The vital role pharmacy technology can play in elevating medication safety

CMS continues to introduce regulations that move our healthcare system toward value-based care. As we make the shift toward payment for outcomes, it’s a good time to think about the role of pharmacy in general, particularly in older adult populations. Polypharmacy¹ (the use of more medications than clinically indicated and/or the use of unnecessary or harmful prescribing) is a particular concern as the U.S. population ages. And, as pharma influence grows, electronic medical records become ubiquitous and e-prescribing processes are streamlined, polypharmacy rates are rising.

Now more than ever, pharmacists are ready and willing to embrace the challenge of keeping patients safe on multiple medications. But pharmacy technology lags far behind the science of medication safety.

Pharmacists are schooled about “competitive inhibition.” We learn about inducers and inhibitors. We learn about bioavailability and half-life. We learn about affinity coefficients and their effects on competitive inhibition. We learn that humans have genes that are singularly purposed to eliminate poisons (drugs) from our bodies or to activate pro-drugs into other substances that can then be eliminated. Our genes affect metabolism by making medications polar or water-soluble.

Competitive inhibition occurs when multiple medications seek a single gene pathway for metabolism. If three medications metabolized by CYP3A4 are administered together (e.g., at breakfast), the one with the strongest affinity to CYP3A4 will first monopolize the enzyme that the gene produces. The other drugs with lower affinity coefficients will continue to circulate throughout the body—working and working and working as a pro-drug (inducing side effects), and/or as an active drug (increasing activity). Now, an unintentional overdose is looming.

We rarely use this science in pharmacy practice, because it is virtually impossible for a pharmacist to memorize the pharmacokinetics and pharmacodynamics of every single drug, and then compute every presented multi drug combination in real time.

Software and accompanying medication decision support aids for pharmacists (and prescribers) have been nonexistent. So, healthcare has relied on algorithms and formularies, and on nursing rules or drug manufacturers’ advice to determine which drugs are “best” and what time of day to administer them. Over the decades, this non personalized approach has neither protected patients nor mitigated medication misadventuring. And, as the prevalence of polypharmacy increases, poor medication-related patient outcomes have been the norm.

New technology needed at the pharmacy level

My call continues to be this: Pharmacy must change course soon. Provider outcomes are being measured, and their referrals may be dependent on their quality metrics. People will always take medication, so dispensing will always be needed. But, individuals, healthcare systems, providers, and plans must understand the value of a pharmacy partner over a dispensary.

For our partners, we have developed medication safety software with metrics and dashboards, used both prospectively (before prescribing) and retrospectively (after dispensing). These metrics help to externalize pharmaceutical logic and expertise.

We also developed a “Medication Risk Score” as a quick and easy way to assess which patients are at highest risk for adverse drug events (ADEs) and require medication management attention. This score is calculated using all active medication ingredients on the profile and accounts for safety indicators that include multi-drug-gene interactions; competitive inhibition/unintentional overdose risk; anticholinergic, cognitive, or sedative burden; cardiac arrhythmia risk; and more.

Translating the science through medication decision support (MDS) tools at the point of care for a particular patient, with a particular set of problems and medications is a leap forward toward personalized prescribing. Knowing a patient’s Medication Risk Score, their particular area/s of safety concern, and their risk for cumulative side-effects within an e-prescribing tool before a medication decision is made, should be the standard of care in 2017.

Embracing the cloud for better decision-support tools at the point of care

Our cloud computing services and simple interoperability solutions put the tools in the hands of clinical decision-makers right at the point of care. These sophisticated, but easy to interpret clinical tools arm prescribers with knowledge during prescribing activities or even before medication decisions are made.

The science is translated through the process of collecting inputs i.e. medications, conditions, and allergies, etc. and analyzing them simultaneously against sophisticated algorithms, instantaneously, in the cloud. In milliseconds high-risk multi drug pharmacokinetic problems are identified and highlighted for the prescriber. The prescriber then knows where to hone in to avoid prescribing medications that put the patient at higher risk. This is truly personalized prescribing.

We know—and can now demonstrate—that focused collaboration with our pharmacists can have a material effect in reducing these medication risk scores. With our medication safety technology, our pharmacists help streamline therapy, reduce overall risk, and identify the most cost-effective options available.

Widespread healthcare technology collaboration is needed—including with EHR vendors that dominate the market and with pharmacy dispensing and operations software vendors—to provide pharmacists nationwide with the disruptive medication risk mitigation tools we need to effect change. It is time to put the science behind medication safety metrics into our pharmacy computer systems.

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