workflow of pharmacist clinical documentation … of pharmacist clinical documentation process in...

Workflow of Pharmacist Clinical

Documentation Process in

Pharmacy Practice Settings

July 28, 2014

WORKFLOW OF PHARMACIST CLINICAL DOCUMENTATION PROCESS IN PHARMACY PRACTICE SETTINGS 2

Table of Contents

1. PURPOSE .................................................................................................................................3

2. OVERVIEW ...............................................................................................................................3

3. DISCUSSION ............................................................................................................................3

3.1. PHARMACIST PROCESS OF CARE FOR CLINICAL DOCUMENTATION SYSTEM AND DATA FLOW ............................................................................................3

3.2. PROCESS-OF-CARE STRUCTURED DOCUMENTS ....................................................6

3.3. EXAMPLE OF PROCESS OF CARE IN PHARMACY PRACTICE SETTINGS ..............8

4. CONCLUSION ..........................................................................................................................8

5. APPENDIX: PHARMACISTS’ PATIENT CARE PROCESS ....................................................8

6. ACKNOWLEDGEMENTS .........................................................................................................8


1. PURPOSEThis paper aims to help system vendors understand the flow of clinical data by defining the clinical documentation workflow of pharmacists in pharmacy practice settings.

The intent of the document is to demonstrate the usefulness of the process flow and how health information technology (HIT) can affect the process of care. Pharmacists are encour-aged to work with their system vendor to build functionality into their system to collect, doc-ument, and exchange clinical information using structured documents that follow electronic industry standards.

Appreciating fully the clinical utility of electronic health data, the pharmacy profession has positioned itself well ahead of the curve for standardized outcomes-related data collection and enhanced electronic data accessibility for delivering quality patient care services. The mission of the Pharmacy HIT Collaborative Work Group on Communication Standards is to further integrate pharmacists who provide patient care services into the national health information exchange framework.

2. OVERVIEWPharmacist workflow, as defined by system vendors, has traditionally focused on the dispensing process. As the pharmacist role changes to encompass patient care services, a clinical workflow model needs to be defined. This document will help system vendors un-derstand how pharmacists collect, document, and exchange clinical information during the process of care.

The creators of this document analyzed the process of care used by a pharmacist during di-rect patient care services in an ambulatory practice setting. This particular process of care was illustrated graphically using a workflow diagram or flowchart. Pharmacists and system vendors can use this document as a starting point to find ways of increasing system usabil-ity for clinical pharmacists in collecting, documenting, and exchanging clinical information outside of the dispensing workflow.

The purpose of this document is to develop a useful guide for pharmacists to explain to sys-tem vendors the workflow of clinical information during the pharmacist’s process of care.

3. DISCUSSION 3.1. PHARMACIST PROCESS OF CARE FOR CLINICAL DOCUMENTATION SYSTEM AND DATA FLOWUnder formal and informal collaborative practice agreements, pharmacists work in col-laboration with physicians and primary care providers to help patients, particularly those institutionalized in hospitals, long term care facilities, as well as ambulatory care patients with chronic conditions, manage their medication regimens in the following ways:

• Performing patient assessments and developing therapeutic plans

• Using their authority to initiate, adjust, or discontinue medications

• Ordering, interpreting, and monitoring appropriate laboratory tests

• Providing care coordination and other health care services for wellness and prevention

• Developing partnerships with patients for ongoing and follow-up care


Diagram 1 depicts the process of care pharmacists follow during the clinical process. Diagram 2 outlines the flow of data during the process of care.

DIAGRAM 1:

Adapted from Pharmacists’ Patient Care Process, May 29, 2014. http://www.pharmacist.com/sites/default/files/JCPP_Pharmacists_Patient_Care_Process.pdf

*Visit is used in this document to describe a patient encounter or admission to a hospital, home care, or other health care organization

Pharmacists’ Process of Care for Clinical Documentation System

(before and during visit)*


DIAGRAM 2:

Collect (before and during visit)

Assess

Plan

Implement

Follow-up (monitor and

evaluate)

Pharmacists’ Clinical Documentation Data FlowAmbulatory Clinic Setting

•Lab results•Discharge summary•Patient care summary•Patient reported data•Med dispensing history

•Demographics•History & physical•Vital signs

Data from External Sources

Data from Internal Sources

Data to External Sources

Data to Internal Sources

•Medication action plan•Patient care summary•Transition of care document with medication reconciliation

•Progress note•Med change •Lab recommendation


3.2. PROCESS-OF-CARE STRUCTURED DOCUMENTSDiagram 3 outlines processes used by pharmacists for patient care. The superimposed circles show what a pharmacist may do from the standpoint of an electronic structured document. During the electronic process of collecting, documenting, and exchanging clinical information, the pharmacist uses the electronic system to create structured documents that are used at different points in the process of care.

