Electronic health records (EHRs) are now an integral part of inpatient and outpatient care. In response, pharmaceutical companies are starting to consider how to leverage EHRs’ considerable face time with the physician and various EHR functions, such as electronic prescribing and for marketing and branding. Yet companies can make some serious strategic missteps if they buy into common misperceptions about EHRs, how they work and what they do. Don’t be misled by these five major EHR myths.
Myth 1: EHRs are only a promotion/advertising channel for the pharmaceutical industry.
Facts: Use of EHRs as an advertising channel may not be as widespread as many believe. Most pharmaceutical brand programs incorporated into EHR workflows are delivered by third-party vendors. According to research by Point-of-Care Partners, only a single digit percentage of EHR users receive banner ads in EHR workflows; roughly a fifth for formulary messaging and clinical decision support; and about a third for company-provided information on copay programs and patient education and adherence. In addition, EHRs can be very selective on which manufacturer-provided information to include in the EHR, which usually requires buy-in from the medical director. Practices often must opt in to access manufacturer-provided content at the point of care; they often do not know that this is a requirement or they forget about opting in, limiting the effectiveness of manufacturer outreach programs.
That said, EHRs have other uses of interest to pharmaceutical companies. Examples include matching patients and providers to clinical trials and identifying new patients, especially for brands in new therapeutic areas. Increasingly, EHRs are becoming tools to help track and report outcomes and adverse events associated with biologics and biosimilars. It’s not all about marketing and promotion.
Myth 2: EHRs are automatically updated with new drug information and new diagnostic tests.
Facts: It takes time to keep an EHR up-to-date. Updates on new drug approvals from the Food and Drug Administration and product changes from pharmaceutical companies are not uploaded automatically. Rather, this information is provided to “drug data compendia.” There are several of these services in the market, which give the information to EHR vendors to upload into their systems. The time lag depends on the EHR vendor’s subscription with the data compendium firm, the specific EHR solution, and the processing time that is needed. Updates are then triggered by the user. It takes about a month for new information to hit the provider’s office, although quarterly updates are possible. As with home computers, providers may not know they have to initiate the update or forget to do it. All of this is important because providers won’t prescribe drugs that don’t appear in their EHR systems.
Myth 3: EHR vendors control how the EHR works and behaves at a health system or practice.
Facts: There are hundreds of EHR solutions in the market and there are major differences among them. Use of a particular EHR is buyer dependent. For health systems and large integrated delivery systems, EHR use and deployment are the purviews of the medical director and IT director. For small and solo practices, the physician and often the practice manager decide about the role of the EHR and its use to improve quality, save time, and cut costs. While EHRs come preloaded with certain functionalities, customization often is needed. Examples include setting up reporting to identify gaps-in-care, reminders for routine testing, and creating order sets to queue common orders and prescriptions for common conditions. In addition, physicians may have to opt in to make use of specific features—a requirement they often don’t know exists.
Myth 4: EHRs have all the information needed to satisfy a prior authorization.
Facts: An increasing number of medications require preapproval—or prior authorization (PA)—before they can be dispensed. The documentation that is required varies by payer and diagnosis. It particularly is dependent on the formulary and benefits structure of the patient’s health plan. As a result, not all relevant information resides in the physician’s EHR and not all EHRs are equipped to capture and share the specific information required by individual payers for individual patients. The documentation disparity is changing as prior authorizations are becoming more automated and requirements are becoming more standardized. Physicians may not realize that their EHR documentation templates need to be updated to include additional information including lab values and patient observations about the conditions.
Myth 5: EHR vendors and health systems have done enough to educate physicians on the use of their EHR.
Facts: There’s never enough training for physicians to keep pace with updates to their EHRs and the changing healthcare environment. Vendor training opportunities are limited and physicians’ training budgets usually are scarce if nonexistent. Here is an area where brand teams can shine and make a difference. For example, physicians tend to use a small subset of functions available in their EHR; they may not know about the tools that already exist and how they can be used.
Account teams can help providers understand the features of their EHRs, create new prompts, and help them report on performance measures that are central to their reimbursement under value-based care. In another instance, most EHRs come pre-loaded with some patient education materials, which lack the breadth and depth required by many providers. Account teams can provide the latest clinical guidelines for use in setting up standard EHR practices and educational materials for various conditions, uploading them into practice EHRs and training practice staff on their use. Physicians can print out educational materials for individual patients or send them to the EHR patient portal, thus freeing up space previously used for printed matter and the time to retrieve material.
Looking to the Future
To be sure, pharmaceutical companies have many opportunities for leveraging EHRs. They should broaden their focus when planning for the future. Even now, many pharmaceutical companies are partnering with stakeholders to use EHRs and application program interfaces to improve population health, enhance member engagement, and address gaps in care. Aggregated EHR data are emerging for use in precision medicine and real-world insights. In short, pharmaceutical companies need to know the facts about EHRs to make the most of their current and evolving potential in the face of growing EHR market consolidation and the changing healthcare landscape.