Expert Interview: Medication Decision Support

September 24, 2020

Anna Dover, PharmD, discusses how modernizations in medication decision support are advancing pharmacy practice.

Drug Topics®: Hi, I'm Gabrielle Ientile with Drug Topics®. Today I'll be interviewing Anna Dover with First Databank. First, here's the latest news from drugtopics.com.

President Trump recently signed for executive orders on drug pricing, directing the Secretary of HHS to take action to lower costs for patients on prescription drugs. The Executive Order focused on pharmacy benefit managers (PBMS) and the process by which PBMs negotiate discounts, sometimes up to 50%, on the list price of drugs that work in their favor and allow them to collect large rebate checks. Medicare patients, on the other hand continue to overpay for their medications.

Though the administration's executive order would conceivably save many patients covered under the Medicare Part D program hundreds or thousands of dollars per year, it fails to implement stipulations addressing the impact that DIR fees are having on the viability of American pharmacies.

Several pharmacy organizations are urging the Trump administration to do away with DIR fees in the executive order. Unless Congress acts, the order in its current form would take effect on August 24 2020. And that's the latest news from drugtopics.com.

Drug Topics®: Before we get into our topic, can you give a little bit of your background in pharmacy and your work with first databank?

Anna Dover: Sure, I actually have been practicing pharmacy since 2000. And I spent most of my time in direct patient care in the hospital setting. I had some management roles, worked primarily in critical care and step down units (SDU). And after about 11 years, I had the opportunity to move over to the IT department at the hospital I was at. We were going through a large EHR implementation, and I moved into more of an analyst role: I became the CDS lead, was the instructional designer, and worked a lot on medication warning optimization, as well as general CDS projects.

I was a customer of FDB while I was doing that. After 6 years, I decided it was time for a new challenge and joined FDB actually to work on a new product suite, working on improving medication decision support. And it's really been great I've enjoyed FDB as a customer and I really enjoy working for the company.

Drug Topics®: Can you touch upon how FDB has implemented and researched this patient first approach and the results from that research?

Anna Dover: So FDB has been interested in making the decision support more patient specific. It predates me for many, many years. There are several folks in the organization that have really made this a desire and a dream, it's kind of the vision we want to do.

And the traditional content, this would require not just FDB revising the content, but also for that vendor system or that software system to program to the new data elements. What we're doing to help get this idea out there in advance is using web service-enabled technology so that we can use an available integration into that software system and provide the new content in advance.

And we've done this based on not just scholarly articles and research, but also based on feedback from our customers and others in the healthcare IT space. And even more exciting is that we can look at some of the alerting statistics from our customers. We have another product, alert space analytics, that customers can provide us with their alerting patterns. So we can actually look and find the things that are likely fatiguing, and our clinicians can look at it to decide, “How can we make this alert work better?”

So the hyperkalemia or high potassium level is one; another area of concern is Qt prolongation, which can lead to a lethal arrhythmia potentially in a patient. So it’s a very important alert, but it's hard to get the required specificity for it.

Our clinicians have actually evaluated not just what would be required clinically to identify those at higher risk based on research, but also evaluated what data is likely available in the software so that they can have a safe path to allow customers and clinicians to use relevant information about the patient and highlight only those patients at the greatest risk.

Drug Topics®: This technology would require that an Electronic Health Record (EHR) system is in place - is that correct?

Anna Dover: Not necessarily. That's the space we started in. Because I think it's funny. As a pharmacist, I think we were so used to alert fatigue that we were less likely to complain compared to physicians who were newer to that type of phenomenon.

And we can provide this outside of EHR, any software system that would be interested in using it. And even more exciting, we're looking at a data version of this that we could provide as well. It's another newer product that we're working on. Because it's been so exciting in the provider space, we're looking at other ways that we can deploy this content, not just the web service model, but other more traditional methods that FDB has provided content.

Drug Topics®: How do you envision the future of medication decision support and pharmacy practice fitting in within that system?

Anna Dover: A great question. I think this is where I could wax philosophical for a while, because it's very exciting to me.

I think where we're heading is moving away from interruptive alerts for things that could be potential problems. And now deploying a way to surveil so that pharmacists who have always managed these things could more easily identify potential risks, and then only use interruptive alerting at the point that it's a concern.