PatientAdvisor is an interactive platform designed to assist healthcare providers improve patient outcomes. PatientAdvisor analyzes data to provide medication adherence alerts, electronic prior authorizations, real-time benefit information, evidence-based patient support (education and copay savings) and multifaceted clinical messages at the point of encounter.
- To access PatientAdvisor, navigate to DrFirst.
- The PatientAdvisor toolbar automatically loads within a patient's chart across the center of the screen.
- There are five tabs available within PatientAdvisor including:
- Patient Scorecard
- Patient Support
- Clinical Decision Support
- Medication Fill History
- In addition to the tabs, there is also a service that will alert you of any coupon, copay savings program, or adherence letter for the electronic prescription just written for the patient.
- You can click the double arrows on the right hand side to minimize the toolbar, if it has been minimized, you can expand it by clicking the diamond on the right-hand side.
The Patient Scorecard is a tool that provides an overview of the patient's medication adherence and alerts you when patients are not filling prescriptions as written. On the PatientAdvisor toolbar, if your patient has any medications with a calculated medication adherence rate below 80%, the "Patient Scorecard" tab alerts the physician by turning orange (see Figure 1-1). If the patient has an adherence rate over 80%, the Patient scorecard will appear unchanged. If the toolbar is collapsed and there is an alert for the patient, a notification will appear on the tab to the far right (see Figure 1-2).
Figure 1-1. Patient Scorecard notification.
Figure 1-2. Patient Scorecard notification with collapsed toolbar.
When you select the Patient Scorecard tab, the screen presents the patient's adherence information (see Figure 1-3).
Figure 1-3. Patient Scorecard adherence information.
The adherence rate is calculated from the medication possession ratio when there is a prescription plus two fill events, and is expressed as a percentage displayed below the name of the drug in the chart. The calculation is made for each prescription with the same generic name regardless of dosage at the time of patient encounter. Next to the patients name and adherence rate, you will see a colored circle based on the adherence rate.
- Green dot: Adherence rate is 80% or greater, i.e. no risk for non-adherence. Patient adherent to treatment regiment most or all of the time.
- Yellow dot: Adherence rate is 60%-80%, i.e. elevated risk for non-adherence. Patient is not optimally following treatment regimen. Recommended action: offer education and or evaluation.
- Red dot: Adherence rate is less than 60%, i.e. high-risk for non-adherence. Patient is not following treatment regimen. Recommended action: requires adherence evaluation.
- N/A: There is insufficient data to calculate an adherence rate. A minimum of two fills for a single prescription are required in order to calculate the adherence rate and for medications that are PRNs.
Interpreting the medication adherence scorecard
In the upper right corner of the scorecard, you can select different views including "2 Months", "6 Months", "1 Year", and "2 Years." By default, six months will be selected, but the scorecard can display up to two years of history. Brand name drugs will have the first letter capitalized, and generics will display in all lowercase. Medications will be sorted by ascending adherence rate with the lowest percentage on the top of the list. Drugs without sufficient fill data to calculate an adherence rate are marked as "N/A" and show at the bottom of the list. The following items listed are the interpretation of the medication adherence scorecard.
- F (actual fill date): Hovering over this icon will show you the drug name, drug strength, fill date, supply, refills remaining, prescriber, and available pharmacy information.
- R (expected refill date): This letter indicates that there was a refill even that should have occurred but was missed. Hovering over the icon displays the projected refill date based on reported fill data.
- X (expected completion date): Hovering over this icon will show you the completion date of the prescription as well as the name of the medication. The end date is calculated and readjusted based on the dates the prescription was filled.
- Red Bar: The presence of this indicates the number of days between the time the patient should have had their medication filled and the next event. These bars appear between an "R" and an "F." If there is a gap in a prescription fill, the red bar is displayed. The date range for the red bar includes the prescription date or expected refill date (R) up to the Day Before the subsequent fill date (F) or "R", and counts only that number of days.
