Over the past 10 years, medical practice has changed dramatically. There are numerous factors that have resulted in these changes, including information technology, reimbursement reform, and the transition to the team-based care. Simultaneously, the relationship between physicians and the pharmaceutical industry has changed. The advent of academic detailing created new and less biased ways for physicians to receive information on drugs from non-industry pharmacists, information on drugs has been more widely available through a wide range of easily accessible and trustworthy websites, and EMRs/EHRs have integrated progressively more detailed information on drugs directly into clinical care with the ability to present relevant alerts at the time of decision making.
In addition, many physicians stopped seeing pharmaceutical reps in their practices. This was partly due to over-detailing (the same reps calling on doctors too frequently or different reps from the same company), uncertainty regarding the value of data being presented, limited time availability, and increasingly stringent guidelines governing the relationship between physicians and pharma companies. The net result was increased separation between pharma and physicians. A major focus for the pharmaceutical industry has been maintaining or increasing access to doctors and protecting brand name drugs against the onslaught of generics, which have eaten away at profits.
There are additional challenges that the pharmaceutical industry faces. Drug research and development cycles are long and costly, making it challenging to bring new drugs to market more quickly and efficiently. With the advent of personalized medication regimens and pharmacogenomics just around the corner, identifying the appropriate therapies for specific patients will not be possible without advanced technologies to support care decisions. As the dominant technology in a doctor’s office, EMRs are becoming the tools of choice for the majority of physicians in terms of documentation and clinical decision support. If a drug is not listed in an EMR’s drug database, it becomes difficult to prescribe. Similarly, without the processing power and logic of health IT systems to support decisions regarding personalized therapies, it will be almost impossible to prescribe the right drug for the right patient at the right time. Catch 22. In the majority of instances, you cannot prescribe the right “personalized therapy” without the right types of technology, and the EMRs are still a long way from being able to consistently support these types of clinical decisions. Getting access to the data in EMR systems for analytics is difficult for physicians. Use of this data by third parties for clinical research purposes, or to identify appropriate cohorts or patients for specific therapies, adds additional levels of complexity.
One of the areas that makes a great deal of sense in terms of collaboration between doctors and pharmaceutical companies is access to ancillary programs offered by brand name drug manufacturers that can be linked to therapies within EMRs. For example, a pharma company may offer a coupon program for low-income patients or additional educational or support programs for a particular therapy. These are difficult to remember at the time of the prescribing, but with an EMR, a physician could receive an alert at the time a drug is prescribed with the ability to easily print a coupon for a patient or an information sheet on an education/support program. This fits very effectively into the workflow of the physician, provides added value to the patient without incurring additional effort, and encourages appropriate utilization of drug therapies.
Building this type of capability into EMRs will not be easy; however, if done appropriately, there is significant value for all parties. Does Pharma have a role in the EMR-based practice? In this area, I strongly believe it does.
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