(Management Case Study) Implementation of an Electronic Scoring System to Prioritize Clinical Pharmacy Services

Purpose: As healthcare transitions to value-based care models, greater emphasis is being placed on quality of care and the impact on patient outcomes provided by health-system pharmacists. Payment models are shifting from reimbursement for volume to reimbursement for value and it is becoming increasingly important to reduce variability in practice models, improve safety, efficiency, quality of care, and decrease costs. To align with these shifts in healthcare, we developed an electronic-based scoring system that updates in real-time to prioritize and expand clinical pharmacy services across a health system. This case describes the development and implementation of this systematic process.

Methods: In accordance with recommendations from health-system pharmacy organizations and the shifting healthcare landscape, a small group of administrative and clinical pharmacists partnered with health information technology (IT) pharmacists to develop a systematic process for patient care. The goal was to prioritize and expand clinical pharmacy services, triage patients, and identify opportunities for pharmacist interventions and medication optimization. After a test phase of 5 single variables, a large workgroup was formed that included pharmacists from all areas and specialties across the health system and IT pharmacists. A full list of variables was compiled by the workgroup and point system created based on prioritization. Variables were then selected in phases based on priority and feasibility to be built into the electronic health record (EHR) by the IT pharmacists. These variables were rolled out in phases for the workgroup to test out. After multiple phases and PDCA cycles, the scoring system was rolled out across the system with several training sessions. Pharmacists were trained to work up patients based on the scoring system, reviewing their highest scoring patients first. After 4 months of roll out, an IRB approved retrospective study was completed to validate the scoring system and survey the staff for feedback. The survey was distributed to all inpatient pharmacists to determine the impact of the scoring system on pharmacist workload and clinical pharmacy services.

Results: The scoring system was developed by IT and clinical pharmacists from all areas and specialties across the health system and rolled out to inpatient pharmacists. It is made up of 70 variables to date and assigns each patient a total score along with a breakdown of the score on the patient list. It updates in real-time to help pharmacists prioritize patients based on acuity and those needing pharmacist review, interventions, and/or interactions. This scoring system allows for a way to document the care provided by inpatient pharmacists and to retrieve data on the quality measures recommended by health-system pharmacy organizations. Survey results from 24 pharmacists thus far show that the scoring system has helped most in prioritization, identifying interventions, and in providing additional clinical pharmacy services that may not have been recognized prior.

Conclusion: Clinical pharmacy services continue to evolve and grow, but there remains significant variability in pharmacy practice models and many do not allow for a comprehensive pharmacist assessment and management of every hospital admission. A systematic process to determine which clinical activities to prioritize and complete during the day for quality patient care has become more critical than ever. This case describes the methods for developing and implementing a systematic process using the electronic health record to prioritize and align clinical pharmacy services across a health system.