ASHP InterSections ASHP InterSections

February 25, 2015

CPPA Helping Ambulatory Care Pharmacies Demonstrate Value

Filed under: Ambulatory Care,Clinical,Current Issue,Feature Stories,Managers,Quality — Tags: , , — Kathy Biesecker @ 12:19 pm

Lynnae Mahaney, B.S.Pharm., M.B.A., FASHP

THE ISSUE OF PHARMACIST CREDENTIALING and privileging continues to grow in the national consciousness as pharmacists seek to differentiate their skill sets in a crowded workplace. But how can the more than 60,000 outpatient pharmacy practices in clinics, health systems, and community settings demonstrate their own excellence in patient care?

The new Center for Pharmacy Practice Accreditation (CPPA), a partnership among ASHP, the National Boards of Pharmacy (NABP), and the American Pharmacists Association (APhA), was created to address that need. CPPA accreditation, according to Center Executive Director and former ASHP President Lynnae Mahaney, B.S.Pharm., M.B.A., FASHP, offers a way for ambulatory care clinics and others to demonstrate their value to patients, payers, and other healthcare providers.

Mahaney recently sat down with ASHP InterSections to talk about how the CPPA’s work will transform pharmacy practice.

Why did you want to lead the Center for Pharmacy Practice Accreditation?

I’ve always been a passionate proponent of the need for credentialing for pharmacy practice. We have to be able to show our value in a predictable, measurable, and specific way, and that’s what credentials do. I also believe that accreditation is an important means of moving pharmacy practice forward. Accreditation standards for how care is delivered in pharmacy practices should originate from within our own profession. That’s critical because we are the medication experts. We know what best practice is. And because ASHP, APhA and NABP have collaborated to create the Center, we serve a real purpose and niche in the accreditation marketplace.

Didn’t the CPPA recently accredit its first pharmacies under its community pharmacy practice standards?

Yes. In 2014, we rolled out the community pharmacy practice accreditation program and subsequently accredited three pharmacy practices: The discharge pharmacy for outpatients at Johns Hopkins Hospital in Baltimore, the Goodrich Pharmacy near Minneapolis, and the Medicine Shoppe in Two Rivers Wisconsin. We also recently released the new CPPA standards for specialty pharmacy practice accreditation, which we’re very excited about.

What qualities does a pharmacy practice need to qualify for accreditation?

We’re recognizing pharmacy practices for their quality, their patient care services, and their approach to medication safety. A practice must demonstrate an advanced and consistent level of high-quality patient care services across a spectrum of pharmacy care.

How long does accreditation process take?

It takes six to nine months from time of application to accreditation. A good portion of that time is dependent on factors such as how quickly the practice is able to submit written documentation of their compliance with the standards and successful completion of an onsite survey.

What value does CPPA accreditation have for ambulatory care pharmacy practice?

It recognizes the practice for its high level of performance and high-value patient care. That value can also be demonstrated to patients and healthcare providers and payers. I spend a lot of time talking with the payer community about the value of accredited pharmacy practices—practices providing patient care services that are contributing to positive patient outcomes.

For example, in order to get accredited, a pharmacy practice has to provide, at a minimum, medication therapy management and patient education and counseling. In addition, it has to provide two more patient care services, such as medication management for chronic disease states, immunization services, adherence services, etc. We know that these areas of care help keep patients healthy and improve outcomes.

What plans are you working on now?

ASHP, NABP, and APhA were very purposeful about why they came together to form this organization, which is to develop accreditation programs for pharmacy practice across the continuum of medication use. As a result, we are now looking at accreditation programs for nondispensing practices, for patient safety practices around medication use, and for acute care pharmacy practices. In addition, one of our goals is to offer accreditation for pharmacy practice across the entire medication-use process, including clinical management services.

Is interest in accreditation growing?

