Exploring the Future of Specialty Prescribing and Pharmacy Interoperability

07/30/24 • 42 min

Welcome to "The Dish on Health IT," a podcast brought to you by Point-of-Care Partners, a leading health IT consultancy. Each episode features a rotating panel of senior consultants and guests who discuss trends and innovations in health IT, providing insights and recommendations to help organizations leverage advances to solve their business problems.

In this episode, POCP hosts Tony Schueth, CEO of Point-of-Care Partners, and Pooja Babbrah, PBM and Pharmacy Lead, are joined by Shivani Patel, Executive Vice President of Patient Access Operations and Technology Solutions at Asembia. Together, they delve into key topics including specialty prescribing, pharmacy interoperability, TEFCA, and consent management, highlighting how technology, policy, and process improvements can drive positive changes in healthcare.

The conversation kicks off with an introduction to specialty prescribing. Shivani explains that specialty prescribing involves treatments that are typically more complex than standard prescriptions due to factors like high cost, special storage requirements, and adherence challenges. She points out the logistical gaps and barriers in the specialty space, such as prior authorizations and communication challenges between stakeholders. Pooja adds that the lack of a standardized definition for specialty medications further complicates the process, leading to delays and confusion.

Moving on to pharmacy interoperability, Pooja describes it as the ability to share clinical data between pharmacists, providers, and other stakeholders. She emphasizes the importance of providing pharmacists with the right information they need, instead of overwhelming them with excessive data. For instance, pharmacists should not have to sift through 500 pages of patient records to find relevant information. Instead, they need targeted, pertinent data to improve patient care and streamline processes.

The discussion then shifts to TEFCA (Trusted Exchange Framework and Common Agreement), which aims to fill information gaps in the healthcare system by setting standards for data exchange. Shivani and Pooja discuss how TEFCA can enhance transparency and interoperability, helping pharmacists and other stakeholders' access and share necessary patient information more efficiently. Shivani notes the potential of TEFCA to establish a universal patient identifier, which could significantly improve data sharing and patient care coordination.

Consent management is another crucial topic covered in this episode. Effective consent management is essential for pharmacy interoperability and ensuring patients' privacy and data security. Shivani and Pooja explore how consent management can be improved to make the sharing of patient information more seamless and secure. They emphasize the need for standardized consent processes that allow patients to control their data while ensuring that relevant information is accessible to healthcare providers.

Throughout the episode, the panel highlights the role of technology in improving the prescription journey. Shivani discusses how Asembia uses technology to support the industry by connecting stakeholders and providing tools to manage patient care better. This includes everything from prior authorizations to benefit checks and copay cards. Pooja underscores the importance of industry collaboration and transparency to create standardized solutions that benefit all stakeholders.

Towards the end of the episode, Shivani shares insights about the Asembia Summit, an annual event that gathers industry stakeholders to discuss trends and innovations in specialty pharmacy. She invites listeners to attend AXS25, the next Asembia Summit, which will take place from April 27th to May 1st, 2025, at the Wynn Las Vegas. The event offers a premier forum for learning, networking, and exploring the latest advancements in the industry.

Tune in to this episode to gain a deeper understanding of the complexities of specialty prescribing, the importance of pharmacy interoperability, and how collaborative efforts in technology, policy, and process can enhance healthcare delivery. Don’t miss the insights shared by industry stakeholders on why they attend the Asembia Summit each year. For more information and to suggest future topics, email us at [email protected] or tweet us at @POCPHIT.

Previous Episode

Expert Takes on HIMSS24: Navigating Another Year of Health IT's Biggest Event

The special episode of The Dish on Health IT episode provides insights and coverage from the recent HIMSS24 conference. Hosts Pooja Babbrah, the PBM and Pharmacy Lead and Jocelyn Keegan, Payer/Practice Lead with Point-of-Care Partners dig into their observation from HIMSS24 before reacting to stakeholder interviews from the floor of the Interoperability Showcase on topics ranging from the impact of the final CMS interoperability & prior authorization, benefits of API adoption and pharmacy interoperability opens with a montage of HIMSS24 attendees.

--NOTE: The sound quality of the kiosk interviews is not ideal. If you prefer, you can watch this episode on video for close captioning of the kiosk interviews--

The episode opens with a montage of HIMSS24 attendees sharing what they find valuable about attending HIMSS. Pooja Babbrah then opens the episode explaining that she and co-host Jocelyn Keegan share their key takeaways and insights from the biggest health technology conference in the industry.

Jocelyn started the conversation off by sharing her observation that the work over the last 15 years to forge scalable connections to improve data fluidity has been fruitful and reached a tipping point. Importantly, the conversations we heard at HIMSS24 showed an acknowledgment as important as data fluidity is the content of what we are exchanging, and that data quality is just as important.

