Transformational strategies for optimizing use of medications and related therapies through us pharmacists and pharmacies: Findings from a national study.

SETTING: Nonoptimized medication therapies (NOMTs) are associated with likely avoidable illnesses and mortality affecting millions of people and costing an estimated $528 billion per year in excess health spending in the United States. The coronavirus disease 2019 (COVID-19) pandemic brought into focus barriers limiting the ability of U.S. pharmacists and pharmacies to provide services that can reduce NOMTs and improve U.S. population health. OBJECTIVES: This National Science Foundation Center for Health Organization Transformation study explored potential strategies that U.S. pharmacists, pharmacies, and their partners could implement to reduce NOMTs while also delivering other forms of value to U.S. populations from 2021 to 2025 (during and after the COVID-19 pandemic). DESIGN: A panel of senior leaders representing the U.S. pharmacist and pharmacy sector participated in a 4-round Delphi process to identify unmet needs, barriers, change drivers, and priority strategies for meeting those needs. Data were gathered and analyzed by public health researchers, most of whom are outside the pharmacist and pharmacy sector. RESULTS: A comprehensive set of evidence-based strategies with potential to reduce NOMTs, protect and improve population health and well-being, and strengthen the sector were identified. Four transformational strategies were recommended: comprehensive payment and practice transformation, strengthening pharmacy data interoperability infrastructure, development of unifying measurement and management mechanisms, and development of a more robust national research infrastructure. Strengthening health equity was a cross-cutting strategy affecting all areas. CONCLUSION: The results may be of interest to policy makers, pharmacists, pharmacies, physicians, nurses and other clinicians, pharmaceutical firms, plan sponsors, plans, health systems, clinics, aging care, digital technology companies, and others interested in optimizing outcomes from medications and related therapies for U.S.

Information infrastructure for consumer health: a health information exchange stakeholder study.

BACKGROUND: An enabling infrastructure for population-wide health information capture and transfer is beginning to emerge in the U.S. However, the essential infrastructure component that is still missing is effective health information exchange (HIE). Health record banks (HRBs) are one of several possible approaches to achieving HIE. Is the approach viable? If so, what requirements must be satisfied in order for it to succeed? PURPOSE: The research, conducted in 2007-2008, explored HRB-related interests, concerns, benefits, payment preferences, design requirements, value propositions, and challenges for 12 healthcare stakeholder groups and the consumers they serve in a U.S. metropolitan area of 1.3 million people. METHODS: A mixed-methods design was developed in a community action research context. Data were gathered and analyzed through 23 focus groups, 13 web surveys, a consumer phone survey (nonstratified random sample) and follow-up meetings. Recruiting goals for leaders representing targeted groups were achieved using a multi-channel communications strategy. Key themes were identified through data triangulation. Then, requirements, value propositions and challenges were developed through iterative processes of interaction with community members. RESULTS: Results include key themes, design requirements, value propositions, and challenges for 12 stakeholder groups and consumers. CONCLUSIONS: The research provides a framework for developing a consumer permission-driven, financially sustainable, community HRB model. However, for such a model to flourish, it will need to be part of a nationwide network of HIEs with compatible HRB approaches able to overcome a number of challenges.

Future trends in the supply and demand for radiation oncology physicists.

Significant controversy surrounds the 2012 / 2014 decision announced by the Trustees of the American Board of Radiology (ABR) in October of 2007. According to the ABR, only medical physicists who are graduates of a Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) accredited academic or residency program will be admitted for examination in the years 2012 and 2013. Only graduates of a CAMPEP accredited residency program will be admitted for examination beginning in the year 2014. An essential question facing the radiation oncology physics community is an estimation of supply and demand for medical physicists through the year 2020. To that end, a Demand & Supply dynamic model was created using STELLA software. Inputs into the model include: a) projected new cancer incidence and prevalence 1990-2020; b) AAPM member ages and retirement projections 1990-2020; c) number of ABR physics diplomates 1990-2009; d) number of patients per Qualified Medical Physicist from Abt Reports I (1995), II (2002) and III (2008); e) non-CAMPEP physicists trained 1990-2009 and projected through 2014; f) CAMPEP physicists trained 1993-2008 and projected through 2014; and g) working Qualified Medical Physicists in radiation oncology in the United States (1990-2007). The model indicates that the number of qualified medical physicists working in radiation oncology required to meet demand in 2020 will be 150-175 per year. Because there is some elasticity in the workforce, a portion of the work effort might be assumed by practicing medical physicists. However, the minimum number of new radiation oncology physicists (ROPs) required for the health of the profession is estimated to be 125 per year in 2020. The radiation oncology physics community should plan to build residency programs to support these numbers for the future of the profession.

The consumer's view of the electronic health record: engaging patients in EHR adoption.

The consumer/patient perspective is often forgotten as it pertains to the electronic health record. This paper focused on engaging the patient in the adoption of EHRs. The Louisville Health Information Exchange (LouHIE) recently completed an extensive research study on this topic, using several data gathering techniques to capture the interest, benefits, concerns and payment choices of the community. This article focuses on the findings of the study and the steps LouHIE will take to ensure consumer perspectives are being heard. Specific elements of the article include explaining the consumer research study and results; discussing the patient-related benefits of an EHR, the barriers, interests and the payment choices as described by the research group; and discussing action steps needed to continue engaging the consumer/patient in the adoption process.

Capitalizing the NHIN: a strategy for funding an integrated nationwide network of community HIEs.

Lack of capital investment is limiting progress towards NHIN goals. A 10-step strategy for engaging new private-sector investment is presented. The vision involves developing an integrated nationwide network of community health record banks that contain costs and improve quality through robust community-wide process improvement efforts. Purchasers, such as employers, Medicare and Medicaid, jump-start the process, beginning with pilots, by making advance commitments of low per-member per-month fees for 10 percent to 30 percent of each community's population. Additional revenue opportunities are identified, includin value-added services for consumers, pharmaceutical manufacturers and providers. Competing for-profit service providers then are offered exclusive multi-year contracts to build and operate the community health record bank using a revenue share contract. After they're selected, service providers invest capital to build record bank technologies, services and infrastructure. Successful service provider gain opportunities to develop record banks nationwide. To achieve success, the private sector, and federal and state purchasers must work together to support robust community-wide pilots.