A DEVELOPEMENTAL, FORMATIVE EVALUATION TO INFORM IMPLEMENTATION OF BIDIRECTIONAL HEALTH INFORMATION EXCHANGE IN COMMUNITY PHARMACIES

Although community pharmacists have further reduced medication errors and improved care with access to patient data through unidirectional health information exchange (HIE), access to routine patient data has not been sustained. Several barriers to sustaining use and access of HIE in community pharmacies have been noted, such as lack of implementation supports and technological restrictions. Further, pharmacists and pharmacy technicians have not been involved in the development of HIE systems for their use previously. My research aims to optimize HIE access for community pharmacists through our co-developed HIE interface prototype specifically for use by community pharmacy teams in collaboration with PioneerRx, a pharmacy dispensing software system and our state HIE, the Indiana Health Information Exchange (IHIE), and provide supports for the sustainability of community pharmacist access to HIE.

Therefore, the objectives of my research are to 1) conduct a formative usability evaluation of the HIE interface prototype with community pharmacists and pharmacy technicians to inform strategies to improve the HIE interface design for future implementation in community pharmacies (“Study One”) and 2) identify the potential barriers, facilitators, and recommendations for HIE implementation in community pharmacies through semi-structured interviews to create a curated list of resources to address identified implementation needs to assist with the future implementation of HIE (“Study Two”).

The findings from Study One demonstrate the HIE interface prototype was viewed favorably by pharmacists and pharmacy technicians, with the average System Usability Scale (SUS) score 69 (scale 0 – 100, where 100 is the best). Pharmacists reported higher satisfaction than technicians on average (74 vs. 65, respectively). Key problems identified included accessibility of HIE links and placement in the existing workflow and application label name clarifications. The same eight pharmacists and eight pharmacy technicians, with the addition of seven patients, completed interviews in Study Two. Five barriers, four facilitators, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE, guidance on workflow and team roles, and provider and patient facing resources for discussing HIE. Curated draft implementation resource items that are responsive to all four key implementation needs are in development. The combination of findings from Study One and Study Two create the blueprint for pharmacy-team informed implementation of HIE in community pharmacies.