Jocelyn then shared her second observation which is that we need to build a skillset and pool of resources who can do the next phase of work that is needed. She shared that when she worked in the financial industry which was at the time transitioning to interoperability and automation, they had to hire and develop the critical thinkers needed to think through how to best leverage technology, approach change management and do the abstractions needed to be successful. Health IT is at a similar place; we probably need more clinical informaticists because how we use technology in clinical workflows is extremely important, but we also need operational experts to help pull through how shifts in one workflow should get pulled through in others. She went on to say that we need people understand data mapping and why clean data is so important.

Pooja thanked Jocelyn for her insights before sharing her own. She mentioned that she heard talk about whether ViVE and HIMSS could both survive because they occur so close together, and are big investments for companies to make to attend or exhibit. She shared that her view is that they are different enough in programmatic and attendance mix that she believes they both have value and will survive.

Adding to Jocelyn’s point about data quality, Pooja added that data governance and sending the right data to the right people at the right time versus just sending a data tsunami. Pooja continued by adding that it’s also important to meet people where they are. This was clear at the post-acute care listening session. Some care facilities are not yet FHIR-enabled, some can send data via FHIR but perhaps are not yet API-enabled, how can we meet those facilities where they are even if they aren’t using cutting-edge technology? Most stakeholders are going to be somewhere on a spectrum of tech adoption. We need to be flexible in how we do things.

Pooja went on to say that another observation is that the importance of consent management will continue to grow, and that real work is starting to be done to figure out what patient-centered consent management might look like. We need to be able to exchange the right data at the right time with the right people, but we need to ensure we have the right consent to go along with it.

Pooja mentioned some industry initiatives on consent including the HL7 FHIR at Scale Taskforce Accelerator, which has launched a new consent project. Public meetings for the FAST Consent project have launched and will be held regularly.

A consent learning lab was held at HIMSS24 for the second year in a row. Pooja expressed that she attended both last year's and this year’s events and she could feel a shift including the presence of regulators who were in the room. She explained that the conversation focused on actual work and progress being made in California and Florida as well as a huge focus on the role of consent in connecting health data and human services data.

Next Pooja and Jocelyn listened and reacted to stakeholders who stopped by the POCP Kiosk in the Interoperability showcase to give their perspectives on the final CMS prior authorization & interoperability rule, API adoption, and pharmacy interoperability.

Interviewees at the kiosk included:

Next Episode

Transforming Pharmacy and Public Health through Health IT: Insights from Pam Schweitzer

In this episode of The Dish on Health IT, Tony Schueth, CEO of Point-of-Care Partners, and Kim Boyd, Regulatory Resource Center Lead, are joined by Pam Schweitzer, former Assistant Surgeon General of the United States and current Chair of the NCPDP Foundation Board of Trustees. Together, they deliver an in-depth discussion on critical topics impacting the health IT landscape, including interoperability, public health data modernization, and evolving healthcare regulations.

The episode begins with introductions from Tony and Kim, highlighting Pam’s extensive career in healthcare, ranging from her leadership roles in the Indian Health Service and the Veterans Affairs (VA) system to her current position as chair of the NCPDP Foundation. Pam reflects on her experience overseeing the transition from paper to electronic health records and how this complex shift required the coordination of multiple healthcare departments, including radiology and labs.

Pam shares her insights into how policy changes, such as CMS 0057 and the HTI-2 proposed rule, are shaping the future of healthcare interoperability. The trio discusses how these regulations, aimed at improving data sharing between payers, providers, and public health systems, will ultimately drive real-time data exchange. They also emphasize the importance of infrastructure, standards, and innovation to support these efforts.

As the discussion moves forward, Pam talks about her work on public health initiatives, particularly around pharmacy interoperability, maternal health, and the broader impacts of nutrition and food supply on community health. Kim and Pam also explore the evolving role of pharmacists in public health, especially in rural areas where they often serve as the primary healthcare providers.

The conversation includes key steps for modernizing public health data systems, such as addressing the data silos between healthcare and public health systems. Pam emphasizes the need for greater collaboration and data sharing to enable a more effective public health response, especially during crises like pandemics or natural disasters.

Pam, Kim, and Tony also touch on the role of the Trusted Exchange Framework and Common Agreement (TEFCA) in promoting data fluidity and expanding the integration of pharmacists and other healthcare stakeholders into the broader healthcare ecosystem.

The episode wraps up with Pam expressing her optimism for the future of health IT and public health interoperability, while stressing the importance of ongoing collaboration between stakeholders, from policymakers to healthcare technology vendors. Kim adds that the evolution of pharmacy practice and regulatory changes are driving significant improvements in patient care and medication management.

Listeners can tune in for a deep dive into the intersections of health IT policy, pharmacy standards, and public health modernization, with practical insights from leaders in the field. This episode is a must-listen for those interested in healthcare interoperability, the impact of CMS and ONC policies, and the future of public health and pharmacy integration.

Catch the full episode on your preferred podcast platform, including Apple Podcasts, Spotify, and Healthcare Now Radio, or watch the video version on YouTube.

Other resources you may be interested in: