Overcoming Health Data Blockages in Polypharmacy

In a video interview with Pharma Commerce, Tom Dorsett, CEO, RazorMetrics, describes how polypharmacy refers to the use of five or more medications by an individual, and it is becoming an increasingly prominent issue in the United States. Polypharmacy has been recognized for years but is growing more significant, especially within Medicaid, Medicare, and large commercial sectors, including self-funded employers.

One of the key drivers of this rise is the growing number of chronic conditions, which affect a large portion of the adult population. Around 40% of adults in the US have four or more chronic diseases, contributing to the increase in polypharmacy. Furthermore, among the working adult population between 40 and 79 years old, 24% are impacted by polypharmacy, a trend that continues to grow. This issue highlights the complexity and challenges of managing multiple health conditions and medications in an aging population, leading to potential risks related to drug interactions and overall healthcare management.

Dorsett also explains why he believes this concept is such an overlooked driver of unnecessary spending and adverse health outcomes, strategies that should be taken to overcome health information exchange blockages, and much more.

A transcript of his conversation with PC can be found below.

PC: What strategies should be taken in order to overcome the health information exchange blockages that are associated with polypharmacy and its cascade of side effects?

Dorsett: What the US healthcare system lacks at this point is ample health information exchange. We did a really good job back with the HITECH [Health Information Technology for Economic and Clinical Health] Act back in 2008, where $22 billion was put out there for the mass adoption of electronic health records. By and large, the whole system is electronic at this point, but those systems still experience data blocking. The 21^st Century Cures Act has gone a long way in trying to remove those blocks between health organizations—they don't necessarily like to share that information because it makes it a lot easier for the patient to go over to another health system if their data is readily available.

The other issue is that EHR vendors themselves don't necessarily like to play ball in that regard. What this creates is a situation where you've got these EHRs not talking to each other. If I go see my cardiologist at one system and am prescribed a statin for my high cholesterol, and for whatever reason, maybe I get referred because I'm on a health plan where you have to have a referral, I get referred over to another system. I might go in, and if I'm not really highly aware of the particulars of the medication, and I don't mention that I'm already on it, they're not going to have any visibility to that at this other institution, and they may prescribe me another statin. This happens all the time.

My co-founder, Dr. Siva Mohan, is a semi-practicing Interventional Cardiologist at Emory, and he sees this almost every day. He practices at Emory, and then patients go over to Piedmont and get prescribed another statin. You have that duplication, which can be very dangerous, and it's due to the fact that they aren't communicating. It’s not their fault—it's just that the systems aren't built to do that in most cases. That's one of the areas where we're able to help, because we see a holistic view through the claims of all the medications, but the duplication issue is a big problem too with polypharmacy.

I think if that can get ironed out at some point, it's been a huge challenge, and maybe they're able to fix it through some sort of government-run utility. I think that's probably what it'll take. They tried to do it by doling out a bunch of money at the same time they were doing the EHR subsidies for physicians and institutions, but by and large, any sort of organization that was trying to exchange information could go purchase their own application or network to do this, and even those wouldn't talk to each other. It largely failed, sadly, and it's really gone a long way towards creating this issue.