Yes, definitely… particularly when you start talking about specialty pharmacy practice standards. We are seeing a lot more interest on the community side for accreditation as well as from health systems that have multiple outpatient pharmacies. As a result, we’ve put together a process for accrediting practices in multiple areas, also called bundling. We also have a mechanism to accredit multi-site practices (including chain drugstores) that includes a headquarters survey and a sampling of locations for onsite surveys. I predict that, in the not-too-distant future, accreditation of pharmacy practice in ambulatory care settings will be the norm rather than the exception. It’s a very exciting time!

–Interview by Steve Frandzel

February 23, 2015

Know What’s in Airplane’s Emergency Medical Kit, Two Pharmacists Say

Filed under: AJHP News,Clinical,Managers,Quality,Residents,Students — jmilford @ 6:34 pm

AS TWO PHARMACIST LEARNED ON A RECENT TRIP, domestic passenger-carrying airplanes with a flight attendant also have onboard an emergency medical kit with a small assortment of medications and supplies.

The Federal Aviation Administration (FAA) has required such a kit since 1986.

Since 2004, this kit (see sidebar) at a minimum has contained several medications in addition to the originally required 50% dextrose injection, epinephrine injection 1 mg/mL, diphenhydramine injection, and nitroglycerin tablets.
That was also the year by which airplanes with a capacity of at least 30 passengers had to start carrying an automated external defibrillator (AED).

FAA in addition requires the airlines to ensure that each crewmember receives training for in-flight medical events.

Some of that training was put to the test this past December, after a passenger lost consciousness on a United Airlines flight from Houston to Los Angeles.

DeeDee HuDeeDee Hu, a clinical specialist in critical care at Memorial Hermann Memorial City Medical Center in Houston, said she reached the man ahead of the flight attendants, did not detect a pulse, and repositioned him across the row of coach-class seats in preparation for chest compressions.

When he suddenly regained consciousness, albeit temporarily, Hu said she further assessed him and asked about his medical history.

The flight attendants “immediately pulled out the AED,” said Sapana Desai, a clinical pharmacy specialist in emergency medicine at Memorial Hermann who, like Hu, happened to be seated near the ill passenger.

But the emergency medical kit did not surface until a physician asked for an i.v. set to infuse fluid, she said.

The family practice physician and a nurse had responded to the overhead page for medical personnel.

Before the physician arrived, however, Hu had called out for aspirin in case the man was having a myocardial infarction.

“I didn’t know that they had this kit,” she said, “so my first thought was, let’s find someone on the plane with aspirin.”

A passenger did provide a tablet of low-dose aspirin, Desai said, and the ill man chewed it between episodes of unresponsiveness.

Desai said the flight attendants’ primary focus had appropriately been on pulling out the AED from where it had been stowed in the cabin.

“But it would have been helpful to have known that the kit was available to us for use,” she said.

The list of minimum contents for the current FAA-approved emergency medical kit was proposed in 2000 and finalized in 2001.

An FAA-led study of in-flight medical care provided in 1996–97 found justification for addition of the following items to the 1986-issued list: oxygen, supportive care items, equipment for closely monitoring a patient, analgesics, a bronchodilator inhaler, and an oral antihistamine.

In at least 70% of the cases in which one of the foregoing items had been deployed, the research team reported in 2000, the passenger in need of medical care improved.

The research was based in part on a survey of U.S.-based air carriers that contract with MedAire Inc. for in-flight medical support.

Heidi MacFarlane, a vice president at MedAire, said FAA undertook the research because passenger-carrying airplanes would soon be equipped with AEDs.

The Aviation Medical Assistance Act of 1998 had directed the FAA administrator to decide whether to require AEDs on passenger-carrying airplanes. If the answer was yes, the law required a decision as to the AED-associated equipment and medications that must be in the emergency medical kit.

At the time, the American Heart Association’s algorithm for providing advanced cardiac life support to an adult after defibrillation for cardiac arrest included the possibility of i.v. injections of epinephrine followed by an antiarrhythmic drug.

FAA selected lidocaine as the antiarrhythmic drug for the emergency medical kit.

