Guiding providers' prescribing practices

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's helped get patients the right antibiotic from the get-go. Compliance with first-line recommended antibiotics has increased 60%, Zane said. Though use of the software isn't mandatory, it's grown exponentially at UCHealth 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."