Electronic medical records hold the key to unlocking dramatic improvements in healthcare. And it can be done while respecting patient privacy. Conscientious analysis of the data contained in prescription insurance claims, for example, can help prevent harmful drug interactions, increase patient compliance and provide information that leads to better prescribing decisions.
It can help to improve health by measuring outcomes and evaluating the efficacy of specific drugs. It can reduce costs by enabling health plans to appraise pharmaceutical usage trends and design benefit programs that steer patients toward the most appropriate and cost-effective therapies. And it can lead to more effective and beneficial relationships between doctors and pharmaceutical companies.
As a physician, I believe it is our duty to help deliver on the promise of improved health that the responsible use of patient data can provide.
Pharmacy benefit managers are in a unique position to play a leading role in this health improvement process. PBMs manage and process more than 1 billion prescription insurance claims annually for some 65% of the nation's population. In so doing, they capture and store valuable information about each transaction. This information is complete, accurate and available in real time-making it ideal for effective research and analysis.
The debate around the use and sale of electronic medical records is, of course, highly charged because of the sensitive nature of the information. Patient privacy and confidentiality are paramount. We strongly believe that any use of electronic data must protect the privacy of the patient. PBMs consider themselves stewards of this highly sensitive information and zealously guard the privacy of the millions of individuals they serve.
We do enter into agreements with pharmaceutical manufacturers, academic institutions and other research organizations to provide data or analyses from our information warehouse of prescription transactions. All data is scrubbed of names, Social Security numbers and other identifying information like addresses and phone numbers before sharing it with our partners. This process makes it impossible for others to know the identity of individual patients or use the information for direct marketing purposes.
Under the Health Insurance Portability and Accountability Act of 1996, government standards also are in place to ensure the appropriate and confidential handling of patient information. Simply put, voluntary industry confidentiality practices and HIPAA guidelines ensure patient privacy. It should not be a concern.
Let's look at how the analysis of prescription information by PBMs can create positive results from the physician's perspective:
- Better prescribing information. The advent of electronic prescribing is enabling connectivity between physicians, pharmacies, health plans and PBMs. Physicians now are or soon will be able to tap into patient data stored by PBMs. At the time of prescribing, physicians can instantly review patient drug histories, check for potential drug interactions, monitor compliance and review health plan formulary guidelines. This information can lead to better prescribing decisions and better patient health.
- Prescription trend analysis. Academic institutions and think tanks use PBM data to study drug-use patterns, quantify changes and make policy recommendations. In a recent study by Brandeis University using AdvancePCS data, researchers showed a dramatic increase in the number of older Americans taking multiple medications. Providing appropriate guidance to seniors taking multiple medications has positive policy and physician practice implications.
- Utilization management and compliance improvement. Evaluation of prescription data also can help ensure that patients are taking their medications appropriately and complying with their physicians' therapy guidelines.
- Outcomes measurement. Patient prescription data are used to evaluate the effectiveness of health improvement programs as well as individual prescription therapies. Data analysis can quantify improvements brought about by disease management programs, for example. In addition, the efficacy and cost effectiveness of competing therapies can be evaluated by looking at patient populations taking different drugs within a therapeutic class.
- Drug company relationships. Pharmaceutical manufacturers use prescription data provided by PBMs to track the market share of their products and to evaluate the effectiveness of their sales efforts with physicians. Access to accurate data allows drug companies to ensure that they are communicating with physicians in the most efficient and helpful manner by determining which approaches and messages work best.
Andrew Garling, M.D., is a senior vice president at AdvancePCS, the nation's largest independent provider of health improvement services.
Editors note: The HIPAA privacy standards do not go into effect until June 2003. Smaller companies may be eligible for a compliance deadline extension. The guidelines, which are being adjusted by HHS, will permit the marketing, sale and use of some otherwise protected confidential patient information.