To learn more about Patient Advisor and electronic prior authorization (ePA), please review the following resources:
What is Patient Advisor?
The Patient Advisor gives physicians a suite of advanced clinical, behavioral, and financial support tools designed to inform and improve medication adherence and disease self-management by high-risk patients.
Patient Advisor enables providers with patient medication adherence rates, electronic prior authorization, real-time pharmacy benefit checking, and evidence-based patient support tools to help solve underlying causes of non-adherence.
What is ePA?
This video explains more about Electronic Prior Authorizations
Medication Adherence and ePA Training Manual for Rcopia 4 is below (download the below document)
Downloads
Rcopia4 PatientAdvisor Manual.pdf
Patient Adherence, Education, Co-Pay Savings,
Adherence Plans, Clinical Messaging and Electronic
Prior Authorizations (EPA)
SPM Patient Advisor Toolbar Manual
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Contents
Introduction ............................................................................................................................................................................ 3
Accessing Patient Advisor ....................................................................................................................................................... 3
How to View and Interpret the Patient Scorecard ................................................................................................................. 3
Patient Support ....................................................................................................................................................................... 6
Clinical Messages .................................................................................................................................................................... 8
Coupons and Co-Pay Savings .................................................................................................................................................. 9
Adherence Plan Letters ......................................................................................................................................................... 10
Electronic Prior Authorizations (ePA) ................................................................................................................................... 11
Medication Fill History .......................................................................................................................................................... 15
Practice Preferences ............................................................................................................................................................. 18
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Introduction
Patient Advisor is an adherence platform within eRx/EMR/HIS solutions designed to improve patient outcomes. Patient
Advisor analyzes data to provide evidence-based patient support (education and co-pay savings) and deliver multi-
faceted clinical messages at the point of encounter.
Supported Browsers:
Patient Advisor is currently supported on the following browsers:
IE: version 8+, newer version preferred
Firefox: version 4+, newer version preferred
Chrome: version 10+
，
newer version preferred
Safari: version 5+
，
newer version preferred
Opera: version 11.1+
，
newer version preferred
Accessing Patient Advisor
1)
To access Patient Advisor you must log launch into the Medreview-ERX Application.
2)
Once within a patient’s chart you will automatically see the Patient Advisor toolbar, normally located towards
the middle of the page.
3)
There are four tabs you can navigate through to utilize patient scorecards, patient support tools, clinical decision
support tools and ePA+.
4)
In addition to the tabs, there is also a service that alerts the physician of a coupon, co-pay savings or adherence
letters for the electronic prescription that was just written for their patient.
5)
Note: If you have recently minimized the toolbar by clicking the double-arrow to the right, you will need to
expand it to view the toolbar. To expand the toolbar, click the bottom highlighted below on the right.
How to View and Interpret the Patient Scorecard
1)
The patient scorecard card is a tool to give you an overview of the patient’s adherence with their medication
regimen and lists the patient’s active medications.
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2)
On the Patient Advisor toolbar if your patient has any gaps in filling their prescriptions the Patient Scorecard tab will
appear orange, meaning your patient‘s adherence rate dropped below 80%.
3)
If the toolbar is collapsed and there is an alert for the patient, you will see the notification on the tab to the far right,
seen below:
4)
For a patient without gaps in their medication regimen the Patient Scorecard will appear unchanged.
5)
When you click on “Patient Scorecard” tab, the Patient Advisor scorecard will display. The screen will give you the
adherence.
Adherence Rate
Adherence Rate is a calculated based on a prescription plus two fill events and 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.
Green Dot – Adherence rate is 80% or greater, i.e. No risk for non-adherence. Patient adherent to treatment
regimen most or all of the time.
Yellow Dot – Adherence rate is 60% - 80%, i.e. Elevated risk for non-adherence. Patient not optimally following
treatment regimen; offer education and/or evaluation.
Red Dot – Adherence rate is less than 60%, i.e. High-risk for non-adherence. Patient not following treatment
regimen; 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.