In 2010, the American Heart Association declared amiodarone the first-line antiarrhythmic drug to be given during cardiac arrest.

Sapana DesaiDesai and Hu said the lack of amiodarone is not the medical emergency kit’s only deficiency.

They pointed to the need to have an injectable drug product for passengers having a breakthrough or acute seizure.

In addition, the pharmacists said, the medical emergency kit should have glucagon for injection, which would immediately help passengers having an episode of hypoglycemia and, unlike dextrose injection, does not require i.v. access.

MacFarlane said the airlines can augment their medical emergency kits without seeking FAA’s approval but cannot provide a substitute for or smaller amount of any item on the agency’s list.

“We recommend that they have EpiPens onboard,” she said, referring to a branded version of 1-mg/mL epinephrine injection 0.3 mL in an autoinjector. “But they’re significantly more expensive, and even if they have the EpiPens they still have to have the [1-mL] epinephrine as it’s . . . required by the regulation.”

That regulation specifies two strengths of epinephrine injection. The 1-mg/mL concentration, commonly used in the emergency treatment of allergic reactions, must be present as two single-dose 1-mL units. The 0.1-mg/mL concentration, which is the common strength of epinephrine for treating cardiac arrest, must be present as two single-dose 2-mL units, which would provide two 0.2-mg doses; the American Heart Association’s recommendations for advanced cardiac life support of adults call for 1-mg doses.

MedAire’s Paulo Alves, global director of aviation health, said the requirement for 2-mL units, rather than 10-mL units, must be a typo or mistake. To his knowledge, every supplier of medical emergency kits to the airlines provides the 0.1-mg/mL epinephrine in 10-mL units, said Alves, who is chair of the Air Transport Medicine Committee of the Aerospace Medical Association.

Heidi MacFarlaneMacFarlane said her company uses data from its ground-based medical advisory service to suggest to airlines the drugs that would be useful onboard from a risk-management standpoint.

“There are some basic things that we do recommend . . . , typically drugs that are in a form that could be delivered by a layperson under the instruction of somebody from our ground-based medical service,” she said.

Ondansetron, an antiemetic available as an oral disintegrating tablet, is another common recommendation, especially for long-haul flights, MacFarlane said. “If you can stop [the passenger] from vomiting, then we can prevent dehydration, which may allow the flight to continue rather than having to make a medical diversion.”

As for the task of finding items in the kit, MacFarlane said the presumption is that items, some of which are prescription drug products, “would only be dispensed by someone who’s qualified to do that.”

For example, a flight attendant would not pull out items from the kit unless under the direction of a ground-based physician who knows the arrangement of the kit, she said.

Airlines’ medical emergency kits have not escaped the nation’s drug shortages. FAA has at times granted temporary exemptions from the onboard requirements for specific drugs. For example, an exemption from the requirement for dextrose injection is in place until March 31, 2016, unless FAA rescinds or modifies the exemption.

FAA has not updated the kit’s list since 2001, an agency spokeswoman confirmed, and has not scheduled a review of it. Suggestions, however, may be directed to Federal Air Surgeon James R. Fraser, Office of Aerospace Medicine, Federal Aviation Administration, 800 Independence Avenue, SW, Washington, DC 20553-0001.

–By Cheryl A. Thompson, reprinted with permission from AJHP
(Feb. 1, 2015; volume 72, pages 176, 178, 180)


California Strengthens Antimicrobial Stewardship Mandate for Hospitals

A CALIFORNIA LAW THAT GOES INTO EFFECT this summer strengthens the state’s previous requirement for acute care hospitals to practice antimicrobial stewardship.

Starting July 1, acute care hospitals in California must put into effect antimicrobial stewardship programs that follow federal and professional society guidelines and include a process to evaluate the judicious use of antimicrobials. The law specifies that the stewardship teams must be multidisciplinary and include “at least one physician or pharmacist” who has expertise and training in antimicrobial stewardship.

