Best Practices: An Electronic Drug Alert Program to Improve Safety in an Accountable Care Environment

Authors: Griesbach, S; Lustig, A; Malsin, L; Carley, B; Westrich, KD; Dubois, RW.
Publication: Journal of Managed Care & Specialty Pharmacy. April 2015.

Accountable care organizations (ACO) focus on improving communication and care transitions by tying potential shared savings to specific clinical and financial benchmarks. An important factor in meeting these benchmarks is an ACO’s ability to manage medications in an environment where medical and pharmacy care has been integrated. The program described in this article highlights the critical components of Marshfield Clinic’s Drug Safety Alert Program (DSAP), which focuses on prioritizing and communicating safety issues related to medications with the goal of reducing potential adverse drug events.

Different health care providers within an ACO may be responsible for managing the care of the same patients, making the dissemination of safety information a critical concern. Marshfield Clinic addressed this concern through its DSAP, which provides clinicians with up-to-date information to prevent drug contraindications, polypharmacy issues, and dosing errors based upon safety information received from the Food and Drug Administration and biopharmaceutical manufacturers. In the study, Marshfield Clinic described what it learned in creating the DSAP and identified several factors for consideration in the development and ultimate success of an electronic drug safety alert program within an ACO:

Leveraging Electronic Health Records (EHRs). Mining clinical data from the EHR, which provides detailed data directly from a patient’s chart, can improve the accuracy and timeliness of the information and assist in monitoring changes in prescribing patterns and in measuring quality improvement. By contrast, traditional drug utilization programs rely on claims data, which can often be inaccurate and accessed in a less timely fashion.

Preventing Alert Fatigue. The Marshfield Clinic’s DSAP is “designed to avoid ‘alert fatigue or overload,’ which occurs when so many alerts come through the EHR that clinicians begin to ignore or overlook them.” Instead of sending DSAP alerts on individual patients, the alerts are packaged in a report that aggregates all of the patients who have been prescribed a specific medication. This critical aspect of the clinic’s DSAP ensures that providers are only given the information they need and encourages them to integrate the alerts into their care plans. The Marshfield Clinic and other health systems have dealt with alert fatigue by using a color-coded alert system to notify clinicians of the level of importance of an alert. This helps distinguish between an alert that is educational in nature and one that is critical to patient safety.

Relevance to Improving Quality for ACOs. The Marshfield Clinic’s DSAP also flags medication issues that are tied to the quality measures that must be met by ACOs in order to qualify for the Centers for Medicare and Medicaid Services’ shared savings program.

This study is part of a broader project supported by NPC, the American Medical Group Association and Premier, Inc. to understand the role of pharmaceuticals in helping ACOs achieve their financial and quality goals. In the project’s foundational stage, the partners, working in conjunction with a group of ACOs, developed a framework for considering the costs and benefits of medications in various conditions. The partners also are exploring other best practices, such as electronic refill services, physician leadership in a team-based care environment, and collaborative opportunities between industry and ACOs.