• During the collection, assessment, phases, the pharmacist creates a pharmacy care note that incorporates the reconciled medication list. In turn, the pharmacy care note forms the basis of the medication action plan.

• The pharmacist uses the medication action plan as part of patient engagement during the implementation phase. During the evaluation phase, the pharmacist uses quality and value assessment documents.

• The pharmacist uses a pharmacy care transition document or other patient medical care documentation record (i.e EHR) during the monitor and transition phases.

DIAGRAM 3:

3.3. EXAMPLE OF PROCESS OF CARE IN PHARMACY PRACTICE SETTINGSDiagram 4 below presents examples of the steps accomplished during the process of care in an ambulatory clinic setting. The authors believe that the process-of-care steps would work in all pharmacy practice settings. The intent of the diagram is to assist system vendors with a process flow for collecting, documenting, and exchanging clinical information and to provide a process flow that ensures that the assessment and outcomes of patient care are enhanced in all pharmacy practice settings.

Pharmacy Care Transitions Document

Quality & Value Assessment

Medication Action Plan

Pharmacy Care Note with Reconciled Medication List

Adapted from Pharmacists’ Patient Care Process, May 29, 2014. http://www.pharmacist.com/sites/default/files/JCPP_Pharmacists_Patient_Care_Process.pdf

Pharmacists’ Patient Care Process Structure Documents


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am

DIAGRAM 4:


4. CONCLUSIONIn today’s health care environment, pharmacists are in a unique position to provide clinical services that manage medications and coordinate patient care to improve quality outcomes.

Pharmacists collect, document, and exchange clinical information with members of an inter-professional care team. The purpose of this document is to help system vendors understand the workflow of clinical information across the continuum. Outlining the clinical workflow by pharmacists will help ensure that medication-related information is shared with the entire patient care team in a way that maximizes patient outcomes.

5. APPENDIX: PATIENT-CENTERED COLLABORATIVE CARE PROCESSFigure 1 depicts a proposed standardized pharmacist patient-centered collaborative care process for pharmacists providing medication therapy management (MTM) services. The pharmacists’ patient care process described in this illustration was developed by examining a number of key source documents on pharmaceutical care and MTM. Patient care process components in each of these resources were catalogued and compared to create the follow-ing process that encompasses a contemporary and comprehensive approach to patient-cen-tered care that is delivered in collaboration with other members of the health care team.

(Source: Pharmacists’ Patient Care Process, May 29, 2014. http://www.pharmacist.com/sites/default/files/JCPP_Pharmacists_ Patient_Care_Process.pdf)


5. ACKNOWLEDGEMENTSThe following representatives of the Pharmacy HIT Collaborative Work Group, which is devoted to Communication Standards, developed this document, “Workflow of Pharmacist Clinical Documentation Process in Pharmacy Practice Settings”:

COORDINATORShelly Spiro, Executive Director, Pharmacy HIT Collaborative

AUTHORSRobert Franz, Senior Clinical Account Executive, Clinical Services, Express Scripts

Sammuel Anderegg, Pharmacy Manager, Oncology Service Line, Georgia Regents University Cancer Center

Jeffrey M. Brewer, Associate Professor of Pharmacy Practice, School of Pharmacy and Pharmaceutical Science, Albany College of Pharmacy and Health Sciences

Mark Brueckl, Assistant Director, Pharmacy Affairs, Academy of Managed Care Pharmacy

Elizabeth Brusig, Clinical Pharmacy Specialist, Optima Health Plan

Özlem H. Ersin, Assistant Department Chair, Pharmaceutical Sciences Associate Professor, Pharmaceutical Sciences, Manchester College School of Pharmacy

Mike Case Haub, Senior Associate, Provider Services, OutcomesMTM

Clark Kebodeaux, Assistant Professor of Pharmacy Practice, St. Louis College of Pharmacy

Cynthia Kesteloot, Vice President of Technology, OutcomesMTM

Mary Ann Kliethermes, Vice Chair of Ambulatory Care, Professor, Chicago College of Phar-macy, Midwestern University

Patty Kumbera, COO, OutcomesMTM

James A. Owen, Associate Vice President, Practice and Science Affairs, American Pharma-cists Association

Robin Ripperger, Senior Associate, Data Management, OutcomesMTM

Leslie Rodriguez, Clinical Education Coordinator, University of Hawai’i Hilo College of Phar-macy

Nicole Russell NCPDP Government Affairs Specialist.

Rebecca Snead, Executive Vice President and CEO, National Alliance of State Pharmacy Associations