“At Indiana Health, using RXO helped us to achieve a 20-30% improvement overall in clinical pharmacy work efficiency,” Jim Jorgenson, Visante CEO.
Clinical pharmacists are charged with assessing all inpatient medication regimens with an eye toward monitoring those who are at highest risk for an Adverse Drug Event (ADE). This is a best-practice approach to oversee patient response to prescribed medicine therapies while in the hospital. The problem is that searching through daily chart entries and multiple information systems can take too long to quickly separate out the high-risk cases and intervene in a timely manner. The end result is that most clinical pharmacists find they are “chasing fires” rather than preemptively intervening before a crisis hits.
Such was the experience at IU Health when Visante CEO Jim Jorgenson was Chief Pharmacy Officer and Vice President for that health system. At the IU Health – Bloomington Hospital Jim was impressed as Derek Fields, Clinical Coordinator and Michael Melby, Director of Pharmacy and Clinical Informatics, put their heads together to come up with a better system. The result was a highly effective, but hard-coded, monitoring program that worked well for their systems but could not be adapted to work with other organizations’ IT systems.
With Jorgenson’s encouragement, in 2014, HighFive CEO, Keith Streckenbach took a hard look at the IUHealth pharmacy monitory program and saw a diamond in the rough. Following a period of negotiation and transfer of rights, Streckenbach redesigned the Fields and Melby model to become more flexible and scalable for use with all US hospital systems, and therefore a more marketable product. He was able to reprogram the tool to be web-based and adaptable for use with all US hospital systems. Now called RXO – “O” for Optimization – the tool resides on the web and is accessed on a subscription basis.
RXO could also stand for “Original.” Most hospital pharmacy monitoring systems search out and identify problems, alerting clinicians when a crisis is imminent or already in progress. RXO is able to pull together critical data from each patient’s electronic health record (EHR) such that it daily stratifies an institution’s entire patient population identifying which patients are most at risk for an adverse drug event (ADE) and puts this into a meaningful interface so that the clinical pharmacists efficiently prioritize their work flow for the day rather than running from medication crisis to crisis. With RXO, interventions made are automatically recorded in the background for reporting and clinical continuity.
When the time comes for a patient handoff between providers, service areas, or shifts, this continuous medication narrative becomes the optimal means of communicating patient status and any interventions made. It is also helpful when transitioning patients to a different facility.
The value of RXO goes beyond optimizing medication management. This is a tool that helps pharmacy directors supervise productivity of the department, too. The risk-based clinical dashboard provides a real-time awareness of both the clinical and operational workload. Department staff can see what is being done and what is left to do, as well as provide additional assistance when a pharmacist is falling behind or when order fill is lagging. A quick glance at RXO will also tell which patients have yet to be reviewed.
RXO supports best practices for medication therapies and these can translate into real cost savings for the institution. In the course of using this tool, there is every indication of the positive outcomes for timely anti-infective conversion therapy (IV:PO), rapid response for correcting “drug-to-bug” mismatches, timely adherence to core measures, and thorough discharge consults for at-risk patients.
It is hard to argue with indicators that support declining lengths of stay, earlier and more effective clinical pharmacist interventions, and reductions in drug spend — especially from costly IV anti-infectives to appropriate oral medications. Derek Fields, Clinical Coordinator at IU-Bloomington Hospital also reports a 30% increase in productivity for his 5 clinical staff pharmacists.
Through Visante’s strategic alliance with HighFive Health, our pharmacy experts have been working closely with Keith Streckenbach and his staff. For more information about RXO and other clinical productivity solutions, use this link.