California is the only state that has enacted legislation mandating antimicrobial stewardship for hospitals.

The law, which was passed last September, supplements legislation from 2006 that mandates stewardship programs for California’s acute care hospitals and requires the state health department to assess them for compliance.

The older law required hospitals to “develop a process for evaluating the judicious use of antibiotics” but didn’t define the process.

As a result, said Olga DeTorres, infectious diseases (ID) clinical pharmacist at Palomar Medical Center in Escondido, “hospital administrators have been very creative in what they define as antibiotic stewardship.”

DeTorres serves on the antimicrobial stewardship subcommittee of the state health department’s Healthcare Associated Infections Advisory Committee. She said many hospitals in the state have not invested in hiring staff to perform tasks like chart reviews and prescriber follow-up and education to improve antimicrobial use.

“Many hospitals just leave it up to the pharmacist to do it at the end of the day, if they get caught up with their work,” she said.

About half of the 233 California acute care hospitals that responded to a state health department survey during 2010–11 reported having a stewardship program, according to a report published in the April 2013 issue of Infection Control and Hospital Epidemiology.

The report stated that 20% of the survey respondents either did not plan to implement a stewardship program or were uncertain of their ability to do so. Among these respondents, 47% cited staffing constraints and 42% named lack of funding as barriers to implementing stewardship programs.

Nonfederal U.S. hospitals in 2012 spent about $375 billion on antibacterial, antifungal, and non-HIV antiviral drugs, according to the 2014 version of AJHP‘s annual article on national trends in prescription drug expenditures [see March 15, 2014, AJHP Special Feature].

DeTorres said California did the right thing by mandating antimicrobial stewardship in order to decrease antimicrobial use and combat the spread of antimicrobial-resistant bacteria.

At Palomar, she said, antimicrobial stewardship is an interdisciplinary project carried out with strong support from the hospital administration and a “physician champion” who fully supports DeTorres’s efforts.

Those efforts include running daily reports on all inpatients who are receiving an antimicrobial and checking culture and susceptibility test results to determine whether the appropriate agent was selected.

DeTorres said Palomar’s antimicrobial prescribing is mostly automated, thanks to a large front-end investment in medication-use and drug-susceptibility evaluations and the development of treatment guidelines endorsed by the hospital’s medical departments.

“All the physician has to do is type in the infection—urinary tract infection, pneumonia, cellulitis—and they’ll get a drop-down box with the preferred agents,” DeTorres said.

If a prescriber strays from the recommendations, “I leave electronic notes for the physician and then . . . I go upstairs to hunt down the physician and persuade him or her to switch to what was suggested,” DeTorres said.

She said Palomar’s stewardship program follows Infectious Diseases Society of America (IDSA) guidelines, with modifications on the basis of the hospital’s antimicrobial susceptibility data.

Palomar is one of about three dozen hospitals that have shared their stewardship progress through the state’s online Antimicrobial Stewardship Spotlight program. Twelve hospitals, including Palomar, have met all 11 predefined criteria for an advanced stewardship program, according to the website.

“Our stewardship program is so successful, we’ve actually seen, since we’ve implemented it, a reversal of the increasing trend of resistance—we’ve seen susceptibility improve in many situations. So we’re able to use much narrower-spectrum antibiotics,” said Jeremy Lee, interim district director of pharmacy services for Palomar Health.

The Centers for Disease Control and Prevention (CDC) strongly encourages all hospitals to implement evidence-based antimicrobial stewardship practices.

“We shouldn’t accept inappropriate antibiotic prescribing from a person who should know better, just as we should never accept someone not washing their hands before they touch a patient,” said Arjun Srinivasan, associate director for CDC’s Healthcare Associated Infection Prevention Programs, during a January 22 antimicrobial stewardship webinar.

Srinivasan said that despite good evidence that strong antimicrobial stewardship programs work and are cost-effective, many hospitals have not implemented the programs.

“When we go talk to people, we oftentimes hear, ‘This is not a priority for us, because it’s not required by anyone,'” Srinivasan said.

That could be changing.

President Obama issued an executive order last September requiring the Department of Health and Human Services to work toward mandating that hospitals implement strong antimicrobial stewardship programs.

Tied to the executive order was the September 2014 “Report to the President on Combating Antibiotic Resistance.” The report urges that the Centers for Medicare and Medicaid Services (CMS), by the end of 2017, require U.S. hospitals to implement evidence-based antimicrobial stewardship programs in order to participate in Medicare and Medicaid.

Private-sector organizations, led by IDSA and the Society for Healthcare Epidemiology of America (SHEA), had previously asked CMS to make antimicrobial stewardship a condition of participation (CoP) in Medicare and Medicaid.

A CMS spokesman stated that the agency is “looking at” this issue but cannot comment on it specifically during the rulemaking process.

Christopher Topoleski, ASHP’s director for federal regulatory affairs, said ASHP consulted with “relevant stakeholders” and opted not to endorse the IDSA–SHEA letter.

“While we would agree with the importance of having antimicrobial stewardship programs in hospitals, having it be a CoP in Medicare may make it more difficult for hospitals to tailor the programs to their specific needs,” Topoleski said. “One alternative approach could be to house it within the Joint Commission; that way, it would allow for more flexibility.”

Kasey Thompson, ASHP’s vice president for policy, planning, and communications, noted that if CMS mandates antimicrobial stewardship for hospitals, this would present a major opportunity for pharmacists to lead their hospitals’ stewardship programs.

–By Kate Traynor, reprinted with permission from AJHP
(March 1, 2015; volume 72, pages 338-340)

February 19, 2015

A Great Start to 2015

Christene M. Jolowsky, M.S., R.Ph., FASHP

Christene M. Jolowsky, M.S., R.Ph., FASHP

EVEN THOUGH IT’S BEEN A DREARY, DIFFICULT WINTER for much of the country, I’m hoping that what I want to talk about today puts a smile on your face. I will take the opportunity of my first column of the new year to tell you about a number of exciting endeavors happening at ASHP.

Winning on Provider Status

Leading the way this year are some exciting successes regarding provider status for pharmacists. As ASHP CEO Paul Abramowitz noted in his recent blog, ASHP’s work to enact provider status legislation has resulted in the introduction of H.R. 592, the “Pharmacy and Medically Underserved Areas Enhancement Act,” and its companion S. 314. Both bills will allow Medicare to reimburse pharmacists in medically underserved communities for certain healthcare services.

On behalf of ASHP, I extend our thanks to the bipartisan co-sponsors of the legislation on both the House and Senate side, including Congressman Brett Guthrie (R-KY), Congressman G.K. Butterfield (D-NC), Congressman Todd Young (R-IN), and Congressman Ron Kind (D-WI) as well as Senators Charles Grassley (R-IA), Mark Kirk (R-IL), Sherrod Brown (D-OH), and Robert Casey (D-PA) .

This is a big bipartisan win in a new Congress, and we are so grateful to the many ASHP members who have been involved in this advocacy effort. The emails, phone calls, hosted health-system site visits, and member visits that you’ve made to your Congressional representatives and senators have made all the difference. But we can’t give up now! We need to keep reaching out to our legislators to urge them to pass this legislation. To find out how you can get involved, visit our advocacy center on

A Fast-Growing Area of Practice

Did you know that ASHP’s Section of Ambulatory Care Practitioners is our fastest-growing membership area? It’s not surprising, given how many ambulatory clinics, physicians’ practices, infusion centers, etc., across the country are including pharmacists on their patient care teams.

ASHP is focusing tremendous resources and effort on expanding opportunities for members who practice in these and other outpatient settings, including adding great new content to the Ambulatory Care Resource Center and making the Ambulatory Care Conference a permanent part of ASHP’s Summer Meetings.

