From an early trailblazer to exploring the next frontier, School of Pharmacy alumni advance patient safety and pharmacy operations through informatics
By Katie Ginder-Vogel
Healthcare, like many industries, is increasingly digital. Electronic health records (EHRs) first entered the scene in the 1990s, but few health systems adopted the new technology until the passage of the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009, which provided financial incentives to adopt EHRs. The Affordable Care Act (ACA) in 2010 gave further motivation, with reporting and other requirements that are most efficient through an EHR.
The adoption rate went from 3.2 percent in 2008 to 14.2 percent in 2015 — and up to 86 percent of office-based physicians by 2017, according to the HIPAA Journal.
“Things really started taking off around 2005–06, and then the incentives under the ACA came,” says University of Wisconsin–School of Pharmacy alum Jim Russell (BS ’91). “One of the best comments I heard from a CMIO [chief medical information officer] around 2010 was installing an EHR for the incentive money is like having a baby for the tax break.”
“As one of the first pharmacists hired at Epic Systems, I got very lucky with all these opportunities and blazed the trail for the next pharmacists.”
—Jim Russell
Russell got a front-row seat to the industry’s explosive growth and helped establish the important role of pharmacists in the field.
“As one of the first pharmacists hired at Epic Systems, I got very lucky with all these opportunities and blazed the trail for the next pharmacists,” Russell says.
Russell, now retired after spending 20 rapidly evolving years in the field, helped pave the way for his pharmacy colleagues currently working at every level in the company, including pharmacist and Patient Safety Officer Nikki Carrico (PharmD ’08) and Vice President of Pharmacy Joel Jones (PharmD ’07), who continue leveraging their pharmacy education and patient care experience to help health systems worldwide improve outcomes for their patients.
An EHR trailblazer
“I’m the worst person in the world to give career advice,” jokes Russell. “The way I got my job at Epic was completely serendipitous — almost quaint.”
His route to the field was winding, first beginning with a business degree that led him into market research roles. He was almost 30 when he decided to attend the University of Wisconsin–Madison School of Pharmacy for a change of pace. After earning his Bachelor of Pharmacy degree in 1991, he interned at UW Hospital and worked there for seven years, also spending a few years in the community pharmacy realm.
In 2003, Russell was working nights at UW Hospital and wanted to do something different. He wondered if he could combine his business and market research experience with his pharmacy education. It was then that he spotted a newspaper ad for a pharmacist at Epic. He didn’t even know what Epic was, but he applied, interviewed, and was offered the job.
Russell joined the clinical informatics team at Epic, where he contributed content to Epic’s Foundation System, which includes clinical content and workflows, and demonstrated Epic’s pharmacy software to prospective customers all over the world.
“My job had so much variety, and I had so much flexibility as to how I structured my time around my responsibilities,” he says. “I did a lot of traveling, which was the most rewarding part of the job. I traveled to 24 or 25 different countries for work, and I learned a lot about pharmacy all over the world.”
For the first two years of his Epic career, he led implementations of patient pharmacy software — the first type of pharmacy software that Epic developed. Today, that’s grown beyond filling software to include inventory, 340B, clinical services, specialty pharmacy, home infusion, medication access, pharmacy revenue cycle, and integrated patient experience.
“It was an interesting time to start at Epic, as the first inpatient and pharmacy sites went live a few months after I started,” says Russell. “The incentives under the ACA may have further accelerated things. It was a very busy time, as we stood by that an integrated pharmacy system was a must.”
Patient safety
Carrico’s collaborations happen a little closer to home. As Epic’s patient safety officer, she helps Epic’s U.S. and global customers optimize systems to support the safe delivery of healthcare.
“My skill set is in clinical pharmacy and process improvement, and with my interest in safety, working at Epic offers a great opportunity to do more of that,” she says. “I get to work with care providers worldwide to improve patient safety.”
She brings feedback and best practices from customers and industry safety groups back to Epic’s Research and Development (R&D) teams and Epic’s Foundation System.
“The Foundation System is an environment Epic maintains that includes robust clinical content and configured workflows,” Carrico explains. “An example of clinical content is medication records, so when a provider places a medication order, the correct dosage will appear by default and can then be edited, which streamlines the process for the provider and decreases the risk of error.”
