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This episode of the MGMA Insights podcast features Bri Palowitch, clinical informatics pharmacist at Surescripts, and Scott Rochowiak, manager of product performance at Surescripts. Palowitch and Rochowiak discuss the issue of prescription quality workflow disruption.
Palowitch and Rochowiak share the findings of a recent study, which show that prescribers and pharmacists alike lose hours each week to poor data quality.
Editor’s note: The following Q&A has been edited for length and clarity.
Q: Can you share an example of human error?
Rochowiak: Back in 2018, it was all over the news, there was a ballistic missile alert sent out to the residents of Hawaii. I had a co-worker there at the time, and, surprisingly, it was not her favorite part of the vacation … so it was a harrowing couple of hours. And it turns out, what really caused this alert to go out was just human error. Allegedly, there's this drop down, and the two options under this drop down are ‘missile test’ and ‘missile alert.’ And as humans tend to do once in a while, the wrong option was chosen and this alert went out. …
Now healthcare individuals, or healthcare workers are really good at catching these errors, which is a really good thing. But we started to wonder, at what cost are we paying to intervene, or to catch these errors? And when we clean this data, are we taking time away from patients or attention away from patients? And so what we did is we went out, and we wanted to try to measure this. And so the purpose our study was to gather information related to what happens when we introduced human intervention into the process. And so what issues cause that need for intervention? Do our users agree on what needs an intervention? And who's performing the intervention? That can be really important, because there can be vast cost differences between various healthcare individuals that may be performing that intervention. And then ultimately, what's the impact to the user?
Q: What is an intervention in a healthcare setting?
Rochowiak: So overarchingly, (when we say) intervention, we mean that you have to step out of your workflow, to figure something out or to clean up some data.
Q: You’ve been involved in some interesting research on workflow disruption. Tell us about this project.
Palowitch: We partnered with a third-party research firm, so that we could better understand how prevalent data issues were impacting pharmacy,
clinical efficiencies, patient safety and satisfaction. ... We suspected that prescriptions were causing pharmacists to pause (and) exit their workflow to either correct or clarify any unclear, confusing prescription information that was coming through in e-prescriptions. Those extra steps or that manual intervention, were a natural place for us to focus. And they absolutely have potential to decrease efficiencies, delay prescriptions getting to the patients, and most importantly, that patient safety.
So to set the scene, we conducted interviews with 12 practicing pharmacists and pharmacy technicians to discuss their workflow and their perceived burden through their day-to-day roles and responsibilities. So each pharmacist received 300 prescriptions to identify any issues or actions needed. For those unaware, 300 prescriptions is a pretty fair average of scripts filled per day at your standard community pharmacy. …
Now, a few seconds or a few minutes (for each intervention) doesn't seem that long or arduous, but it quickly adds up. So that pharmacy with an average of 300 scripts per day, staff is spending 18 hours a week performing minimal or moderate intervention, which is almost two days of a full-time employee (spent) focused on these (interventions). So that is a big chunk, that was a glaring number. … And if we break down that 6% (that) have a significant intervention, these are taking 10 minutes or more. At that same pharmacy of 300 scripts per day, staff is spending 15 hours a week performing these interventions.
Rochowiak: These numbers Bri has presented are really the things we can measure that are happening within the four walls of the prescriber’s office, or within the four walls of the pharmacy. The impact we’ll never really be able to measure is that pharmacist lying in bed at night staring at the ceiling, thinking, ‘Gosh, I saw Mrs. Jones today, but I didn't get a minute to speak with her. I hope she understands how to use this.’ Or that pediatrician who's lying at home at night looking at the ceiling, thinking, ‘Oh my goodness, I hope I explained to Mrs. Smith how to use her inhaler well enough. I hope the pharmacy had a moment to do that.’
Q: How do we begin to make that connection and remove some of these interventions that are taking place?
Rochowiak: First and foremost, it would be to ensure that you have a culture of quality. While our study looked at pharmacy workflow disruption, as Bri mentioned, a number of the interventions came back to the prescribers office for clarification, which takes up time within the prescriber’s office as well. You know, our EHR and pharmacy partners have done an amazing job building out functionality, which helps ensure high quality communication. I would ensure you're using all the functionality available to you. … And then also, I would ensure you're using price transparency tools … and electronic prior authorization to help prevent calls coming back because the medication costs too much or it needs a prior authorization. Finally, I'd say just ensure you have best practices and processes in place to ensure good quality script creation.
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