EMR Integrations Explained: Improving Hospice Pharmacy Efficiency

Under the Medicare hospice benefit, hospices are responsible for nearly every aspect of a patient’s care. Prescribers, nurses, pharmacists, social workers, home health aides and other professionals all play a part. One of the ways they coordinate their efforts is by documenting their actions and observations. These days that’s usually in a cloud-based electronic medical record (EMR) which their colleagues can access in real-time.

“We like to call the EMR the single source of truth in patient care and it’s essential that it remains accurate and up to date at all times,” Enclara Pharmacia Director of Technology Solution Implementation, Matt Repec, said.

Repec leads the team responsible for maintaining and improving interoperability between the hospice EMR and Enclara’s own system. It’s a serious undertaking. “These are complex systems that are handling every aspect of agency management including not only patient records but admissions, scheduling, billing and payroll,” Repec said. “There are also a lot of competing products that all work a little differently.”

Why is Software Interoperability Important for Hospices?

Interoperability between a hospice’s agency management software and its vendors eliminates the need to enter the same information in two different places, saving time and reducing the risk of inconsistencies. This is especially important when it comes to pharmacy benefit managers (PBMs) like Enclara because medication management is such a large part of patient care.

When hospice clinicians enter patient demographics, diagnoses, allergies and medications in the patient record, that information flows to Enclara to enable coverage determinations and support billing and fulfillment. By providing full visibility to Enclara pharmacists, the interface supports clinical consultations, patient safety and reporting for compliance and utilization management.

“With ongoing labor shortages and inflation, hospices are looking to technology to maximize efficiency and scale their teams,” Repec said. “In order to do that, you have to have stable, reliable integrations and responsive service. That’s what we provide at Enclara.”

Which EMRs Does Enclara Support?

Currently Enclara maintains interfaces with over 20 different EMR systems. That number changes from year to year as some companies merge and consolidate while new players enter the market. “For us, it’s about ensuring we’re strategically integrating with the right partners to enable our clients to take advantage of the efficiencies our technology supports,” Repec said. “As the market leader in terms of patients served, we have the resources to partner with both the largest platforms and some of the more niche-oriented systems favored by smaller hospices.”

While some pharmacy vendors outsource integration work, Enclara’s in-house development, implementation and support helps ensure each interface meets the unique needs of the hospices that depend on it. Interfaces aren’t a “one and done” proposition. They start with mapping basic database fields like patient demographics, medication names and dosages from one system to the other, but additional data points and logic can be added over time. Overall functionality can be enhanced through automation and reporting capabilities. The ultimate goal is what Repec calls a “two-way closed loop integration experience” in which information flows seamlessly from one system to the other. Many planned innovations fall under the category of bidirectional interfacing.

What Is (And Isn’t) A Bidirectional Hospice EMR Interface?

EMR interfaces typically go in one direction: Information is entered in the EMR and flows to a third party like Enclara. Most of the time that works fine, but there are times when greater flexibility would be helpful. “The logical next step is bidirectional but this concept has been loosely defined in our industry and can mean different things to different hospices, EMRs or PBMs,” Repec said. “This creates a lot of confusion in the marketplace. Is it actually updating the patient record or is it something else entirely?”

A truly bidirectional interface allows any information entered on one platform to automatically synch with the other. Most hospice software systems don’t yet support that level of integration. However, Enclara has worked with select partners to develop such capabilities. Enclara’s two-way medication interfaces can synchronize a patient’s medication orders for when a medication is added, updated (coverage level) or discontinued in either the EMR or Enclara’s platform.

“It’s understandable that our EMR partners are cautious about supporting fully bidirectional interfacing, but the efficiencies realized by our initial deployments make a strong case for more widespread adoption,” Repec said. “That’s true even if you limit the scope to just the data points we create on our end. For example, when Enclara’s mail order team ships a prescription, adding the dispense date directly to the hospice EMR would help maintain it as that single source of truth. So could adding coverage updates for medications dispensed locally.”

This buzz around interoperability has led to standard interface capabilities being marketed as bidirectional when they really aren’t. For example, most integrations include reporting capabilities to support CR8358 Medicare compliance. That is important, but it’s not updating actual patient data in real time. Similarly, electronic prescribing integrations are standard offerings. A one-way patient demographics interface from the EMR to PBM coupled with a one-way medication interface from PBM to EMR is also sometimes referred to as bidirectional but can actually create a more bifurcated, less efficient workflow.

“Our goal is to elevate industry standards and expectations for interoperability between an EMR and a PBM,” Repec said. “That includes bidirectional, but we are also investing in other enhancements such as electronic delivery of reports from Enclara directly to the EMR. It’s all about finding the solution that best supports patient safety and nurse efficiency, regardless of what we call it.”

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