The Gap in Our Attention to the Gaps in Care

While gaps in care can be defined in many ways, we mean the difference between well-known national standards for care and what is actually happening. We have identified some important remedies that can be effected quickly and with demonstrable success, such as medication fulfillment, adherence, and patients gaining better understanding of their treatments. A recent PDR survey (n=606) revealed what’s missing and how to address it. And it all comes down to what we do all the time: Communication—in the right way and through the channels most likely to support physician decision-making.

When prescribing for a patient, PDR provides an automated prompt or reminder within the workflow of the EHR, about potential gaps in care on behalf of the patient’s healthcare payer. The prompt is informed by the data available in the patient record with their healthcare payer. For example:

  • Age-based or seasonally based reminders for screenings or vaccinations (e.g., colorectal screening for a patient aged 50 or over; pneumococcal conjugate vaccination for a patient aged 65 or over).
  • Suggestions to review a prescribed medication that might not be appropriate for a patient based on evidence-based guidelines (e.g., glyburide for an elderly diabetic patient, benztropine for an elderly patient with Parkinson’s).
  • Suggestions to consider adding a medication to meet evidence-based guidelines (e.g., suggest adding an ACE-I/ARB for a patient taking a diabetes medication and a diuretic).

PDR looked specifically at how to identify the gaps in care and whether in-workflow reminders through the use of EHRs would make a difference, particularly among prescribers who have value-based contracts, or VBC (pay for performance, outcomes/quality goals, shared savings, and similar value-based guidelines). The short answer is yes. Although offices still tend to rely a great deal on paper files, it’s no secret that the healthcare providers themselves have become much more oriented toward electronic means of communication. Our study gathered info from physicians in family care, cardiology, endocrinology, internal medicine, psychiatry, and neurology, and we discovered some important statistics.

Why Gaps in Care Letters are Less Effective

Today, identification of gaps in care is largely done through patient discussions and manual review of the patient record. This includes gaps in care letters from payers, but those letters often don’t get the attention they require. Over 64% of physicians recalled receiving a gap in care letter, but only 24% of practices systematically processed the information into the patient file. Why? According to the physicians, the reports may be too general, include multiple patients, be based on outdated information, or be considered clinically insignificant. In addition to the fact that they’re on paper.

Some physicians selectively process gaps in care, prioritizing notifications that indicate patients may not have filled a script for a chronic medication, may be due for chronic condition monitoring, or may be on the wrong medication or need additional medication. All good reasons for attention and prompt follow-up.

This led to the question of whether healthcare providers would be likely to consider (and act on) an EHR reminder for these kind of notifications that require prompt attention when with a patient. The most impactful in-workflow reminders are described below:

  • Notifications of potential adherence-related issues were welcomed: 85% of physicians would be likely to consider a notification that a patient had not filled a prescription, and 90% would consider a notification of a significantly overdue refill.
  • Reminders to consider appropriate vaccinations are also useful: 83% said they would be likely to consider an EHR reminder to vaccinate a patient, for instance, one aged 65 or over with pneumococcal conjugate.
  • Similarly, physicians welcome reminders to monitor a patient or provide a screening: When asked about a reminder to monitor a patient, say, for a colorectal screening, the number went to 82%.
  • Physicians were even open to notifications that sensitively requested they review their prescribing: 70% would consider an EHR suggestion to review a medication that may not be appropriate for a patient, and 74% would consider an EHR suggestion to add a medication to meet evidence-based guidelines.
  • And many welcomed in-message links to further information.

These are not insignificant numbers. What they tell us is that manual processes and gaps in care letters, while useful, are often insufficient and can be improved on. The physicians we surveyed reported a much higher likelihood—over 75%—of responding to EHR reminders of gaps in care. They are especially open to those referencing adherence issues.

There are many reasons for this, but two stand out. One, of course, is that healthcare providers are more focused on digital communication today. The other is that EHR reminders happen while they are with the patient, so they are prompted to act in the moment.

One caveat though: The EHR is just as subject to overuse, inaccuracy, and lack of application as letters are. So, we also have to pay attention to the specific requests of physicians for information to be succinct, easy to act on, clear, accurate, and appropriately targeted.

Physicians are not only more responsive to EHR notifications, but they see them as being much more customizable, to address highly specialized needs of individual patients—just the kind of capability the digital revolution has offered us.

We’re not finished with our research. Next, we’re going to be investigating how prescribers’ perception of adherence differs by disease, and we’ll alert you to those results as well. For now, we hope this information builds some important bridges over gaps in care.

  • Rick Ratliff

    Rick Ratliff is President and Chief Commercial Officer at ConnectiveRx. Rick heads ConnectiveRx, a company that connects prescribers, pharmacists, and consumers to simplify how people get and stay on medications by providing information, savings, and access to medications people need.

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