â€œPharmacists certainly have the skills, training, and knowledge to be prime players in a coordinated approach,â€ said Judy Cahill, executive director of the Academy of Managed Care Pharmacy. â€œAn inherent shortcoming to this idea, however, is lack of pharmacist access to patientsâ€™ medical records. For them to play a pivotal part in care management, the medical record is essential.â€
Keckley agrees. Lack of pharmacist access to patient medical records currently limits the role of pharmacist to medication management only, rather than offering an opportunity to manage care between patients and providers, such as nutritionists and physical therapists, he saids.
Two developments can change that: the increasing use of electronic medical records and the industry-wide promotion of electronic prescription transmission. EMRs will allow pharmacists access to diagnostic rationales and long-range patient treatment histories. For example, an EMR can give pharmacists access to laboratory data. HIPAA privacy concerns may have to be addressed through authorization forms, and state boards of pharmacy may have to reexamine current regulatory practices.
But these concerns are already being addressed through medication therapy medication initiatives across the country â€” many sponsored by health plans that see a cost advantage in having pharmacists counsel patients. E-prescribing not only gives pharmacists access to insurance information â€” data available through pharmacy benefit management software â€” it also enhances communication with physicians.
Several emerging e-prescribing models, sponsored by health plans, include e-prescribing as a component of EMRs. â€œBring into that the use of clinical management tools, which are the tools that DM companies now market, and pharmacists will be able to offer a degree of coordination, especially for patients with chronic diseases, that no other provider, including physicians, are as readily able to provide,â€ said Keckley. â€œPlans could consider paying for that service.â€
This is a prime example of how technology can be used to expand the pharmacistâ€™s role in patient care.