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1)
Interpreting the Medication Adherence Scorecard:
a.
The Patient Scorecard tab alert will be triggered when the patient is on a drug for which his/her
adherence rate is less than 80%.
b.
In the upper right corner of the scorecard, the user can select different views: 2 Months, 6 Months, 1
Year and 2 Years. The default view is six months and the scorecard displays two years of fill history.
c.
Brand name drugs will have the first letter capitalized. Generics will be displayed in lower case.
d.
Medications will be sorted by ascending adherence rate with the lowest percentage on the top of the
list. N/A will appear at the bottom of the list. Drugs marked as N/A do not have sufficient fill data to
show an adherence rate.
e.
F
(Actual Fill Date) – When you hover over the icon you will be shown drug name, drug strength, fill
date, supply, refills remaining, prescriber and available pharmacy information.
f.
R
(Expected Refill Date) – Indicates that there was a refill event that should have occurred but was
missed. When you hover over the icon you will be shown the date it was expected to be refilled based
on the original prescription. The refill takes into account when the prescription was actually filled.
g.
X
(Expected Completion Date) – When you hover over the icon you will be shown completion date of
the prescription along with the name of the medication. The end date will be calculated and readjusted
based on dates the prescription was filled.
h.
Red Bar
– Indicates the number of days between the time the patient should have had their
medication filled and the next event. This can show up between an “F” and an “F” and between an “R”
and an “F” or the end of a prescription.
i.
Blue 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.
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i.
No Gap in Rx - If there is no gap in Rx fill, then the blue bar is displayed. The date ranges for the blue bar
includes the Rx 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 Rx/F to prescription end (X), the date
range includes the X date and is included in the number of days.
j.
Gap in Rx - If there is a gap in Rx fill, and then the red bar is displayed. The date range for the red bar
includes the Rx 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. If the red bar is from Rx/F to prescription end (X), the date range
includes the X date and is included in the number of days.
Patient Support
1)
Click on the second tab in the Patient Advisor toolbar titled Patient Support. This section will have education
documents available for this patient based on their active medications list, diagnoses, and lab orders. The user
can also search by term or codes.
2)
These materials are automatically retrieved when a patient has active medications (with accompanying RxNorm
codes) and/or problems assigned (with accompanying ICD9 codes) (ICD10 codes available in future build) and
LOINC codes for lab results.
3)
Within this section, labs ordered for a given patient can be entered by entering the LOINC code for the lab.
4)
Within the Patient Support tab there are, four different selectable tabs available, shown below:
a.
Diagnosis
b.
Medication
c.
Labs
d.
Search
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5)
Clicking on a category tab, will then illuminates it in "white" and the results will be displayed.
6)
Within the "Diagnosis" tab the results for the patient’s diagnosis codes are listed.
7)
If none of the first three tabs contains values, then the ‘Search’ tab will be the best way to find education
materials.
8)
The medication, lab or diagnosis description will be displayed on the left and the corresponding code and/or
value will be listed on the right. The search for education can be done based off the description, code type, and
value.
9)
When the user clicks the
button, all education materials are retrieved and displayed in one display box.
Currently, the education resources are provided by The National Institutes of Health’s National Library of
Medicine (Medline Plus program).
10)
Clicking the
will search for available documents by code and the
will search for available documents by
description. When the user clicks either
or
, available materials will be displayed individually.
11)
Once the education material is presented, physicians are encouraged to discuss education materials with
patients. Physicians can print educational materials by clicking the print button in the upper right corner
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12)
Links displayed on the education document take the user to external sources. The source link is also available for
the user above a disclaimer message. The disclaimer message is on every content page.
Clinical Messages
During the user workflow, clinical messages will trigger based on patient demographics, provider specialty and/or
medications.
1)
Messages will first display as an “auto-preview” message for 15 seconds in a yellow box at the top of the page.
2)
If a link is available, clicking the link will display additional content in a display box.
3)
As long as the rules supporting the clinical message are satisfied, the message will be located in the clinical
decision support tab.
