Daily prescription refill requests swamped the physicians at Scripps Health. What should have been a routine task began eating away at the time available for direct patient care.
Up to an hour a day became devoted solely to refill management, even though most were routine requests. When the task began forcing physicians and staff to stay beyond regular hours, the doctors at the San Diego, Calif.-based health system rebelled. They made it clear to administrators that something had to change.
“They were getting home late and not able to spend time with their family because they were finishing up documentation and, on top of that, refilling medication.” said Monica LaJoie, Prescription Refill Center Nurse Manager at Scripps Health.
The nonprofit health system treats 700,000 patients annually at its four hospitals and more than 28 outpatient clinics. Those patients require about 40,000 prescriptions per month.
Refills are generated either electronically through the pharmacy or manually by a patient registrar. A task gets created that highlights the requested medication, and it goes to the appropriate provider. Scripps Health has 200 internal medicine and family medicine providers that once received all of these refill requests for approval.
Each prescription refill request would appear in the clinical inbox as a task with the medication name, but without the necessary information to make a decision. Physicians had to manually look up office visit dates, lab results, and last refill dates in the patient's electronic health record (EHR) one by one — a tedious and time-consuming process.
Scripps Health is not the only health system dealing with this and similar issues involving tasks that are ancillary to direct patient care. Research published by the New England Journal of Medicine in 2010 found that primary care physicians on a typical day will handle 12 prescription refills (not counting those written during a visit), 19 phone calls, 17 e-mails, 20 lab reports, 11 imaging reports, and 14 reports from specialists.
“Our physicians felt that there was just not enough time in the day,” said LaJoie. “They were overwhelmed. Having to do all these tasks really took the joy out of being a provider.”
LaJoie and her colleagues first thought about hiring additional nurses to help out with the mountain of refill requests. But their analysis found that they would have to hire about 30 new staff members — a costly and cumbersome option.
Instead of bringing in more nurses, they opted to look for an alternative involving technology that could speed up the refill process and free up providers' time.
Providers at UT Southwestern Medical Center in Dallas faced a similar dilemma in managing the growing burden of menial administrative tasks. Many physicians were frustrated by their inability to quickly respond to refill requests. They reported spending more than two hours per day on the routine tasks that filled their electronic in-basket.
It was dragging the nurses away from direct patient care, too. “Nurses are consumed with the daily administrative duties that are behind the scenes such as the pre-authorizations for the medications that are ordered, the prescription refills, the patient messages, the complicated referral arrangements,” said Stacey Clark, Assistant Vice President of Ambulatory Clinical Operations and Training at UT Southwestern.
With two hospitals and dozens of outpatient clinics, UT Southwestern handles more than 92,000 hospitalizations and 2.2 million outpatient visits every year. The mundane task of dealing with dozens of prescription refill requests each day took up valuable time.
“Managing prescription refills are a big problem for any practice. There are thousands of medication requests every month, and the manpower to take care of all that is phenomenal,” Clark said. “The patient may call you for a refill, send a message through My Chart, use a fax, or an electronic request — there are so many different ways they can come to you, and sometimes there are duplicates.”
Clark and her colleagues decided to build a team to tackle the problem. Their model was a process used by UT Southwestern to standardize processes across all of its ambulatory clinics. The initiative, dubbed the Ambulatory Quality Outcomes Project, had won the system the 2016 Healthcare Informatics Innovator of the Year Award.
That effort brought together clinical staff, information resources specialists, quality analysts, and data analysts to create standardized tools for clinical decision support, data management and quality reporting.
Perhaps a similar team could find an innovative solution to the seemingly endless list of routine and repeatable administrative tasks that were overwhelming both practitioners and their support staff.
Next week, part 3 of Automating Routine Tasks will review a number of start-ups developing information technologies that claim to free up time for physicians and other clinical staff.
Meeri Kim is a freelance writer based in Los Angeles.