“Using the EpicCare electronic medical record system's SmartPhrases feature, I created what we call 'RxRefill phrases' for all formulary drugs where lookup of essential information is required for a refill,” he said in an interview. “The process of making sure that lab tests, blood values, and mammogram results are current takes about 5 minutes per prescription. I do 100 refills a week in a practice that is about 60% full time.”
Dr. Brush's office is 1 of 14 sites in the Harvard Vanguard group, all of which are served by EpicCare. “In moving from paper to EpicCare's EMR system, I noted little improvement in the efficiency of refilling medications. It was just a shift from paper to electronic medium. When refills required essential data such as creatinine and potassium and last blood pressure values for diuretic refills, someone still had to spend time looking up and communicating the information to the clinician ultimately responsible for that prescription,” he explained.
As leader of the Harvard Vanguard's Internal Medicine Design Team, Dr. Brush helps make medical records more user friendly to clinicians. Three years ago, he decided to tackle the refill problem.
Now, for formulary drugs that require clinical data, “all my assistant has to do is type 'Rx' followed by the name of the drug—for example, 'RxSimvastatin'—and all the data are generated. These phrases contain the request for the drug, as well as data links that automatically bring the required lab tests and clinical information into the refill request,” he explained.
When the test is overdue or the last blood pressure test is beyond the time for a reasonable refill, the medical assistant or nurse requesting the clinician to sign off knows to first arrange the needed appointment or tests and to request a refill that lasts just beyond that date.
When the timing is up to date, the essential data become part of the medical record at the time of the refill, indicating that it has been reviewed, he added.
“Not only does the medical assistant or nurse save time in looking up the essential information, but the clinician sees [only] refill requests that are already adequately researched,” he said. “When I receive a prescription refill request now, if everything has been done, all the necessary data appear on the screen. To complete the process, I hit 'approve,' and 'close encounter,' and the refill process is complete.”