We also are working on a new Ambulatory Care Self-Assessment Tool that will help pharmacists identify patient-care gaps and opportunities for improvement. Like its companion the Hospital Self-Assessment Tool, this web-based resource is designed to help you prioritize the changes you wish to make in your practice. Stay tuned as we work toward a spring launch date!

Residency Accreditation News

ASHP members who are residents, preceptors, or residency program directors will be happy to learn that Katrin S. Fulginiti, B.S.Pharm., M.G.A., has been named the new ASHP Director of Residency Accreditation Services. Katrin was formerly ASHP’s director of Process & Quality Improvement in our Accreditation Services Office. Prior to joining ASHP, she worked at Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., where she served in various positions, including as residency program director of the ASHP-Accredited PGY1 Managed Care Program and as director of the ASHP-Accredited Technician Training Program.

That’s just one of the many wonderful things happening in accreditation services. ASHP also is continuing its rollout of our new PGY1 residency standards, which simplify and reduce the number of goals and objectives to be achieved. The new guidance document for the PGY1 standard should be completed in the spring. Watch for future revisions to the PGY1 community and managed care standards and the PGY2 standards.

ResiTrak, which is being redesigned based on the new PGY1 standard and on recommendations from the ResiTrak users group, will transition to PharmAcademic™ for those on the new standard by June 1. We think that ASHP’s members who are preceptors and our student members will be very happy with this new web-based tool that fully integrates curricular outcomes, assessments, and experiential education.

Changes to ASHP’s Strategic Plan

Everything that ASHP does is related in some way to our Strategic Plan, which helps us work toward collective goals and objectives, prioritizes ASHP’s work, and allows us to be more effective as we drive improvements in patient care and advance practice.

ASHP’s Board of Directors recently updated the Strategic Plan, adding three new goals. They include:

Advance Patient Care and Pharmacy Practice in Small, Rural, and Underserved Settings

ASHP’s membership is made up of practitioners who work in all kinds of settings, from large academic medical centers to hospitals and clinics in small, rural, and medically underserved areas. This new goal solidifies our commitment to members who practice in these special settings. And it ensures that we will continue to develop tools, resources, and best practices for this unique area of practice.

Address the Needs and Interests of Pharmacists Who Practice in Multi-Hospital Systems

As more and more hospitals and health systems consolidate, ASHP members who work in these large and diverse healthcare systems find unique challenges. So, ASHP is dedicated to helping these members succeed in their organizations by offering the kinds of support, resources, and services that they need.

Helping Members Lead and Address Issues Related to Specialty Pharmacy

ASHP will soon offer resources specifically designed to help health systems address the growing use of specialty pharmaceuticals. A resource guide is being developed that will assist in determining the best specialty pharmacy business and patient care strategy, coupled with targeted education through webinars and ASHP live meetings. Stay tuned for this and more, including an ASHP Specialty Pharmacy Resource Center.

A More Timely and Responsive Policy Process

ASHP’s policy making process is the backbone of much of what we do to serve you, our members, and to advance practice and patient care. The policies approved by ASHP’s House of Delegates drive all of our initiatives, from legislative advocacy to the creation of practice resources.

I’m excited to share with you the changes we’ve made to create a more timely and responsive policy process based on recommendations of ASHP’s Task Force on Organizational Structure. This year, we will kick off a year-round policy process, which includes meetings of our policy committees in February, July, and September, along with new and enhanced ways for all ASHP members to participate in the process. We’re also launching a virtual House of Delegates in addition to the face-to-face meeting in June, an innovative online approach that will allow us to work virtually together on policies that lend themselves to consensus.

This is just a taste of the exciting work that is going on at ASHP as we continue to support your professional aspirations to be the best patient care provider you can be. Much has been done, but there is always more to do! You can bet that ASHP is hard at work on your behalf.