Carrico also works on the clinical application teams, where she mainly focuses on three areas: ambulatory pharmacy, specialty pharmacy, and population health.
“I recently went out with our R&D team to a customer that was implementing our specialty pharmacy module, to see their workflows, make recommendations, and take learnings back to Epic to further enhance our pharmacy software,” Carrico says.
Carrico has been at Epic for over ten years and enjoys her variety of projects. Recently, she’s been working with data scientists to explore Epic’s Cosmos database — a huge longitudinal data set combining population data across several health systems — and publish articles on Epic’s research-focused website. Her most recent publication found looked at the likelihood of a mental health diagnosis in patients prescribed montelukast, used to treat allergies and asthma.
“I enjoy being able to work on tools in the ambulatory pharmacy space — it’s cool to create new modules in our software targeting different areas of care,” she says. “For me, that’s where the pharmacy profession is evolving.”
Collaboration and innovation
Jones, as vice president of pharmacy informatics, has a very different purview. He says he’s focused on doing two things: “Working with current and future customers to make sure we’re developing great software, and making sure we have happy customers.”
Jones achieves that by working directly with customers.
“Epic is employee-owned and independent, which gives us the ability to grow sensibly and focus on what customers need, even if it’s something we need to take time to build,” Jones says. “We can work with customers to make good long-term decisions to help them.”
Jones frequently visits healthcare leaders and pharmacy teams across Epic’s customer base that now spans 16 countries.
“We spend time figuring out what’s most important,” says Jones.
Internally, Jones’ role includes helping to develop strategic roadmaps on rising issues, like leveraging artificial intelligence (AI), expanding specialty pharmacy and infusion services, cell and gene therapies, 340B, medication access and revenue cycle, healthcare system-wide medication and supply distribution, and an integrated pharmacy digital experience. He and Carrico collaborate with many development teams at Epic including pharmacy, population health, transplant, oncology, research, revenue cycle, and patient experience teams, to broadly improve medication use among customers’ patients.
“That means working with R&D, spending time with customers, attending and hosting conferences, and helping to build teams and launch new things at Epic,” says Jones.
Prior to joining Epic, both Jones and Carrico spent several years working in health systems that used Epic software, gaining an understanding of how health systems operate, what patients need from pharmacists, and what the operational and administrative needs are.
“In pharmacy and technology, you touch every part of the healthcare system, which is always changing, and I enjoy being able to work with our customers — the most innovative organizations in healthcare — and see what technology combination drives the best outcomes,” says Jones. “There are so many opportunities to try new things.”
The future is data
Jones and Carrico often interact with School of Pharmacy alumni — in all corners of the U.S. — as well as student pharmacists, who reach out to learn more about pharmacist roles in an EHR company.
“To work on this side of an EHR, it’s important to get first-hand experience with patient care first, working in an integrated health system and delivering patient care as a pharmacist,” Carrico says. “We build off that experience when we give advice on projects and software design.”
Jones agrees — before diving into the industry, he says it’s critical to first gain a deep understanding of patient relationships and care delivery.</p
“To work on this side of an EHR, it’s important to get first-hand experience with patient care first.”
—Nikki Carrico
“That experience allows you to appreciate the problems that need to be solved,” he says. “There’s no replacement for those years doing the work and direct patient care, and then launching off from that point.”
As healthcare continues its digital evolution, Carrico and Jones both view data and analytics as “a core competency for future pharmacists,” as Jones puts it.
“Being able to leverage analytics, and solve problems with large data sets, is a critical skill,” Jones says. “Pharmacists have an opportunity to touch many lives through data, including the areas of rare diseases, medication use, and treatment pathway development. Today, the Cosmos dataset includes over 250 million longitudinal patient records, ready and waiting for new discoveries.”
Cosmos also provides key information to clinicians for the patients in front of them.
“For example, we are working on community antibiograms in Cosmos. And the coolest part is that we are hardwiring the insights into prescribing workflows to get patients the right antibiotics faster,” says Jones. “It’s been something we’ve dreamed about for years, supercharging antimicrobial stewardship. And there is so much more ahead for the next generation of pharmacists to understand and leverage large datasets like Cosmos.”