- Blue Bar: This bar indicates the duration of the fill for that medication before a refill is required, or when the prescription ends. The number of days and the date range are displayed. If there is no gap in the prescription fill, then the blue bar is displayed. The date ranges for the blue bar include the prescription date or fill date (F) up to the Day Before the subsequent fill date or expected refill date (R) and counts only that number of days. If the blue bar is from the prescription "F" to the prescription end (X), the date range includes the "X" date and is included in the number of days.
Electronic Prior Authorizations (ePA)
Through PatientAdvisor, you have the ability to submit electronic Prior Authorizations (ePA). PatientAdvisor begins the prior authorization process for prescriptions that require them.
Prior authorizations in PatientAdvisor are triggered by prescriptions written in DrFirst. They can be created two ways:
- A "PA" tag (see Figure 1-4) for that drug based on the patient's formulary information, or;
- From a real-time benefit verification done by myBenefitCheck.
It should be noted that patient-specific benefit information returned and presented by myBenefitCheck supersedes the formulary tags found in DrFirst.
Figure 1-4. A "PA" tag.
Prior authorizations can be initiated from two places, directly from the benefit determination (see Figure 1-5) or you can select the "ePA+" tab within the PatientAdvisor toolbar (see Figure 1-6) to view prior authorizations.
Figure 1-5. Prior authorizations from benefit determination.
Figure 1-6. Prior authorizations from "ePA+" toolbar.
Once you have opened the "ePA+" tab, you will have the following sections available across the top bar:
- PA Question Set Available: A prior authorization task was created based on the prescription and the patient's formulary data. A question set (prior authorization form) for that drugs prior authorization was then requested and received from the payer, and is ready to be completed.
- PA Needed: A prior authorization task has been created from a real-time benefit check (myBenefitCheck), but requesting the question set requires an initiation from the user.
- PA Submitted to Plan: The question set has been completed and submitted to the payer/PBM.
- PA Decision Received:
- PA Partially Denied: Drug approved, but quantity needs to be adjusted.
- PA Denied: Denied by the payer.
- PA Approved: Approved by the payer.
- PA Closed by Plan: Closed by the payer, additional notes will be available for completion.
PatientAdvisor automatically places the ePA+ tasks within the appropriate section, depending on their status (see Figure 1-7). This makes it easy for you to find the task.
Figure 1-7. Prior Authorization tasks sections.
If a prior authorization is needed, you can access the question sets provided by the insurance plans by selecting the ePA+ tab and reviewing the "PA Question Set Available" section. In order to start an ePA from the available question set, select the "Complete Now!" button. This displays the prior authorization question set for the user to complete and submit to the payer (see Figure 1-8).
Figure 1-8. Prior authorization question set.
By default, the tasks display for the practice location and provider that are associated with the login. You can select other options from the drop-down arrows and select the "Apply" button (see Figure 1-9). You can also filter the tasks by using the "Search by Patient Last Name" text box, and selecting the "Search" button. The "Reset to All" button will clear the search criteria and revert the view to display all tasks for all patients. You can also select the "Show Current Patient Only" button to display tasks for only that patient. To view tasks for all patients, you can select the "Reset to All" button again. The "Update List" (formerly "Refresh") will upload new tasks or update the status of tasks.
Figure 1-9. Filtering options in Prior authorization.
ePA status groupings
The different tasks are grouped by status and you can view a count for each task grouping when you open the "ePA+" tab (see Figure 1-10).
Figure 1-10. Task grouping.
ePA task details
The following information is included in the tasks, with the action item displaying on the right (see Figure 1-11).
- Patient name
- Patient date of birth
- Prescriber name
- Date created
- Name of task assignee
Figure 1-11. Information included in a task.
When you select the information button located beside the drug detail, the "PA Note" displays, showing more information about the task such as the Transaction ID, updated date, patient insurance information, prescription details, and notes from the insurance plan (see Figure 1-12).
Figure 1-12. Information button details on the task.
myBenefitCheck in PatientAdvisor is a real-time benefit check that displays the drug coverage and pricing for prescriptions before they are sent to the pharmacy. This enables you to select the best drug and pharmacy options based on the patient's formulary and benefit design. The benefit check will return the following information:
- A patient-specific drug coverage determination, including whether a prior authorization is required.
- The patient's out-of-pocket cost for the prescription.
