PioneerRx Pharmacist eCare Plan Workgroup

Why should academia leverage software tools to teach the Pharmacist eCare Plan?

Pharmacists play an important role in healthcare and within communities. Community pharmacies are an open-door access for medication counseling, immunizations and a wide array of patient care services. Nearly 9 out of 10 Americans live within 5 miles from a community pharmacy.¹ A pilot program was conducted with local primary care providers to coordinate care for Medicaid recipients. It was shown that patients visit their primary care providers on an average of 4 times a year and visit their community pharmacy 35 times a year.² Pharmacists remain the most accessible and front-line healthcare providers nationwide. Healthcare is rapidly evolving, and pharmacist-led patient care services are a key component to advancing the profession of pharmacy. Pharmacists provide a wide array of patient care services that focus beyond medications, such as providing adult and child immunizations, point-of-care testing, travel vaccine consults, chronic disease state education, counseling on prescription and over the counter medications, and comprehensive medication management.

Comprehensive Medication Management (CMM) is a vital aspect for patient care. Pharmacists across various settings such as community, hospital, telehealth, long-term care, specialty clinics and primary care practices collect and assess patient information on a daily basis in order to provide patient care services. The Joint Commission of Pharmacy Practitioners (JCPP) and 11 national pharmacy organizations developed the Pharmacists’ Patient Care Process (PPCP) to provide pharmacists with a framework for delivering these patient care services. This process allows for effective communication with healthcare professionals and patients to optimize patient care.³

The Pharmacist eCare Plan Standard is an interoperable standard that provides a common method of exchanging information between pharmacy technology platforms, clinically integrated networks such as CPESN pharmacies, chain pharmacies, and electronic health records.⁴ Clinical information exchanged includes, but not limited to, patient health history, medications, allergies, laboratory results, drug-drug interactions, payer and billing information. The Pharmacist eCare Plan can be used to collect patient information, share with other healthcare providers and analyze patient history. It is one of the few adopted standards that different healthcare providers and stakeholders can access to optimize medication use.⁴ The follow-up and monitoring component of patient care is essential for pharmacists to provide efficient medication use strategies. Key to the success of a pharmacist is the ability to utilize documentation systems that can interact with multiple team members and payers using technologies that meet their workflow, practice site and population needs. Whether someone is a pharmacist in a community-based pharmacy, a primary care clinic, long-term care facility, or staffing a call center, maintaining a consistent workflow across all patients will improve the quality of practice. Interoperability makes choice of system and workflow possible.

Colleges and schools of pharmacy can and should teach the Pharmacist eCare Plan throughout the curriculum. Student pharmacists must understand and be able to utilize clinical documentation systems in order to be prepared to practice effectively upon graduation. These eCare plans can be taught using patient case examples in the classroom as well as within community and clinical assessment laboratories. During community-based experiential rotations, students can obtain real-world experience with Pharmacist eCare plans embedded within pharmacy management systems for clinical workflows and documentation. These experiences open up potential opportunities for student pharmacists and show how the profession is transforming practice by improving the effectiveness of communication with patients and other healthcare providers in order to optimize continuity of care.

What solutions are available for curriculum consideration?

Software vendors like PioneerRx are at the forefront of developing an intuitive user interface experience on top of the Pharmacist eCare Plan for community pharmacists and their clinical workflows. PioneerRx has a comprehensive training module that demonstrates how to effectively use the pharmacy management system software to implement clinical documentation within the constructs of the Pharmacist eCare Plan data standard. The software is designed to support data collection needs for any clinical program, such as the Flip the Pharmacy initiative, state based CPESN pilots with payors, and specialty/chronic care management services. As of July 2020, 660 pharmacies have generated over 325,000 Pharmacist eCare Plans using PioneerRx. Many of these pharmacies were also IPPE and APPE rotation sites where students were actively documenting and creating care plans within the pharmacy management system.

In addition to independent community pharmacies, PioneerRx also supports schools/colleges of pharmacy and pharmacy technician training programs with the PioneerRx University program. PioneerRx University enables pharmacy schools and technician training programs to integrate the pharmacy management system into their existing lab curriculum, with a lab book that explains how to best use the software given practical use cases. The PioneerRx lab book and its curriculum is curated by clinical pharmacists and pharmacy technicians at PioneerRx, with consultation from pharmacy lab instructors from 25 institutions. All lessons within the lab book are mapped to ASHP and ACPE standards.

