Q&A: As Scope of Practice Expands, Technology Must Catch Up

Melanie Marcus, Chief Marketing and Customer Experience officer at Surescripts, sat down with Drug Topics at the 2024 National Association of Chain Drug Stores Total Store Expo to discuss the primary care shortage, the way pharmacists can fill that gap, and how Surescripts is working to make sure pharmacists are paid for the services they provide.

Drug Topics: Given the current health care landscape, why are sustainable care models so important for patients?

Melanie Marcus: Right now, there is a primary care shortage across the United States. At Surescripts, we can see this on the network. We can see that almost two-thirds of counties in the country have less than 1 primary care provider per 1500 population. And we can see that there's an opportunity for pharmacy to help fill a gap in at least two-thirds of those counties. We've got to create teams of providers who can spell each other on the care that's provided, whether that's Food Is Medicine, whether that's test and treat, or immunizations in the pharmacy, or so forth, pharmacists have a big role there.

Drug Topics: Can you share how Surescripts is working with stakeholders to develop and improve sustainable care models?

Marcus: Surescripts today is working very hard every day to make sure that the work that the pharmacist does is streamlined, so that pharmacists have time to take on more of the clinical care.

READ MORE: Pharmacists Have a Role in Health Care System Sustainability

Beyond that, I would just note that as pharmacists take on more clinical care, pharmacists must have access to clinical information about the patient. Right now, that's tricky: You've got different pharmacy technology involved in different pharmacies across the country; some might be using…a clinical direct message [or] other ways to get clinical information, but it's not scaled. The electronic health record (EHR) side of the world has been working on this issue of interoperability for years, and Surescripts has been working with EHRs for years to do that. Last year, we exchanged almost 2 billion clinical records across the country, across EHRs.

But we all know as patients, that's not good enough. The government has stepped in and said, with the 21st Century Cures Act and with something called TEFCA, or the Trusted Exchange Framework and Common Agreement, we're going to do this differently. There are a set of Qualified Health Information Networks or QHINs, coming up across the country. Surescripts is a candidate QHIN. These QHINs will allow health information to be exchanged with their participants; once that happens, the QHINs will exchange clinical information amongst themselves so that all of the participants have access to the clinical information that they need about patients.

The great news here is that pharmacy was included as a participant by ASTP/ONC [the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology] in July. As long as pharmacists are providing care, pharmacists have the right to have access to the clinical information available through a QHIN.

There are 2 gating factors to this. One is, what information does a pharmacy really need on the patient? Probably not the entire clinical record. We need to understand from industry what exactly are the elements of the clinical record that you need, and how is your pharmacy technology going to access it and present it? There are several things happening in the industry to help that. The [National Council for Prescription Drug Programs] Foundation is doing a study to understand the lay of the land on pharmacy technology to accept clinical information now, and Surescripts is helping a pharmacy interoperability work group with the Sequoia Project. We encourage all pharmacy to consider getting involved in this work group; just go to the Sequoia Project website and you can get more information. This is incredibly important to be able to scale interoperability across the pharmacy world.

Drug Topics: Is there a specific recent success you can share with our audience?

Marcus: There are many successes. We work with pharmacy at scale across the country, every day, with electronic prescribing. We've worked over the last 7 years to seriously improve the accuracy of a prescription so that when a pharmacist receives it, there are less phone calls and faxes back and forth with the physician to make sure they've got the right SIG, or the right elements of the prescription.

We also are starting to bring the price of a prescription, based on a person's pharmacy benefit, both to the prescriber, so that the prescriber can see, “Oh, this, this prescription is going to cost you, $100 [but] there are 5 therapeutic alternatives. We'll pick the one that's going to cost $10.” What does that do? When the patient shows up at the pharmacy, we're saving that pharmacist another set of phone calls or faxes back to the physician because they've sent a $100 prescription that the patient can't afford. We're also bringing that functionality into the pharmacy so pharmacists can do that same work with the patient if the patient hasn't already had it from the physician.

Surescripts sees the role of the pharmacist as critical to the future of health care in America and we are committed to working with pharmacy across the country to help make that happen. We've been doing it over the past several years, including convening in Washington, D.C. with AHIP [the trade association for the health insurance industry], APhA [the American Pharmacists Association] and Surescripts focused on, how do we get pharmacists paid to do the clinical work that they need to do? We're committed to working with pharmacy on the technical roadmap to make that happen as the payment happens for them.

The 2024 National Association of Chain Drug Stores Total Store Expo was held August 17 to August 19, 2024, in Boston, Massachusetts. Click here for more of our coverage.