The electronic health record has grown and advanced in the last decade and in recent years, basic interoperability has been successfully adopted. Organizations are able to see data from other organizations. Prescriptions are no longer hand written and are sent electronically to pharmacies. One major barrier that continues to exist, however, is electronic communication of medication cancelations and electronic notifications when patients require a medication renewal. It is often forgotten that when medications are discontinued in the local electronic health record, communication is not sent to pharmacies outside the local institution. When pharmacies request a renewal, they have been utilizing FAX as a means to communicate this message.
Purpose: Our organization investigated functionality to allow for electronic communication of medication cancelations to external pharmacies and to allow for receipt of medication renewal requests from external pharmacies. We leveraged existing functionality already available to us to implement electronic cancelation and refill messages.
Description: Our organization, like many organizations, uses Surescripts interface to communicate electronic prescriptions to external pharmacies. The Surescripts interface also allows to send cancelation messages to pharmacies and allows for receipt of renewal requests from external pharmacies. Our organization put together a team of pharmacists, physicians, nurses, informaticists, and IT analysts to turn on functionality to allow our organization to send cancelation messages to external pharmacies and for our prescribers to receive renewal requests from external pharmacies. After studying the existing workflows, we decided on configurations for the interface and initially went live with providers in the Hospital Medicine group, Emergency Department, and a few select clinics. After a successful pilot, the functionality was deployed across the enterprise.Within the first month, 11, 187 cancelations were successfully sent to external pharmacies. If these cancelations were called in to the pharmacy and if we estimate each phone cancelation takes an average of three minutes to complete, this implementation resulted in a time savings of 559 hours of work within one month of time.Comparing the new electronic renewal message process to the prior FAX workflow showed that our turn-around-time from the time the pharmacy contacts us to the time we respond decreased by 46% or 1.5 days. Pharmacies were receiving responses from us faster and patients were able to get their medications quicker because of it.
Conclusions: Medication reconciliation is complicated because of the lack of interoperability between hospital systems and pharmacies. Discontinuing medications in the local system and not effectively canceling the prescription at the pharmacy has led to medication safety events. The interface we adopted is not new and most external pharmacies support it. We actively sought out a solution and with the right team of individuals, were able to successfully implement the added functionality to electronically communicate cancel and renewal messages. This technology is likely available to most organizations, and with the proper advocacy and a project team, can lead to improvement in patient safety while also saving time for physicians, APPs, pharmacists, and nurses.
