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

摘要 该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，这是一个基于网络的即时电子事先授权平台。之前 授权给当前的医疗系统带来了负担，阻碍了提供者有效开处方的能力 及时用药。这通常导致患者不依从治疗， 特别是对于精神疾病，这往往需要处方药快速稳定。 还有证据表明，如果药物昂贵或难以获得，则治疗不依从性很高。 此外，大量的经验证据强化了来自单调乏味的高水平的提供者倦怠 必须事先获得保险公司的授权。提供者以电子方式传送 药房的处方和实际配药的时间也给病人带来了负担，他们经常会发现 只有在他们前往药房取药之后，他们的药物才不受承保。最近 美国医学会和其他医疗保健倡导组织对医疗服务提供者进行的调查显示， 的劳动时间，可以谨慎地花在提供治疗上，而是分配给点对点 咨询或填写保险批准所需的表格。这些手动过程消耗了宝贵的 时间和资源，并减少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。的 提供者在护理点启动Breezmed，提取诊断信息，患者治疗历史， 保险授权要求和处方集规则，以有效地订购药物。该平台提供 可观的经济和社会效益，并可以安全地搭载到现有的EHR与最小的工作流程 破坏拟议的研究涉及三个综合武器，包括消费者偏好调查 向全国招募的医生、执业护士、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，以更详细地探索 事先授权的障碍和探测计算机中介解决方案。我们还利用关键线人访谈 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 详细信息来构建Breezmed的线框架构。我们还使用 模拟EHR并测试与EPIC病历系统的应用程序接口，以确保 在安全的符合HIPAA的环境中实现顺畅的链接。我们与奥马哈的H4科技公司合作- 的Web应用程序开发公司，也是内布拉斯加大学的方法和评估 研究核心进行形成性评价的组成部分。该项目得益于一个咨询委员会 拥有医疗保健和信息技术方面的专业知识，以及UNMC经验丰富的教师团队， 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.