title: Using an Electronic Medication Refill System to Improve Provider Productivity in an Accountable Care Setting.
abstract: BACKGROUND
  Even within fully integrated health care systems, primary care providers (PCPs) often lack support for medication management. Because challenges with conducting medication reconciliation, improving adherence, and achieving optimal patient outcomes continue to be prevalent nationally, it is critical that PCPs are provided the resources and support they need to provide high-quality, patient-centered care in an accountable care environment.
  
  
  METHODS
  Sharp Rees-Stealy Medical Group uses a fully electronic medication refill system that allows for a centralized team to manage all incoming requests. Over time, 16 disease-specific protocols were created that allowed the pharmacy team to absorb approximately 80% of incoming refill requests for all enrolled PCPs. The refill clinic assessed all clinic information that a PCP would normally review in order to approve a refill. Tasks performed by the clinical pharmacists included medication reconciliation, dosage adjustment, and coordination of distribution from external mail order and retail pharmacies.
  
  
  METHODS
  In 2014, the number of tasks related to refill management reviewed by the refill/medication therapy management service totaled 302,592, resulting in 140,350 refill authorizations and multiple interventions related to medication use. Physicians have estimated that the service provides between 20 and 30 minutes of time savings per day. Assuming an annual PCP salary of around $200,000, 20 to 30 minutes per day would amount to $33 to $50 saved per day per physician. The savings is even higher when time savings from other clinical staff is included.
  
  
  CONCLUSIONS
  The development of this electronic medication refill service has provided the following important lessons: (a) organizations rely on a leader or champion to push through process reforms--this program started with reluctant physicians first to determine best practices; (b) the lack of clinical pharmacist profiles within electronic health records (EHR) is a serious concern, since the creation of these profiles may not be easy or timely; and (c) PCPs working within an EHR environment will quickly embrace the idea of a service that can save them up to 30 minutes per day. With PCPs continuing to take on additional population health management tasks in accountable care organizations, pharmacists can provide workload offsets by meaningfully contributing to medication-related care.
authors.affiliation: 1 Director, Pharmacy Benefits Administration, Ambulatory Care, Sharp Rees-Stealy Medical Centers, San Diego, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Schoenhaus
authors.affiliation: 2 Research Manager, National Pharmaceutical Council, Washington, DC.
authors.forename: Adam
authors.initials: A
authors.lastname: Lustig
authors.affiliation: 3 Clinical Supervisor, Pharmacy Benefits Administration, Ambulatory Care, Sharp Rees-Stealy Medical Centers, San Diego, California.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rivas
authors.affiliation: 4 Clinical Pharmacist, Ambulatory Care, Sharp Rees-Stealy Medical Centers, San Diego, California.
authors.forename: Victor
authors.initials: V
authors.lastname: Monrreal
authors.affiliation: 5 Vice President, Health Services Research, National Pharmaceutical Council, Washington, DC.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Westrich
authors.affiliation: 6 Chief Science Officer, National Pharmaceutical Council, Washington, DC.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Dubois
mesh_terms: D060866:Accountable Care Organizations / Q000379:methods*; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D057286:Electronic Health Records; D055695:Electronic Prescribing; D006801:Humans; D054539:Medication Therapy Management; D010593:Pharmaceutical Services; D010595:Pharmacists; D011320:Primary Health Care / Q000379:methods*