Electronic Health Records

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Medication Data in EHR Provides Basis for Tracking Adherence

"Access to aggregated, multi-payer pharmacy data creates an opportunity to identify and address primary non-adherence in clinical practice."

By Frank Irving

- Medication fill data available within electronic health records can identify primary nonadherence in clinical practice, according to results of study published online Jan. 4 by the American Journal of Managed Care.

Multi-payer claims data within an EHR may serve as a foundation for ongoing medication monitoring and improving adherence, a new study finds.

The research team from Thomas Jefferson University and Christiana Care Health System in Delaware found that multi-payer claims data within an EHR may serve as a foundation for ongoing medication monitoring and improving adherence in a non-integrated primary care network.

“The recent adoption of e-prescribing systems has made prescription fill information increasingly available to providers within their native electronic health record. This access to aggregated, multi-payer pharmacy data creates an opportunity to identify and address primary non-adherence in clinical practice, possibly even in real time,” the study report states.

The study looked specifically at patients prescribed a new antihypertensive medication in a large, multi-specialty practice with 14 primary care sites in northern Delaware and surrounding communities. The practices share an EHR used for all clinical encounters. In addition, the EHR generates all prescriptions in the practices. With patient consent, obtained during the registration process, medication histories are accessible through the Surescripts health information network, which covers aggregate pharmacy claims. Once accessed, the medication history is available in the EHR.

The study required patients to have at least one primary care visit recorded in the EHR in the 18 months prior to the index visit date. Researchers matched prescriptions for the new antihypertensive to pharmacy claims listed in the EHR to see whether there was a fill for the new medication within 30 days of prescription.

Of the 791 patients in the study cohort, 66 percent filled their prescription within 30 days. In fact, 78 percent of adherent patients filled the prescription on the day it was issued. Lower diastolic blood pressure and Medicare coverage increased the probability on non-adherence, according to the study authors.

“Our findings suggest that aggregated pharmacy claims available within a provider EHR may be useful in identifying patients with primary non-adherence in routine clinical practice. However, if interventions are meant to impact clinical care, the data must be sufficiently complete, accurate, and accessible in real time to clinicians with minimal interruptions to work flow.”

The study team noted that, ideally, identification and data sharing could be automated and presented to providers in a standardized and actionable format. For example, the EHR could generate a prompt for a follow-up call or letter in the absence of evidence of a fill within a certain time period. Since the majority of patients in the study who filled their medication prescription on the day it was issued, such an intervention could be applied in the first few days following prescription.

“Our findings suggest that the increased availability of medication fill histories in clinical practice can provide objective insight into a patient’s medication adherence, and may provide a foundation for targeted interventions to improve primary non-adherence,” the study authors wrote.

A noted limitation of the study was that prescriptions paid for with cash or coupons, or those filled by pharmacies not contributing to the source database, may not have been available.

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