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Almost upon inception, Midland Care's program for elderly care ran into a problem it needed to address: The more popular the program became, the harder it was to stay on top of prescriptions.
David Wensel, chief medical officer at the Kansas-based health system and a key player in the development of the system's Medicare and Medicaid Program of All-Inclusive Care for the Elderly (PACE), said Midland Care quickly outgrew the local pharmacy's ability to keep up with the vast number of medications prescribed to PACE participants, who, on average, take around 10 medications daily. It prompted Wensel to begin looking for a partner to help with medication management.
His timing couldn't have been better. Midland Care was in the process of upgrading its EHR and searched for a product with a medication management capability. Wensel opted for Tabula Rasa HealthCare's software, which was embedded in the organization's Prime Suite EHR.
Tabula Rasa's medication management system facilitates electronic prescribing and medication monitoring, as well as the ability to assess multiple drug interactions simultaneously and alert providers to medication risks.
"That's critical in the population we serve," Wensel said.
Midland Care reduces medication risks
Since Midland Care, which provides services mostly to the aging population, started using Tabula Rasa's medication management system five years ago, it has seen a reduction in medication-related risks; a reduction in the risk of adverse drug events, such as falls, hospitalizations and emergency room visits; and a reduction in the total number of medications PACE participants take, according to Wensel.
The results partly stem from the software's ability to compare how multiple drugs interact with each other and how the drugs interact with a patient, Wensel said.
Tabula Rasa does that by considering the active ingredients of all the medications a patient is taking and then ascribing a medical risk score based on the drugs' combined risk for adverse drug events, which range from allergic reactions to overdoses. Wensel said analyzing the interactions of a patient's entire medication profile isn't something every medication management system does. Instead, many use a "one-to-one" model, comparing medications and their effects one at a time instead of all at once.
"When you go to the pharmacy -- Walgreens, Walmart or whatever pharmacy it is -- when they actually look at a medication you're going to take, the software they're using only has the capability of comparing one medication to one other medication at a time," Wensel said.
But at Midland Care, as soon as providers prescribe a medication for a PACE participant, caretakers are able to see the drug risk analysis instantaneously after it has compared the newly introduced prescription to all others a patient might be taking. The information helps clinicians make better decisions about what drugs to prescribe to a particular patient, Wensel said.
"If we're going to pick a medication in any one class, knowing which one will have the least amount of drug interactions, the least amount of problems in terms of being eliminated by the body, that's the one we want to pick," he said.
Another key component of the medication management system comes from a cheek swab, Wensel said.
Tabula Rasa can use the swab to provide pharmacogenomics information to providers, giving them a look at a patient's genetic makeup to determine how medication will be processed. The health system can then make precise adjustments in what to prescribe and how to prescribe it.
"The problem with our current system has always been we have no earthly idea how any particular drug is going to function in a person's body in terms of how quickly it will be eliminated or how quickly it will be activated, because that's really based on the genetics of that person," Wensel said. "For years in medicine, the perception was, if I gave you an aspirin or me an aspirin, they would be the same in all of us. And that is not true ... so having access to that information is very beneficial."
Finding the right medication management system
Anne Burns, vice president of professional affairs at the American Pharmacists Association in Washington, D.C., said having a medication management system that provides clinical decision support can help dramatically in raising awareness for a potential medication problem.
Anne Burnsvice president of professional affairs, American Pharmacists Association
The medication management market is still developing, and Burns said the biggest problem physicians can experience with software like this is becoming inundated with information and flags to potential problems that aren't clinically meaningful. Yet, systems are becoming more advanced in their capabilities, she said.
"I would say these systems are becoming more and more sophisticated in their abilities to look for various types of problems that can occur when you take different medications together," she said. "In the end, the goal is to optimize the patient's therapy across the board."
As in other areas of healthcare, interoperability and sharing data can be a challenge, and medication management system vendors are working to build EHR functionality in an effort to exchange information, aggregate data and document patient care more efficiently, according to Burns.
"I think the challenge for the provider is it's most efficient from an administrative perspective to be able to document in one system," she said.
When looking for a medication management system, Wensel said it was important to find something that was easy for providers to use. Because Tabula Rasa's software was already embedded in their EHR, it allowed providers to prescribe electronically within their workflow.
Additionally, the medication management system uses a seven-day packaging system, meaning the system ships a week's worth of medications to a patient at a time. The package includes a card that features a picture of the medication, an explanation of what the medicine does and what time the patient is supposed to take it.
Wensel said the electronic prescribing and shipping process eliminated the complexity of using a local pharmacy, which required prescriptions to be handwritten and delivered.
"They have integrated shipping to the place where it is instant, like Amazon," Wensel said. "They can have a medication at my participant's home the next day -- and packaged in the right way."