Do Not Disturb
With EHRs, disruption of a physician's "chat, chart, and charge" workflow is unnecessary, says Fotsch. Physicians will use
EHRs during an exam with patients, and if they can find valuable services one click away, or embedded within the EHR technology—easy
access to patient education materials, coupons and other financial assistance, or samples—they'll use them, or their office
managers and nurses will use them. Rose Crane, CEO at Epocrates, is also targeting the physician's workflow with that company's
EHRs. Crane says the four criteria used by Epocrates when developing its EHRs were affordability, ease of use, a focus on
the patient encounter for the physician-facing template, and uninterrupted workflow. "We are admittedly coming late to the
[EHR] market, but I'd say that we've learned from a lot of the current EHR providers out there, and what physicians find problematic,"
says Crane. Epocrates announced the first phase of its EHR roll-out on July 27. The company will target small physician practices,
rather than compete with the companies mentioned above.
The other major development within the new crop of EHR providers is access: PDR and Epocrates, both of which made their bones
initially as a drug reference for physicians, have kept up with shift in technology platforms used by physicians, beginning
with smartphones and now tablets. As such, the companies' EHR offerings utilize mobile and SAAS technology, which lets physicians
bypass much, if not all, of the hardware installation, a key barrier to adoption. Additionally, drug updates, such as black
box warnings, risk, and REMS information, are updated live in real-time. "The fact that box warnings aren't surfaced real-time
in EHRs, and that EHRs don't contain the full updated FDA-approved labeling, is kind of astounding," says Fotsch, adding that
with EHRs only recently being underwritten by the federal government, it's perhaps not entirely astounding. After talks with FDA in April, PDR, with its partners, launched an adverse events reporting service in June,
which is incorporated into the EHR platform. Fotsch says physicians don't have time to report every adverse event they encounter
with patients through the traditional channels, which is typically a phone call to a pharmaceutical company. In her keynote
address at the PDR-sponsored PharmEHR Summit last April, Janet Woodcock, director of the Center for Drug Evaluation and Research
(CDER) at FDA, advocated for not only adverse events reporting through EHRs, but also talked about incorporating REMS programs
into EHRs. "REMS are very clunky, and not well integrated into the physician's workflow ... I think [REMS] can be integrated
into the workflow through EHRs and electronic prescribing, and can have much more value for everyone." Woodcock said EHRs
can provide a fail-safe for prescribers: "You shouldn't get your warfarin refilled for the first time if you haven't had an
INR test in the intervening month," for example. It would also be useful, said Woodcock, to provide pharma-sponsored support
services like financial assistance through EHRs.
It's important for brands to "skate toward the puck," in terms of creating a strategy for EHRs, says Fotsch. Pharma companies
that get involved now can say, "Here are my samples, coupons, copay cards, warnings, etc., and they're available within your
EHR, and my competitor has nothing," says Fotsch.