Given the existing infrastructure with PioneerRx University and a mutual desire to teach the Pharmacist eCare Plan to our next generation of pharmacists with a software tool, AACP and PioneerRx chartered a pilot program to implement the Pharmacist eCare Plan in colleges/schools of pharmacy in November 2019. The aim of this pilot program was to create a scalable process with an educational toolkit to introduce and implement the Pharmacist eCare Plan in the lab practice curriculum of participating colleges/schools of pharmacy for Spring 2020. A Call to Action statement and a participation survey was sent by AACP to CEO Deans and Pharmacy Practice chairs, and a total of 32 distinct schools/colleges of pharmacy responded.

The results from the participation survey were compelling. About 60% of the survey participants rated the usefulness of a software tool like PioneerRx as “5” (extremely useful) to supplement implementation of the Pharmacist eCare Plans into the practice lab curriculum. The remaining 35% of respondents rated it as a “4” (very useful). Interestingly, almost 50% of colleges/schools of pharmacy that responded to the survey do not use a pharmacy management system in their practice lab curriculum. At the time of the survey, around 84% of the responders to the survey had never generated and/or submitted a Pharmacist eCare Plan in practice. However, 100% of survey respondents were interested in using PioneerRx as a tool to implement the Pharmacist eCare Plans in the practice lab curriculum.

Colleges/schools of pharmacy who expressed interest in the workgroup were invited to a demonstration of the software and existing educational resources for the Pharmacist eCare Plan developed by PioneerRx. A subsequent implementation readiness survey was sent to these participants, and 11 schools were initially included in the workgroup. However, over the course of biweekly workgroup meetings, only eight schools remained active in the workgroup. Most cited the lack of flexibility to introduce and implement the Pharmacist eCare Plan to their lab curriculum by Spring 2020 but wanted to implement at a later date. The workgroups were led by a clinical pharmacist at PioneerRx, with support from the AACP Academic Leadership and Education Fellow. Workgroups members composed of lab instructors from each participating college/school of pharmacy were split into two workgroups to complete distinct deliverables. Each workgroup met biweekly starting at the end of November 2019 to March 2020, for a total of seven one-hour meetings per workgroup.

Colleges/schools of pharmacy received the same version of the software that a regular pharmacy would receive. However, it was clear that the participating workgroup members wanted a more turn-key and academia-friendly solution; the version of the software that needed to be enhanced as a teaching tool, rather than as a pharmacy dispensing system. Hence, PioneerRx commissioned software development resources to code key functionalities for academia into the PioneerRx University version of the software. The feedback and persistent advocacy of workgroup members were instrumental in developing a usable software program to teach the Pharmacist eCare Plan in the lab curriculum, thus imparting a scalable process for wide-spread implementation.

The deliverables were two clinical use cases, initially modeled after Flip the Pharmacy eCare Plan hypertension change packages.⁶ These use cases were coded into the PioneerRx University version of the software, to allow most of the data elements in the use cases to be generated by the system with one click. There were, however, deliberate and realistic missing data elements (such as allergies and past medical history) that each level of learner was expected to capture and document using the software.

Each use case had activities that were mapped to Entrustable Professional Activities (or EPAs) and the Pharmacist Patient Care Process so institutions can easily crosswalk the Pharmacist eCare Plan activities to support their lab curriculum.⁷ The use cases focused primarily on chronic disease states managed in the community setting that are familiar to all levels of learners, such as diabetes, cardiovascular disease, and smoking cessation. Given that the institutions will likely implement each use case across different levels of learners, a rubric of the activities was developed to ensure learners were assessed according to their level. The cases were presented in a familiar SOAP note format, with an emphasis on how a learner posited their Assessment and Plan while interacting with the software to document their eCare Plan. Each data and conceptual element of the clinical use cases were also mapped to a software key to help guide the lab instructor on best practices in clinical documentation within PioneerRx.

In March 2020, the first institution that was part of the workgroup executed one of the two clinical use cases in their second-year lab curriculum. Faculty used the baseline implementation process developed by the workgroup and was able to provide valuable feedback to iterate on the process for improvement. Other schools that were part of the two workgroups were also set to implement around the same time frame, but COVID-19 pandemic halted these plans until July 2020 as faculty was planning and adopting educational changes at their institutions. In July 2020, we reached out to the schools to gain knowledge on feasibility to implement an eCare Plan for Fall semester. Due to the continued COVID-19 related academic changes, some institutions differed to implementing the Pharmacists eCare Plan in Spring 2021. We are currently working to virtually implement the Pharmacist eCare Plan for Ambulatory Telehealth Rotations for 2020-21 academic year.