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Coupons and Co-Pay Savings
1)
Prescribe a medication through the eRx application.
2)
If the prescription is a branded drug and has a coupon or co-pay savings a preview window will appear with the
savings offer. This will only appear after the prescription has been created.
3)
The information will automatically be amended to the electronic prescription as part of the notes to the
pharmacist. If the “Notes to Pharmacist” section is being used by the prescriber, the coupon information will
not be amended to that field and the coupon should be printed separately.
4)
First, a small display box will present a file which can be printed. At the bottom will be checkboxes for the
delivery option.
5)
The user can enlarge/minimize the display box by selecting the ‘+’ / ’-‘ in the upper right corner of the display
box and close the display box by clicking on the ‘X.’
View of expanded co-pay savings.
6)
Radio buttons will be placed before programs when two or more program types are available (co-pay savings or
adherence plans) for the user to select the program they would like to view and it will display. The user should
then select the communication/delivery option for that program. After clicking ‘Submit’, the user can view other
program types and choose the desired delivery option. If program titles are long, the user may need to use the
vertical scrollbar to view all the programs.
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Adherence Plan Letters
After a prescription is created, an adherence plan may display an available patient print-out if available. These letters are
typically for refill reminders. An office letter displays in the display box and additional education content can be sent to
the patient’s home on behalf of the physician at no charge.
1)
The ‘In-Office Print’ option is for materials the user wants to print for the patient.
2)
The ‘At Home Communications’ will send additional education content that is different than what is available for
print.
3)
The default ‘Patient Communication Options’ selected in the ‘Patient Advisor Preferences’ will set the default
checked options. The user can change the delivery option without affecting their default settings, if they choose.
4) The user can choose on a case-by-case basis which patients receive at home communications without impacting
default settings.
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Electronic Prior Authorizations (ePA)
Through Patient Advisor, a user has the ability to submit Electronic Prior Authorizations (ePA). Patient Advisor will start
the prior authorization process in the back-end for prescriptions that require them. A user can click on the ePA+ tab
within the Patient Advisor toolbar to view the prior authorizations.
The available sections within the ePA+ tab are:
1.
PA Question set available – a questions set for a prior authorization is available
2.
PA Needed – a prior authorization is needed for a patient
3.
PA Submitted to plan – the prior authorization has been submitted to the payer
4.
PA Decision Received
a.
PA Denied – Denied by the payer
b.
PA Approved – Approved by the payer
c.
PA Closed by Plan – Closed by the payer
Patient Advisor will automatically place the ePA+ tasks within the appropriate section depending on its status. This
makes it very easy for a user to find the task.
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If a prior authorization is needed, users can access the question sets from the insurance plans once they are available in
the ePA+ tab within the PA Question set available section. Users will be able to click on action buttons on the right hand
side within each section. In order to start an ePA from the available question set, click on the Complete Now! button.
This will populate a prior authorization question set for the user to complete and submit to the payer (shown below).
Filtering Options:
Upon logging in, by default the tasks display for the practice location and provider associated with the user who logged
in. Users can select from the dropdown and click the “Apply” button. Users are also able to filter the tasks by patients’
last name by using the Search textbox and clicking the “Search” button. The tasks display under the appropriate status
headers. The “Reset to All” button clears the Search criterion and reverts the view to display all tasks for all patients. If a
patient’s chart is selected or opened, the users can click on the “Show Current Patient Only” button to display tasks for
that patient. To go back to view tasks for all patients, users can click on the “Reset to All” button. The “Update List,”
formerly the “Refresh” button, when clicked uploads new tasks or updates the status of tasks.
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ePA Status Groupings:
Instead of showing all tasks in one table, the different tasks are grouped by status and users can view a count for each
task grouping when they click open the ePA+ tab.
ePA Task Details:
The information about the tasks are the following – Patient Name, Patient Date of Birth, Drug, Prescriber Name, Date
Created and Name of whoever the task was assigned to. The action buttons display on the right.
