How would you like to reduce your practice's patient data research load by 12 hours a week? That's precisely what Dr. Alan Brush did for his multispecialty practice in Cambridge, Mass.
“Using the EpicCare electronic medical record system's SmartPhrases feature, I created what we call 'RxRefill phrases' for all formulary drugs where lookup of essential information is required for a refill,” Dr. Brush said in an interview. “The process of making sure that lab tests, blood values, and mammogram results are current takes about 5 minutes per prescription. I do 100 refills a week in a practice that is about 60% full time.”
Dr. Brush's office is 1 of 14 sites in the Harvard Vanguard group, all of which are served by EpicCare. “In moving from paper to EpicCare's EMR system, I noted little improvement in the efficiency of refilling medications; it was just a shift from paper to electronic medium. When refills required essential data such as creatinine and potassium and last blood pressure values for diuretic refills, someone still had to spend time looking up and communicating the information to the clinician ultimately responsible for that prescription.”
As the leader of the Harvard Vanguard group's Internal Medicine Design Team, Dr. Brush started working on a catalog of formulary drugs that had parameters one had to follow at the time of refill.
“Now, all my assistant has to do is type 'Rx' followed by the name of the drug—for example, 'RxSimvastatin'—and all the data are generated. These phrases contain the request for the drug, as well as data links that automatically bring the required lab tests and clinical information into the refill request,” Dr. Brush explained.
When the test is overdue or the last blood pressure test is beyond the time for a reasonable refill, the medical assistant or nurse requesting the clinician to sign off knows to first arrange the appropriate appointment or tests and to request a refill that lasts just beyond that date, he said.
When the timing is up to date, the request automatically includes the essential data for the clinician to view. This information becomes part of the medical record at the time of the refill, indicating that it has been reviewed, he added.
“Not only does the medical assistant or nurse save time in looking up the essential information, but the clinician sees [only] refill requests that are already adequately researched, much simplifying his or her work,” said Dr. Brush, who has no financial interest in EpiCare. “When I receive a prescription refill request now, if everything has been done, all the necessary data appear on the screen. To complete the process, I hit 'approve,' and 'close encounter,' and the refill process is complete.”