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In this week’s episode of Tuning Into the C-Suite, MHE's Briana Contreras spoke with Denise Basow, president and CEO of Clinical Effectiveness at Wolters Kluwer. Briana and Basow discussed the importance of uniting prescribers and pharmacists at the point of care and how this form of care can create more efficient and effective operations within health systems.
Uniting prescribers and pharmacists at the point of care correlates with the Institute for Healthcare Improvement's (IHI) triple aim framework: improving quality of care, reducing cost of care, and enhancing the patient experience, according to Denise Basow, president and CEO of Clinical Effectiveness at Wolters Kluwer.
IHI's triple aim approach was developed as a way to optimize health system performance and has been adopted globally as as an important framework. Basow believes this form of unity and harmonizing care helps with the triple-aim approach within health systems.
"First, from a quality perspective, helping all members of the care team make decisions based upon the best possible evidence has been been demonstrated to increase performance on important quality measures and hospitals," Basow says. "From a cost reduction perspective, hospital formularies are designed to accomplish many tasks, but one of the more important objectives is to reduce the cost of medication spend. So helping clinicians adhere to hospital formularies is a cost savings to health systems. And then finally, in terms of the the third arm of the triple aim: enhancing the patient experience.
This is certainly relevant in outpatient prescribing settings where sending patients to the pharmacy with the wrong prescription can be a frustrating experience. But even in the inpatient setting, it's important since smoothing out the process between prescribers and pharmacists enhances both the speed and the accuracy of drug delivery."
A strategy proven to be successful in providing care teams on formulary medications is granting access to hospital drug policy information in the same workflow as clinical decision support.
According to Basow, care teams are more and more time constrained and simply don't have the time or the desire to go hunting for information. In her experience, if access to information isn't convenient and fast it won't be used. The ability to combine decision support and drug formulary information within the same workflow, not only can drive better decision making, it also makes it more efficient for clinical teams.
An example of how this works is a physician going up to date with a clinical question and then providing care based on what they learn. If the physician decides his or her patient needs a particular class of an antihypertensive drug, getting to that decision is actually only half the battle, she says.
The physician then has to begin to decide which drug in that class to use, what dose, and then has to write an order that's filled by the pharmacy and is finally administered by nurses in the hospital. In that time there was an important break in that chain of events that occurred at the time that prescribing was happening.
In the example given, she adds there wasn't a good way for most health systems to inform the physician there was a preferred antihypertensive drug in the formulary.
To help this situation, a tool called Formulink was built by Wolters Kluwer, that not only helps hospitals build their formulary, but sits within their Lexicomp application, she says. So, formulary information is right there alongside critical drug decision support. Then, they went a step further and linked that formulary information to up to date right at the point of making the critical decision that the patient needs an antihypertensive treatment. This means within the same workflow and only a click away from up to date, the clinician can see which drugs in that class are on the hospital formulary and get any additional information they need about the drug that may be useful, like dosing, drug interactions, and so on.
"What we've tried to do is essentially take the friction out of the process, because now when that order goes to the pharmacy, the drug is already known to be on formulary," she says. "The pharmacist is seeing the same information as the doctor. And really, critically, the nurse is seeing the same exact guidance. So we just tried to smooth out that entire process."