February 25, 2015 at ePharma in New York City, Craig Kemp, Innovative Partnerships at Merck Vaccines and Andrew Dunning, Director of Life Sciences Partnerships at Practice Fusion discussed the partnership between Practice Fusion, the fourth largest electronic health record (EHR) in the United States and Merck Vaccines. The partnership began in April of 2014 with the goal of improving population health by alerting providers when a patient was due for one of the six CDC recommended adult vaccines. There are tools such as clinical decision support that EHR vendors provide, which assist healthcare providers in delivering higher quality healthcare to patients. These tools are widely available with the growth in adoption of EHRs driven by the federal government’s Meaningful Use program. The challenge is that many providers have yet to adopt these tools into their clinical practice. EHR vendors are partnering with life science stakeholders such as vaccine companies to educate and raise awareness of clinical guidelines such as the CDC Immunization Guidelines and to determine how tools such as clinical decision support within the EHR can help provide better healthcare to their patients according to the guidelines. Patients, Providers, EHR vendors and life science companies all benefit from such a collaboration. Health of a population improves when patients receive their vaccinations, providers and EHR vendors meet their objective of delivering higher quality care, and life science companies meet their business objectives when their products are appropriately used according to quality guidelines.
Some providers still do not see the benefit of clinical decision support (CDS) and believe that they can appropriately care for their patients without CDS. I was recently ill in Orlando, Florida and saw the benefits of CDS first hand. I went to a Walgreens Clinic with little expectations because I live in Boston and have access world class healthcare. I ended up seeing a registered nurse who gave me the most thorough exam that I have ever had in my life and I even received a follow up call two days later to see how I was doing. This comprehensive patient encounter was all made possible because of clinical decision support. Walgreens uses ePass created by Invoalon, its analytics use predictive algorithms to suggest health conditions that patients might have. I have worked with almost all healthcare informatics vendors, have implemented countless interfaces, and have asked ever doctor that I have seen in Boston how they like working with Epic (I get a similar semi-positive bland response every-time), and this was the most meaningful moment where I could see first-hand how healthIT is improving the lives of patients.
Hopefully I have convinced you of the importance of clinical decision support. Providers are notorious for being slow to adopt healthcare technology that could improve patient care. Admittedly, it is hard to have the foresight to see how a bare bones ADT interface, a simple repository for data in 2010 can pave the way for the clinical decision support system I witnessed at Walgreens. Hospitals and providers were provided 19.2 billion dollars in federal funds to implement healthcare informatics technology, they did not start this process on their own and it will take continued effort and funding for a complete adoption of technology. While many do not like the idea of Big Pharma and other stakeholders funding these programs to increase adoption, is it unreasonable to expect that providers and hospitals will continue the rapid increase in healthcare technology without broader support and funding of other life science stakeholders.
Merck and Practice Fusion entered a partnership to improve patient health outcomes through a Population Health Management (PHM) program for adult vaccines. Merck provides funding to Practice Fusion to increase the adoption of clinical decision support tools such as vaccine-related notifications to providers who opt into the program. In a four-month study period ending in August, there was a 73% increase in vaccinations compared to a control group with no notifications.
Below is an image of the Practice Fusion EHR patient chart showing the vaccine alert. The alert does not tell the provider which vaccine to use and allows the provider to easily click out of the alert if the patient is not well enough to receive a vaccine at that particular encounter. There is a citation on the alert which notifies the provider that the clinical guideline alert was funded by Merck.
Every year, over 42,000 people in the United States die as a result of not being vaccinated, so this increase in vaccination is no small victory. Unfortunately, this statistic also proves the need for clinical decision support. Although, there is a small minority of patients who refuse vaccines, most patients do not know what vaccinations they need to get and when they need to get them and providers have been ineffective at vaccinating the United States population.
The newest group of doctors grew up in my generation, in which marketing has infiltrated almost every aspect of our life. We have been consistently bombarded with television ads, spam email messages, popup ads and the like more than any other generation. However, we have almost always had access to infinite amounts of information to provide us with other opinions. Therefore, if stakeholder partnerships are prudent, regulated and ethical such as the Merck and Practice Fusion partnership, population health could be greatly improved.