ASHP Student Pharmacists Visit Capitol Hill to Support Provider Status

Filed under: Ambulatory Care,Current Issue,From the CEO,Provider Status,Students — Tags: , , — Kathy Biesecker @ 2:41 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

On February 3 and 4, 2015, ASHP hosted more than 40 student pharmacists from all around the country to meet with lawmakers in the U.S. House of Representatives and U.S. Senate in support of provider status legislation. These eager young leaders and the energy they brought with them as they prepared to meet with their elected officials was incredible, and they were poised, motivated, and professional. There is no doubt in my mind that the future of our profession is in good hands!

On the first day of this inaugural event, the students participated in an orientation session with ASHP’s government relations team as well as a number of outside guests, including the chairperson of the ASHP PAC Advisory Committee, Diane Ginsburg, M.S., Ph.D., and former ASHP President, Kathy Schultz, Pharm.D., M.P.H., FASHP.

On the second day, the students heard from Jaymi Light from Congressman Todd Young’s (R-Ind.) office, who shared perspectives on the most effective ways to discuss the legislation and make the most out of their visits to the Hill.

Congressman Brett Guthrie (R-KY) talks with student pharmacists (from left) Cassie Stewart of West Virginia University, Morgantown, and Katie Oliver and Brian Hancock of University of Charleston, W.Va., about the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592).

Congressman Brett Guthrie (R-KY) talks with student pharmacists (from left) Cassie Stewart of West Virginia University, Morgantown, and Katie Oliver and Brian Hancock of University of Charleston, W.Va., about the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592).

These exceptional student leaders visited over 50 offices and met with elected officials and their staff members, asking them to sign on as cosponsors of H.R. 592 and S. 314. They also took time to thank the many current cosponsors of these important pieces of legislation, and let them know that ASHP will be here to support them every step of the way. I’ve been told that their visits made a difference, and that we anticipate a number of new cosponsors to sign on in support of the legislation.

As you read this message, please view the various images of these student leaders exercising their civic duty on behalf of the profession of pharmacy and our patients. I know that they will go back home and recruit many of their peers to get involved and reach out to their Senators and Representatives in Congress. We need for you to do the same. Please start by sending a letter to your Representative and Senators.

Once you send your letters, please recruit at least 10 of your peers to do the same. Also, please consider supporting the ASHP PAC so that we can continue to support the candidates who support your interests as pharmacists and patient care providers.

I will end this message by again giving our thanks to the students who joined us in Washington, D.C., last week and to all of the students and practitioner members of ASHP who will be a vital part of making provider status for pharmacists become the law of the land.


February 2, 2015

SNOMED CT Codes: Making the Case for Pharmacy Services with Hard Data

SNOMED_IG_V7MOST PHARMACISTS ARE NOT FAMILIAR with SNOMED CT – yet. But it’s a good bet they’ll start hearing the acronym a lot more and learn that it represents a major step toward normalizing reimbursement for pharmacy services.

SNOMED CT is a clinical coding nomenclature that contains more than 300,000 codes to document patient care in the electronic health record (EHR) – simply put, it’s a language that all EHRs will use to “talk” to each other.

Unlike other commonly used coding systems, such as ICD-9 and ICD-10, SNOMED CT is not used for billing. It’s also far more specific and complex. SNOMED CT is controlled by the International Health Terminology Standards Development Organization (IHTSDO).

In the U.S., the National Library of Medicine manages SNOMED CT. As of 2012, SNOMED CT was being used to some extent in more than 50 countries.

A Common Language

“Think of SNOMED CT as the Rosetta Stone for health information. It allows different electronic health record systems to understand one another,” explained Samm Anderegg, Pharm.D., M.S., BCPS, pharmacy manager with the Oncology Service Line at Georgia Regents Medical Center in Augusta, GA. Anderegg serves as one of the ASHP member representatives on the Pharmacy Health Information Technology Collaborative (Pharmacy HIT Collaborative) workgroup that is responsible for submitting and vetting the codes.

