Patient Enrollment Criteria and Documentation Data

Patient eligibility for charity services frequently varies from that normally used when filling a routine prescription. See Eligibility Guidelines. This may require creating customized fields. Additional information needed beyond demographics and allergies/sensitivities include:

  • Income/Federal Poverty Level (FPL)
  • Size of household: adults/children
  • Preferred language
  • Ethnicity (if required)
  • United States residency status
  • Insurance status (uninsured, pending, ineligible)
  • Eligibility for other assistance programs
  • Referral source
  • Veteran

Additional software may screen patients for insurance.

Maintain patient database by removing patients who have not filled a prescription within a set period of time as determined by the site.

Systems are upgrading to accommodate documentation of patient interactions and health information. Exchange of health information allows pharmacists to improve their clinical services—especially medication therapy management (MTM). Hospitals and clinics may allow a view-only link to access patient data. Access to lab values and other trackable measures (blood pressure, weight, etc.) may allow opportunities for collaborative practice agreements. Documentation of clinical interventions within the patient profile allows for metrics collection and tracking outcomes even when this is not a billable service. By 2018, pharmacy systems should be Centers for Medicare and Medicaid Services (CMS) compliant, allowing trackability of outcomes pertaining to reimbursement by Medicaid and Medicare.

Bidirectional systems allow other healthcare providers access to pharmacy information and vice versa. Some systems accommodate linking multiple systems for information exchange. Following control substance prescriptions is an example of many healthcare providers, including prescribers and pharmacists, having access to pertinent patient data across a geographical area. Connecting systems may allow pharmacist documentation of a medication problem or recommendation to be transmitted directly to the prescriber. SeeHealth information technology in the community pharmacy.