- Up to three preferred alternatives (as provided by the payer) (see Figure 1-13).
- Any alternate pharmacy benefit the patient may have (usually a mail order benefit)
You can change the drug, the pharmacy or both by using the "Change" button on the far right of the provided option (see Figure 1-14). When a non-covered drug requires a prior authorization (PA) there will be a red bar below the name of the drug. In cases where this is necessary, you can begin this prior authorization immediately by selecting the "Start PA" button (see Figure 1-15).
Figure 1-13. Covered drug with preferred alternatives.
Figure 1-14. Change the drug or pharmacy.
Figure 1-15. Non-covered drug requiring Prior Authorization.
During your workflow, clinical messages may be triggered based on the patient's demographics, provider specialty, and/or medications. These message will first display as an "auto-preview" message for approximately 15 seconds in a yellow box at the top of the page (see Figure 1-16). These messages may include links to additional content, and selecting the link will display more information. In many cases, the message will be stored in the "Clinical Decision Support" tab after the "auto-preview."
Figure 1-16. Auto-preview of clinical message.
Financial savings programs for prescriptions
Cost is one of the primary factors in medication non-adherence. To assist your patients with cost, PatientAdvisor incorporates financial savings programs into the eprescribing workflow. These programs appear once the prescription is in the review process.
Once a drug is prescribed, PatientAdvisor reviews the prescription to determine if it is eligible for any savings program. Eligibility criteria may include:
- Days supply
- Previous fill history
- Patient or Prescriber demographics
If the drug has a coupon or copay savings program available and it meets the eligibility criteria, the information necessary to process the program at the pharmacy is automatically appended to the electronic prescription as part of the "Directions to Pharmacist" field. If there is content already in the "Directions to Pharmacist" field, the coupon information does not overwrite the notes, and will not be appended to that field. The coupon can still be printed separately and provided to the patient.
You can see any inserted financial savings information and its accompanying printable information on the prescription review screen (see Figure 1-17).
If you select the "Print Coupon" button this will open the coupon into a larger window, allowing you to use your computer's print functionality or download a copy of the coupon (see Figure 1-18).
Once you have completed the prescription and selected the "Save Pending Rx" button, you can still view and print the financial savings program from the "Prescription Management" area. This can be accessed at the bottom of the patient record by selecting the tag icon on the prescription(see Figure 1-19).
Figure 1-17. Reviewing prescription financial savings information.
Figure 1-18. Print or download coupon.
Figure 1-19. Financial savings program from "Prescription Management" section.
To view available support materials, select the "Patient Support" tab in the PatientAdvisor toolbar (see Figure 1-20). This section includes educational resources available for the patient based on their active medications list, diagnoses, and lab orders. You can also search by term or codes. These materials are automatically retrieved when a patient has active medications (with accompanying RxNorm codes), problems assigned (with accompanying ICD-10 codes), and/or LOINC codes for lab results.
Figure 1-20. Patient Support tab.
Within the "Patient Support" tab there are four different selectable tabs available:
Selecting a tab will illuminate it in white, and display the results. If none of the first three tabs contain information, then the "Search" tab is the best option to find education resources (see Figure 1-21).
The Diagnosis, Medications, or Labs description displays on the left with the corresponding "Code Type" and "Code Value" listed on the right. The search for education resources can be done based on the description, code type, and value (see Figure 1-22).
When you select the "i" button, all the education materials are retrieved and displayed in one display box. Currently, the education content is provided by "The National Institutes of Health's National Library of Medicine" (Medline Plus Program). Selecting the "c" button searches for available documents by code, and the "d" button searches for available documents by description. When you select either "c" or "d", available materials will display individually (see Figure 1-23).
Once the education material is presented, you are encouraged to discuss the material with patients You can print educational material by selecting the "Print" button in the upper right corner (see Figure 1-24).
Links displayed on the educational document take you to external sources. The source link is also available for you above a disclaimer message. The disclaimer message is on every content page.
Figure 1-21. Search option.
Figure 1-22. Description, code type, and value.
Figure 1-23. Additional information icons.
Figure 1-24. Print educational materials.
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