Abstract
Objectives Medication refill processing is a repetitive and predictable time-intensive task
for ambulatory primary and specialty care. Refill protocols are a clinical decision
support (CDS) tool that allows clinicians to quickly and safely determine appropriateness
of a refill request. Our health system opted to improve the quality and breadth of
electronic health record vendor-supplied protocols to consistently leverage best practices
and emerging evidence and to create novel protocols that further support clinicians.
Methods We established a refill protocol governance group to guide new protocol build and
to review existing protocols regularly to keep current with emerging guidelines. Data-driven
prioritization was used to create new protocols for the most frequently refilled medications,
as well as for less-prescribed but higher risk medications. Ad-hoc specialist inclusion
as subject-matter experts provided greater detail, accuracy, and broader consensus
in protocol criteria.
Results Approximately 11 million refills are processed each year by our health system's providers.
The proportion of refill requests supported by a protocol increased over a 2-year
period from 49 to 82%, representing a net increase of 3.63 million refills in the
second measurement year as compared to the start of the first measurement year. All
published refill protocols were reviewed by the governance group over the measurement
years for compliance with clinical guidelines. In addition to the structure of the
refill protocols' CDS, the process was supported by filters that enable practices
to quickly approve refills that pass protocol, providing more time for clinicians
to review refills that fail a protocol or for which no protocol exists.
Conclusion A refill protocol is a valuable CDS tool that can improve efficiency, effectiveness,
and user satisfaction when processing refill requests. A refill protocol governance
structure is an effective way to review, edit, and build refill protocols within a
health system.
Keywords
primary care - prescription - electronic health record - protocols - clinical decision
support