When user clicks the “i” button located beside the drug detail, the PA Note displays showing more information about
the task such as task transaction ID, update date, patient insurance information, prescription details and notes from the
insurance plan about the requested task.
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ePA Status Notification:
To alert the users of incoming new ePA statuses, Patient Advisor will display messages to the users.
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Medication Fill History
Fill Notification in Patient Advisor is a solution that proactively identifies patients eligible for the program. It periodically
monitors and provides ready access to patients’ fill history information at the point of care to allow providers make
necessary interventions that will help patients’ adherence to their prescribed treatment. Such proactivity helps achieve
the dual goals of positive impact on health outcomes and eventual reduced healthcare costs.
In the Rcopia UI, when a prescriber completes a prescription for which the medication is eligible for the drug fill
notification program, a message window displays alerting the prescriber and provides the option to either opt in or opt
out the patient from the program.
Fill Notification Enrollment (Opt-In) Auto-display Message:
Fill Notification Enrollment (Opt-Out) Auto-display Message:
Once the patient is enrolled in the program, users can track patients’ status and progress from the new tab labeled
Medication Fill History, on the Patient Advisor Toolbar.
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When a user clicks the Medication Fill History tab, the default list displays the drug fill information for the selected
patient in Rcopia. The table consists of the following columns: Patient Information (Patient Name, Date of Birth and
Phone Number, if available), Prescription Information (Medication Name, Number of Refills and Prescription Written
Date), Fill Status, Prescriber and Actions.
The Status column has the following icons:
a.
A Green heart signifies completed fill. The fill date was provided by either the Pharmacy/PBM or by the
prescriber/patient. The hover information displays the actual fill date.
b.
A Red heart signifies missing fill. The prescription was not picked up from the pharmacy as of the expected fill
date. The hover information will display the expected fill date. The user has the option to enter fill details as
reported by patient by clicking on the red heart.
c.
A White or clear heart signifies a future fill. The hover information will display the expected future refill date.
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The Status column also contains a link to display fill history details such as expected prescription fill date, actual date,
drug name, quantity, days’ supply and source of info for the actual fill date. The user is able to print this page by clicking
the Print button.
The users are also able to select to display the list of patients depending on the criteria:
1)
Enrolled patients who have not picked up their prescription from the pharmacy on the expected fill date are
labeled Enrolled with Missing Fills
a.
Available action for the prescriber: Stop Tracking (removes the patient from the program list)
2)
Enrolled patients who picked up their prescription from the pharmacy by the expected fill date are labeled
Enrolled with Complete Fills
b.
Available action for the prescriber: Stop Tracking (removes the patient from the program list)
3)
Lastly, patients who were prescribed medications that were eligible for the drug fill notification program but the
prescriber has not taken action from the enrollment window.
c.
Available actions for the prescriber: Start Tracking (enrolls the patient to the program) and Stop
Tracking (removes the patient from the program list)
The Fill Notification table can be filtered by location. The user can select the desired location from the dropdown and
click the Apply button to update the list displayed.
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Practice Preferences
1)
At this time practice preferences for the Patient Advisor Toolbar can only be changed by the practice
administrator. In future releases providers will have this capability.
2)
For Practice Administrator - In “Options” go to “Preferences – practice:” to modify the following:
a.
If all three are YES the toolbar will be visible along with medication adherence, education and coupons.
b.
If patient education is NO the toolbar will still appear with medication adherence and coupons.
c.
If prescription savings is NO the toolbar will still appear with medication adherence and education.
d.
If patient education and prescription savings are NO the toolbar will still appear with medication adherence.
e.
If medication adherence is NO the toolbar will not appear but patient education and prescription savings will
be available if those are enabled.
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3)
For Provider - Since the toolbar is controlled by the practice administrator you still have the ability to control
adherence plans, patient education, prescription savings and Patient Communication Options. In “Options” go
to “Patient Advisor Preferences”. By checking off the boxes you are enabling these features in the ERX
application.
NOTE: This preference will not be available once Patient Advisor becomes standard functionality on December
15, 2014.