Samm Anderegg, Pharm.D., M.S., BCPS

Samm Anderegg, Pharm.D., M.S., BCPS

“Clinicians are moving away from free text and towards discrete data documentation. This structures the data in a way that it can be packaged and sent to other healthcare providers at different institutions,” he added.

The Collaborative is an alliance that includes ASHP and a dozen other professional and industry groups whose goals include ensuring that health information technology supports pharmacists in healthcare service delivery; achieving pharmacists’ integration within health information exchange; and supporting national quality initiatives enabled by health information technology. The Collaborative found very few codes among healthcare coding systems for documenting direct patient care provided by pharmacists.

“We know that we take care of patients, and we know we have an impact on care, but pharmacy has been behind the curve when it comes to documenting that impact,” said Anderegg.

That’s all changing. In 2012, the Collaborative submitted and won approval for more than 250 codes specific to medication therapy management in the SNOMED CT system. The Collaborative’s Value Set Committee, chaired by Anderegg, will maintain and update the codes to stay current as pharmacy practice evolves.

Demonstrating Pharmacists’ Contributions to Patient Care

For pharmacy, the availability of universal, pharmacy-specific coding will provide an unparalleled opportunity for pharmacists to document their actions, track resulting outcomes, and prove, with hard data, the value of medication therapy management in patient care.

A guide to SNOMED CT issued recently by the Pharmacy HIT Collaborative offers a compelling case for why the new codes are so important.

Ultimately, we want to justify the value of our services by tying what we do to patient outcomes.

“As we move toward more team-based care delivery modes, it is vital for pharmacists to be able to demonstrate their ongoing contributions to patient care,” said Anderegg.

“Adopting and using MTM SNOMED CT codes will enable pharmacists to capture those contributions in discrete data documentation, instead of free text and narrative, which can’t be analyzed in any meaningful way.”

For years, SNOMED CT has lingered in the background of U.S. healthcare. Then, recently, the Centers for Medicare and Medicaid Services declared that a significant portion of medical coding must be reported in SNOMED CT in order for EHR technology to be certified. Such certification is required for health systems to qualify for Medicare and Medicaid “meaningful use” financial incentives.

Before any of that happens, though, healthcare providers must adopt SNOMED CT, integrate the coding into their EHRs, and make it available to frontline medical staff. It’s a formidable task that has hospital IT departments and healthcare IT vendors across the country teaming up to sort out the myriad challenges. Already there are a number of products that translate – or “map” – codes from the well-known ICD-9, and its ICD-10 successor, into reportable, standardized SNOMED CT codes.

What the Codes Mean for Pharmacy’s Future

In the meantime, ASHP and the Pharmacy HIT Collaborative are pushing hard to raise awareness of SNOMED CT, according to Allie D. Woods, Pharm.D., director of ASHP’s Section of Pharmacy Informatics and Technology.

Allie D. Woods, Pharm.D.

Allie D. Woods, Pharm.D.

“Pharmacists need to know not only that these codes exist, but also what they mean for the future of our profession,” she said. “Frontline pharmacists can help by learning more about SNOMED CT from ASHP and other organizations and speaking with informaticists at their institutions, then discussing its benefits with colleagues and pharmacy managers.”

Woods noted that although the codes have been in existence for two years, few pharmacists are ready to use them yet. “Our greatest hope is that these codes will be used in the effort to obtain pharmacist’s provider status and, eventually, to bill for services. We’re just not quite there yet,” she said.

SNOMED CT eventually will become the coding norm, allowing pharmacists to produce data-rich reports pooled from multiple EHR systems.

“It all starts with incorporating the codes into pharmacy documentation within the EHR and making sure that pharmacy clinicians, IT staff, and administrators are all involved in that process,” said Anderegg. In addition, according to Anderegg, pharmacists need to begin building these codes into the EHR in an intelligent way so that the data can be reported and analyzed.

“Ultimately, we want to justify the value of our services by tying what we do to patient outcomes. If we can do that, the sky is the limit,” he said.

–By Steve Frandzel

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