(Management Case Study) Advanced Electronic Medical Record Tool (E-tool) to Automate Payor-Specific Preferred Biologic Product Selection in an Academic Medical Center

Purpose: The case describes the development and implementation of an E-tool that automated the selection of preferred biologic products with consideration for payor preferences and practice site economics, with the goal of improving authorization turnaround time, decreasing pharmacist and provider intervention time, and increasing utilization of biosimilar products.

Methods: The Department of pharmacy developed an Advanced Electronic Medical Record Tool (E-tool) to automate biologic product selection using advanced order groups rule based functionality in the EMR (Epic). The Epic tool Advanced Order Group (AOG) is a rules-based function that provides options for a treatment pathway that clinicians have available placing an order. Our organization leveraged this tool for its capability to trigger an auto-selection of a medication choice at the time of entering a medication treatment plan. The AOG will only apply for plans that occur on the first day of the first cycle of a newly placed treatment plan. One of the limitations of the AOG was that changes in insurances or payor preference changes after the plan is placed will not update or auto-populate for existing plans or patients. However, this also prevents automatic changes to medications previously authorized by insurance. The e-tool was piloted with Bevacizumab and quickly expanded to rituximab, trastuzumab, and infliximab.

Results: The e-tool resulted in the following for the included biologics: (1) a 36% improvement in turnaround time for prior authorization (9.17 days pre-implementation and 5.84 days post implementation) (2) an increase in utilization of biosimilars (3) Improvement in satisfaction related to the prescribing on biologics.

Conclusion: Leveraging EMR driven tools can improve the turnaround time for biologic approvals, increase biosimilar utilization, and improve staff satisfaction.