RxHub offering hospitals access to patient claims data

A pilot project examining the value of incorporating electronically transmitted patient claims data into a health-system medication dispensing process has been pronounced a success by the hospital that implemented it.

"It will soon become a full part of our hospital system," said Steven B. Miller, M.D., chief medical officer for Barnes-Jewish Hospital, a 1,400-bed facility in St. Louis. He was referring to RxHub MEDS, a service of RxHub, a company created by three pharmacy benefit managers to electronically connect payers, physicians, pharmacies, and health systems.

The project, which began in January, is the first contractual relationship between a hospital system and RxHub to offer inpatient physicians, pharmacists, and nurses information from its PBM sponsors' databases. "This tool can have a huge impact on preventing medical errors, an issue Barnes-Jewish is passionate about," said Miller. "The knowledge it provides about what medications a patient has been taking is far ahead of anything else available, which more often than not is little more than a slip of paper a patient brings to the hospital."

RxHub MEDS aids in diagnosis by providing information about prescribing patterns, helps eliminate duplicate medications, supplies additional information on the potential for a drug-drug interaction, facilitates discharge prescriptions, and supports institution research, said Miller. In evaluating the usefulness of RxHub MEDS, Barnes-Jewish officials polled the experience of its cardiologists. The anecdotal results were "very positive," he said.

"By transmitting vital patient data to the point of decision-making, RxHub enables physicians to provide the continuity of care necessary to reduce costly errors and adverse drug events," said Majkowski.

That's important because about half of preventable adverse drug events in hospitalized patients are due to errors in the medication ordering process, according to several studies, including a series of reports by the Institute of Medicine. Among the most frequent types of errors are those involving wrong drugs or doses, incorrect frequencies, known allergies, and drug-drug interactions, often from missing or inaccurate information.

The RxHub MEDS-which stands for "medication and eligibility delivery solution"-is designed to alleviate some of those ordering problems. The process begins with access to a database directory containing the drug benefit eligibility of more than 150 million people, enrolled in about 100 health plans served by the three founding PBMs, AdvancePCS in Irving, Texas; Express Scripts, St. Louis; and Medco Health Solutions, Franklin Lakes, N.J. That's about 75% of all patients with a pharmacy benefit, said Majkowski, and that number is increasing.

Majkowski and Miller noted that RxHub MEDS has its limitations, however. Patients may have had their Rx claims settled by a company other than the three RxHub-related PBMs, for example. And the RxHub database does not contain information about the over-the-counter drugs or vitamin and herbal supplements a patient may be taking, or medication purchases made by cash. In addition, the data may not reflect new instructions a physician gave a patient right before hospitalization.

"We are not meant to be a substitute for a complete medication history," said Majkowski. "But our goal is to streamline the acquisition and delivery of patient-specific information to help achieve safer outcomes."

Miller said RxHub MEDS enhances the health system's ability to meet a recently announced patient safety goal of the Joint Commission on Accreditation of Healthcare Organizations: "Accurately and completely reconcile patients' medications across the continuum of care."