Guid­ing providers’ pre­scrib­ing prac­tices

Modern Healthcare - - INNOVATIONS - By Rachel Z. Arndt

A lot goes into choos­ing a med­i­ca­tion for a pa­tient. There are best prac­tices, con­sid­er­a­tion of a pa­tient’s med­i­cal his­tory and in­sur­ance cov­er­age. And there’s also cost.

RxRevu al­lows doc­tors to take all those fac­tors and more into con­sid­er­a­tion through its pre­scrip­tion de­ci­sion-sup­port plat­form, RxCheck, which helps clin­i­cians choose which drug to give a pa­tient based on that pa­tient’s per­sonal health in­for­ma­tion, cost and other guide­lines.

“RxCheck brings to­gether two crit­i­cal pieces of in­for­ma­tion: clin­i­cal in­for­ma­tion and in­sur­ance in­for­ma­tion,” said Carm Hun­tress, CEO of RxRevu, the Den­ver com­pany he founded in 2013. In­for­ma­tion tai­lored to each pa­tient can re­duce clin­i­cal vari­abil­ity. “We’re help­ing providers make more in­formed de­ci­sions,” Hun­tress said. “This is driv­ing safety and ef­fi­cacy.”

It’s also driv­ing pa­tient sat­is­fac­tion, he said. “Pa­tients aren’t get­ting to the phar­macy any­more and find­ing that the med­i­ca­tion isn’t cov­ered or there’s a prior au­tho­riza­tion needed.”

This kind of de­ci­sion sup­port is es­sen­tial, Hun­tress said, es­pe­cially as health sys­tems move into value-based pay­ment mod­els. Not only does it help im­prove out­comes by get­ting pa­tients on the right med­i­ca­tions at the point of care, but it also yields in­sight into providers’ pre­scrib­ing habits. Clin­i­cal ad­min­is­tra­tors can see the pre­scrib­ing pat­terns of their providers and help them im­prove if need be.

RxRevu has raised $5 mil­lion to date. The com­pany’s soft­ware is in use at five health sys­tems across the coun­try. Some of those de­ploy­ments, for pri­mary-care providers, cover ev­ery drug that could be pre­scribed in a pri­mary-care set­ting. Oth­ers are fo­cused on drugs for spe­cific con­di­tions.

That’s the case in a new part­ner­ship with UCHealth, a 1,620-bed sys­tem in Colorado that’s us­ing RxCheck for treat­ing heart-fail­ure pa­tients in pri­mary-care clin­ics. Physi­cians can get pre­scrib­ing guid­ance from the plat­form, help­ing them choose from among the more than 30 com­monly pre­scribed med­i­ca­tions for heart fail­ure. If a pa­tient’s reg­i­men does not meet the na­tional guide­line, for in­stance, RxCheck will dis­play rec­om­men­da­tions to rem­edy that, and with just a few clicks, providers can change course.

UCHealth has al­ready been us­ing RxCheck for an­tibi­otic pre­scrib­ing. Al­most one-third of an­tibi­otic pre­scrip­tions are un­nec­es­sary, ac­cord­ing to re­search by Pew Char­i­ta­ble Trusts. To make its pre­scrib­ing prac­tices more ac­cu­rate and to cut down on need­less pre­scrip­tions, UCHealth in­tro­duced RxCheck last year, first in the Uni­ver­sity of Colorado Hos­pi­tal’s emer­gency depart­ment.

For an­tibi­otic pre­scrip­tions, a key piece of in­for­ma­tion RxCheck dis­plays is the an­tibi­ogram, which tells providers how re­sis­tant a bac­te­rial strain is to dif­fer­ent an­tibi­otics; the first-line an­tibi­otic in Colorado, for in­stance, might not be the same in Maine.

As with its other solutions, all of this in­for­ma­tion is avail­able from within the elec­tronic health record. “RxCheck is com­pletely em­bed­ded within the provider work­flow,” said Dr. Richard Zane, UCHealth’s chief in­no­va­tion of­fi­cer. That’s key for clin­i­cal de­ci­sion sup­port to work. “It al­ways has to be the path of least re­sis­tance,” he said. The tool has evolved to meet providers’ needs. “We part­ner engi­neers with clin­i­cians and ob­serve how they’re us­ing the tool,” Zane said, “and we it­er­ate as we go.”

Since the pro­gram launched, it has helped get pa­tients the right an­tibi­otic from the get-go. Com­pli­ance with first-line rec­om­mended an­tibi­otics for cer­tain con­di­tions has in­creased 60%, Zane said. Though use of the soft­ware isn’t manda­tory, it’s grown ex­po­nen­tially at one UCHealth clin­i­cal site nev­er­the­less. Over the next two years, RxRevu’s goal is to fur­ther de­velop the net­work of providers who use its tech­nol­ogy. Hun­tress also hopes to build con­nec­tions with pay­ers and phar­macy ben­e­fits man­agers to bring ad­di­tional cost and ben­e­fit in­for­ma­tion into its soft­ware.

“We see a big gap to­day in tools and tech­nol­ogy within the pre­scrip­tion drug mar­ket, and we think we’re re­ally be­com­ing the leader in pre­scrip­tion de­ci­sion sup­port,” Hun­tress said. “Ul­ti­mately, we’re try­ing to cre­ate this cat­e­gory of pre­scrip­tion de­ci­sion sup­port within clin­i­cal de­ci­sion sup­port.”

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