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

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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.