An Economical Point-of-Care Software Solution Prototype for Medication Prior Authorization

摘要 此STTR第一阶段项目使用混合方法形成性评估策略来开发、测试和评估 Breezmed的Alpha原型，一个基于Web的护理点电子事先授权平台。之前 授权给当前的医疗系统带来了负担，阻碍了提供者有效地开出处方的能力 及时用药。这经常导致患者不遵守治疗规定，并 对于精神疾病来说尤其繁重，这些疾病通常需要通过处方药迅速稳定下来。 也有证据表明，如果药物昂贵或难以获得，就会出现高度不遵守治疗的情况。 此外，大量的经验证据证实了由单调乏味引起的高水平的服务提供者倦怠。 需要获得保险公司的事先授权。提供商以电子方式传输 药房的处方和实际配药的发生也给患者带来了负担，他们经常会发现 只有在他们前往药房获得药物后，他们的药物才不在保险范围内。近期 AMA和其他医疗保健倡导组织对提供者进行的调查显示， 可以谨慎地用于提供治疗的工作时间，但却分配给了点对点 咨询或填写保险审批所需的表格。这些人工过程消耗了宝贵的资源 时间和资源，并减少了所需的临床实践时间。Breezmed提供软件即解决方案 基于Web的平台，与现有的电子健康记录系统无缝、安全地集成。这个 提供者在护理点启动Breezed，提取诊断信息，患者治疗历史， 保险授权要求和处方规则，以有效地订购药物。该平台提供 可观的经济和社会效益，并可以安全地利用现有的EHR，只需最少的工作流程 颠覆。拟议的研究涉及三个综合部门，包括消费者偏好调查 管理到一个由国家招募的医生、护士从业者、医生助理和 药剂师。从这个小组样本中，我们进一步招募焦点小组参与者进行更详细的探索 事前授权和探索计算机中介解决方案的障碍。我们还利用关键的线人访谈 与医院管理人员、医疗信息学方面的医疗技术专家和保险公司合作，并使用此 构建Breezmed的线框架构的详细信息。我们还使用一个 模拟EHR并测试与EPIC病历系统的应用程序接口，以确保 在安全的HIPAA兼容环境中实现顺畅的链接。我们已经与H4科技公司合作，一家奥马哈- 基于Web应用程序开发公司，也是内布拉斯加大学的方法学和评估 研究核心是进行形成性评价的组成部分。该项目受益于一个顾问委员会。 拥有医疗保健和信息技术方面的专业知识，以及UNMC经验丰富的教职员工团队 牧羊人及时执行赠款。

ABSTRACT This STTR Phase I project uses mixed-method formative evaluation strategies to develop, test, and evaluate an alpha prototype of Breezmed, a point-of-care electronic prior authorization web-based platform. Prior authorization burdens the current medical system, hampering a provider’s ability to efficiently prescribe medication and in a timely fashion. This often leads to treatment non-compliance among patients and is particularly onerous for mental illnesses, which often require rapid stabilization with prescription medication. There is also evidence of high treatment non-compliance if medications are expensive or difficult to obtain. Moreover, substantial empirical evidence reinforces high levels of provider burnout stemming from the tedium required to obtain prior authorization from insurers. The lag between when the provider electronically transmits the prescription to the pharmacy and when actual dispensing occurs burdens patients too, who routinely find out their medication is not covered only after they have traveled to the pharmacy to obtain the medication. Recent surveys of providers conducted by AMA and other healthcare advocacy organizations show a considerable loss of workforce hours that could be prudently spent providing treatment, but is instead allocated to peer-to-peer consultations or completing forms required for insurance approval. These manual processes consume precious time and resources and detract from needed clinical practice time. Breezmed offers a software-as-a-solution web-based platform that seamlessly and securely integrates with existing electronic health record systems. The provider initiates Breezmed at the point-of-care drawing off diagnostic information, patient treatment history, insurance authorization requirements and formulary rules to efficiently order medication. The platform offers considerable economic and societal benefits and can securely piggyback to existing EHRs with minimal workflow disruption. The proposed study involves three integrated arms including a consumer preference survey administered to a nationally recruited panel of physicians, nurse practitioners, physician assistants, and pharmacists. From this panel sample we further recruit focus group participants to explore in greater detail barriers to prior authorization and probe computer-mediated solutions. We also utilize key informant interviews with hospital administrators, healthcare technology experts in medical informatics, and insurers, and use this detailed information to construct Breezmed’s wireframe architecture. We also conduct live usability tests with a simulated EHR and test the Application Program Interface with the EPIC medical records system to ensure smooth linkages in a secure HIPAA compliant environment. We have partnered with H4 technology, an Omaha- based web application development company, and also the University of Nebraska Methodology and Evaluation Research Core to conduct the formative evaluation components. The project benefits from an advisory board with expertise in medical care and information technology, and a team of experienced faculty at UNMC to shepherd timely execution of the grant.